Journal of the American Heart Association · Mar 4, 2026

Cerebrovascular Risk Factors for Body Mass Index, Diabetes, and Atherosclerosis in a Wisconsin Native American Population: A Cross-Sectional Observation Study

By Mitchell CC, Wilbrand SM, Hess T et al.

BACKGROUND: Native American (NA) people are at an increased risk for stroke and are disproportionally affected by stroke risk factors such as hypertension and diabetes. The objective of this study is to characterize stroke risk factors in Wisconsin Native American people compared with an age- and sex-matched population in the SHOW (Survey of the Health of Wisconsin) study to direct future therapeutic efforts. METHODS: Stroke risk factor information was collected from an NA and an age- and sex-matched general Wisconsin population. Stroke risk factor data collected included age, sex, height, weight, body mass index, systolic and diastolic blood pressure, history of transient ischemic attack/stroke, history of coronary artery disease, history of hypertension, history of diabetes, current smoking status, and laboratory bloodwork (lipid panel, hemoglobin A1c, and average glucose). In addition, all Oneida NA participants had a comprehensive carotid ultrasound examination performed to evaluate for the presence of atherosclerotic plaque and examine hemodynamics. RESULTS: The NA population had significantly higher systolic and diastolic blood pressure, were taller, and had higher body mass indices and higher rates of diabetes compared with the Wisconsin general population (all P<0.05). Significant differences were also noted in total cholesterol, high-density lipoprotein cholesterol, triglycerides, hemoglobin A1c, and average glucose (all P<0.05). In addition, 81.5% of the Oneida NA population had atherosclerotic plaque present in their carotid arteries. CONCLUSIONS: This study demonstrates several statistically significant differences in stroke risk factors between the NA population and a general Wisconsin sample population. These results indicate a strong relationship between obesity, diabetes, hypertension, and atherosclerosis in the NA group. Thus, there is an opportunity to work with NA communities to identify and modify stroke risk factors. Future work will examine the impact of exercise, diet, and nutrition on these risk factors. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04382963.

doi.org/10.1161/jaha.125.043224Open accessPubMed 41778537Populations