The need for specific ethnic and cultural understanding and sensitivities was recognized from the onset, so the study has a community-based participatory research (CBPR) model.
Now in its seventh phase, the extensive research has led to many important findings about heart disease and unique risk factors in native populations.
[6] In 1997, Phase III launched the Strong Heart Family Study (SHFS) with 900 first-degree relatives and grandchildren of members of the original cohort.
[3] The SHFS participants provided clinical examinations matching earlier phases, as well as DNA samples for genome-wide linkage analysis of cardiovascular disease biomarkers.
[7] Phase IV expanded the SHFS, bringing the total number of participants to 3,776 and continuing the ongoing morbidity and mortality surveillance of the original cohort.
[3][9][10] The Strong Heart Study was the first research funded by the NHLBI focusing on specific ethnic groups in rural communities.
[11] The 13 American Indian communities were involved in partnership with investigators in all aspects of the study design to ensure the recruitment of participants and conduct of examinations was culturally appropriate and relevant.
[11] The research shows that for American Indian populations, type 2 diabetes was the strongest risk factor for heart disease.
[11][15][16] In young adults, diabetes and prediabetes was found to be independently associated with early adverse effects of heart structure and function.