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Prevalence and correlates of rheumatic heart disease in American Indians (The Strong Heart Study)*

      With the exception of isolated outbreaks, acute rheumatic fever has all but disappeared from developed nations, and its sequela, chronic rheumatic heart disease (RHD), has become uncommon. Prevalence estimates for RHD vary, from 0.6/1,000 among American school-age children
      • Miller R.A.
      • Stamler J.
      • Smith J.M.
      • Milne W.S.
      • Paul M.H.
      • Abrams I.
      • Hastreiter A.R.
      • Restivo R.M.
      • DeBoer L.
      The detection of heart disease in children.
      to <0.05/1,000 among hospital discharge diagnoses.

      Jamison DT, Mosley WH, Measham AR, eds. Disease Control Priorities in Developing Countries. Oxford University Press, 1993:222

      In developing nations, rheumatic fever and RHD continue unabated, with RHD affecting an estimated 5 to 30 million worldwide.
      • Soler-Soler J.
      • Galve E.
      Worldwide perspective of valve disease.
      Documented outbreaks of streptococcal infections in American Indian communities
      • Zimmerman R.A.
      • Cross W.M.
      • Miller D.R.
      A streptococcal epidemic in an isolated civilian population with institution of mass prophylaxis.
      ,
      • Anthony B.F.
      • Kaplan E.L.
      • Wannamaker L.W.
      • Briese F.W.
      • Chapman S.S.
      Attack rates of acute nephritis after type 49 streptococcal infection of the skin and of the respiratory tract.
      and retrospective studies of valvular heart disease
      • Coulehan J.
      • Grant S.
      • Reisinger K.
      • Killian P.
      • Rogers K.D.
      • Kaltenbach C.
      Acute rheumatic fever and rheumatic heart disease on the Navajo reservation, 1962–77.
      ,
      • Becker T.M.
      • Wiggins C.L.
      • Key C.R.
      • Samet J.M.
      Ethnic differences in mortality from acute rheumatic fever and chronic rheumatic heart disease in New Mexico, 1958–1982.
      suggest that this population may have a high prevalence of RHD. Therefore, the Strong Heart Study (SHS) assessed the prevalence and correlates of RHD in American Indians.
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