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Canadian Journal of Cardiology

Cardiovascular Disease Susceptibility and Resistance in Circumpolar Inuit Populations

      Abstract

      Cardiovascular disease (CVD) is a major public health issue in indigenous populations in the Arctic. These diseases have emerged concomitantly with profound social changes over the past 60 years. The aim of this study was to summarize the literature on CVD risk among Arctic Inuit. Literature on prevalence, incidence, and time trends for CVD and its risk factors in Arctic Inuit populations was reviewed. Most evidence supports a similar incidence of coronary heart disease and a higher incidence of cerebrovascular disease among Arctic Inuit than seen in western populations. Factors that may increase CVD risk include aging of the population, genetic susceptibility, and a rapid increase in obesity, diabetes, and hypertension in parallel with decreasing physical activity and deterioration of the lipid profile. In contrast, and of great importance, there has been a decrease in smoking and alcohol intake (at least documented in Greenland), and contaminant levels are declining. Although there have been marked socioeconomic and dietary changes, it remains unsolved and to some extent controversial how this may have influenced cardiovascular risk among Arctic Inuit. The increase in life expectancy, in combination with improved prognosis for patients with manifest CVD, will inevitably lead to a large increase in absolute numbers of individuals affected by CVD in Arctic Inuit populations, exacerbated by the rise in most CVD risk factors over the past decades. For preventive purposes and for health care planning, it is crucial to carefully monitor disease incidence and trends in risk factors in these vulnerable Arctic populations.

      Résumé

      Les maladies cardiovasculaires (MCV) représentent un problème de santé publique majeur dans les populations autochtones de l'Arctique. Ces maladies sont apparues de façon concomitante avec de profonds changements sociaux au cours des 60 dernières années. Le but de cette étude était de résumer les données de la littérature sur le risque de maladies cardiovasculaires chez les Inuits de l'Arctique. La littérature sur la prévalence, l'incidence et les tendances temporelles de MCV et de ses facteurs de risque chez les populations inuites de l'Arctique a été examinée. La plupart des données présentent une incidence similaire de la maladie coronarienne et une incidence plus élevée de maladies cérébrovasculaires chez les Inuits de l'Arctique qu’observée dans les populations occidentales. Les facteurs qui peuvent augmenter le risque de MCV incluent le vieillissement de la population, une susceptibilité génétique, et une augmentation rapide de l'obésité, du diabète et de l'hypertension, en parallèle avec la diminution de l'activité physique et la détérioration du profil lipidique. En revanche, et de façon importante, il y a eu une diminution du tabagisme et de la consommation d'alcool (documentés au moins pour le Groenland), et les niveaux de contaminants sont en déclin. Bien qu'il y ait eu des changements socio-économiques et alimentaires marqués, la question de savoir comment cela peut avoir influencé le risque cardiovasculaire chez les Inuits de l'Arctique demeure indéterminée et, dans une certaine mesure, controversée. L'augmentation de l'espérance de vie, en combinaison avec une amélioration du pronostic pour les patients atteints de MCV manifestes, conduira inévitablement à une forte augmentation du nombre absolu de personnes touchées par les MCV chez les populations inuites de l'Arctique, exacerbée par l’augmentation de la plupart des facteurs de risque de MCV au cours des dernières décennies. À des fins de prévention et de planification des soins de santé, il est indispensable de surveiller attentivement l'incidence de ces maladies et les tendances des facteurs de risque dans ces populations vulnérables de l'Arctique.
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