Hauora Manawa mō ngā Kaumātua me ngā Whānau: a co-designed community-based cohort study of cardiovascular health among older Māori in Canterbury, New Zealand-a study protocol.

Abstract

Cardiovascular disease remains a leading cause of preventable mortality in Aotearoa New Zealand (NZ), with Māori continuing to experience earlier onset, higher hospitalisation rates and greater mortality than non-Māori. Despite this inequity, community-based data describing cardiac structure, function and circulating cardiovascular biomarkers in older Māori are very limited, particularly for those over 65 years. The Hauora Manawa mō ngā Kaumātua me ngā Whānau (Heart Health of Older Māori and Families; Kaumātua Manawa) study aims to examine associations between ethnicity and age on cardiac structure, function and plasma cardiovascular biomarkers in Māori and to evaluate the suitability of current clinical reference standards. Kaumātua Manawa is a community-based, co-designed study comprising a baseline assessment of cardiac structure, function and biomarkers, combined with prospective ascertainment of hospitalisation, all-cause mortality, pharmaceutical dispensing and clinical laboratory outcomes via ongoing linkage to national administrative health data held by the Ministry of Health and Te Whatu Ora | Health NZ. The study is conducted in partnership with Māori communities in Canterbury, NZ, with study clinics conducted at marae to ensure cultural safety for participants. Adults aged ≥18 years are recruited using convenience sampling, with a primary focus on Māori aged ≥65 years. Participants undergo nurse assessment (demographics, medical history, cardiovascular risk factors), 12-lead ECG, comprehensive transthoracic echocardiography following American Society of Echocardiography guidelines and non-fasting blood sampling. Biomarkers include N-terminal pro-B-type natriuretic peptide, high-sensitivity troponin T, growth differentiation factor-15 and lipoprotein(a). Descriptive statistics will summarise cardiac measures overall and by marae. Associations between biomarkers and demographic and clinical variables will be examined using regression modelling. Echocardiographic parameters indexed according to international and NZ-specific recommendations will be compared with existing NZ European cohorts. This methodology paper uses the principles of the CONSolIDated CritERia for Strengthening the Reporting of Health Research Involving Indigenous Peoples statement (CONSIDER). Ethics approval has been obtained from the NZ Health and Disability Ethics Southern Committee (2022 EXP 11434), and the protocol is registered at the Australian NZ Clinical Trials Registry. The study is governed by a dedicated Māori Governance Rōpū (Group) to ensure alignment with tikanga Māori (Māori protocols) and community priorities. Meetings will be conducted with participating marae and communities to discuss findings prior to publication. Results will be disseminated through open-access peer-reviewed publications and via presentations. ACTRN12626000348358.