When the Heart is Spiritually and Physically Strong, Women Have Lower Incident Cardiovascular Disease: Quantifying Aboriginal Women’s Narrative of Cardiovascular Protection

Background: Aboriginal women have described the heart as healthy when they are spiritually and physically strong, and personal attributes (i.e., a sense of belonging) and socioecological factors (i.e., family and community) are in balance [[1]]. Socioecological factors affect women’s capacity to influence personal attributes. This study sought to explore whether women’s conceptualisation of personal attributes was associated with incident CVD, and whether socioecological factors predicted personal attributes in a cohort of Central Australian women.
Methods: A 7-year cohort study of 608 Aboriginal adults (46% women). Clinical, behavioural and psychosocial risk at baseline, and incident CV events from primary health care, hospital and mortality data were reported. Four personal and 4 socioecological constructs from women’s narrative were assessed for internal consistency. Survival analysis tested the effect of personal protective attributes to incident CVD, regression analysis explored effect of socioecological factors on personal attributes.
Results: 205 CVD-free women at baseline (age, mean [SD]: 41.5[13.6]; 2% moderate, 31% high absolute CV risk [ACVR]). 13.7% had incident CVD. Women with a high aggregated personal attribute protective score (vs. low score) were significantly less likely to develop CVD after adjusting for ACVR (HR: 0.31, p=0.008). Higher aggregate socioecological protective scores were associated with higher aggregate (co-eff 0.26, p=0.000) and individual personal attribute protective scores.
Conclusions: In quantifying Aboriginal women’s holistic, socio-cultural conceptualisation of CV protection, we demonstrate that women with a high level of attributes which keep their heart strong have reduced incident CVD. Additionally, having socioecological protective factors increases a woman’s capacity to care for her heart.