Urbanization and cardiovascular health among Indigenous groups in Brazil

BackgroundWe described the prevalence of cardiovascular risk factors in groups of Brazilian Indigenous people at different degrees of urbanization.MethodsThe Project of Atherosclerosis among Indigenous populations (Projeto de Aterosclerose em Indigenas; PAI) is a cross-sectional study conducted in Northeast Brazil between August 2016-June 2017. It included three populations: Fulni-o Indigenous people (lowest degree of urbanization), Truka Indigenous people (greater urbanization), and a highly urbanized non-Indigenous local cohort (control group). Participants were assessed to register sociodemographic, anthropometric, as well as clinical and laboratory-derived cardiovascular (CV) risk parameters. Age-adjusted prevalence of hypertension was also computed. Nonparametric tests were used for group comparisons.ResultsHere we included 999 participants, with a predominance of females in all three groups (68.3% Control group, 65.0% Fulni-o indigenous group, and 60.1% Truka indigenous group). Obesity was present in 45.6% of the urban non-Indigenous population, 37.7% Truka and in 27.6% Fulni-o participants. The prevalence of hypertension was 29.1% (n = 297) with lower prevalence in the less urbanized Fulni-o people (Fulni-o - 18.2%; Truka - 33.9%; and Control - 33.8%; p < 0.001). In the elderly male population, the prevalence of hypertension was 18.7% in the Fulni-o, 45.8% in the Truka, and 54.5% in the control group. Of the 342 participants that self-reported hypertension, 37.5% (n = 68) showed uncontrolled blood pressure (BP). Uncontrolled BP was more prevalent among Truka people when compared to Fulni-o people and non-Indigenous participants (45.4%, 22.9%, and 40.7%, respectively; p < 0.001).ConclusionsWe found a higher cardiovascular risk in communities with a higher degree of urbanization, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health. Armstrong et al. describe how rates of obesity and hypertension differ across three sub-populations of Brazil, including two under-studied Indigenous groups. The more urbanized cultures experience more obesity and hypertension, suggesting urbanization impacts cardiovascular health. The plain language summaryThe lifestyles and environments of traditional indigenous and city-living communities differ. We compared rates of obesity and hypertension in members of two under-studied Indigenous groups in Northeast Brazil and a nearby urbanized group. We found higher rates of obesity and hypertension amongst members of the more urbanized community, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health. These results suggest those living in the city should modify their lifestyle and monitor their cardiovascular health more carefully if possible.