Leukocyte telomere length and ideal cardiovascular health in American Indians: the Strong Heart Family Study

Eur J Epidemiol. 2017 Jan;32(1):67-75. doi: 10.1007/s10654-016-0199-6. Epub 2016 Sep 22.


Telomere length, a marker of biological aging, has been associated with cardiovascular disease (CVD) and its risk factors. Ideal cardiovascular health (CVH), defined by the American Heart Association (AHA), has also been associated with a reduced risk of CVD, but the relationship between telomere length and ideal CVH is unclear. We measured leukocyte telomere length (LTL) by qPCR in 2568 American Indians in the Strong Heart Family Study (SHFS). All participants were free of overt CVD at enrollment (2001-2003). CVH indices included four behavioral factors (smoking, physical activity, diet, BMI) and three health factors (blood pressure, cholesterol, fasting glucose). Each index was categorized as poor, intermediate, or ideal according to the AHA's guideline. CVH was further categorized into below average (0-1), average (2-3) and above average (≥4) based on the total number of ideal indices. Results showed that, 29, 50 and 21 % of study participants had below average, average, and above average CVH, respectively. Participants with above average CVH had significantly longer LTL than those with below average CVH (β = 0.034, P = 0.042) after adjusting for age, sex, education level, marital status, processed meat consumption, alcohol consumption, and study site. Compared to the U.S. general population, American Indians achieved lower rates for five out of the seven ideal CVH metrics, including smoking, BMI, physical activity, diet, and blood pressure. Achieving four or more ideal CVH metrics was significantly associated with longer LTL. This finding suggests that achieving an ideal CVH may prevent or delay CVD, probably through promoting healthy aging.

Keywords: American Indians; Biological aging; Ideal cardiovascular health; Leukocyte telomere length; Strong heart family study.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure / physiology
  • Body Mass Index
  • Cardiovascular Diseases / epidemiology*
  • Cholesterol / blood
  • Diet
  • Exercise
  • Female
  • Health Status*
  • Humans
  • Indians, North American*
  • Leukocytes* / metabolism
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Risk Factors
  • Smoking / epidemiology
  • Telomere / genetics*
  • United States / epidemiology
  • Young Adult


  • Cholesterol