The Strong Heart Study is an ongoing cohort study of cardiovascular disease (CVD) and its risk factors among American Indian men and women. The original cohort began in 1984 with 4,549 participants ages 35–74 from 13 tribal nations and communities in Arizona, Oklahoma, North Dakota, and South Dakota. The need for specific ethnic and cultural understanding and sensitivities was recognized from the onset, so the study has a community-based participatory research (CBPR) model. Community members were involved in all stages of conception, design, and implementation of the research. Now in its seventh phase, the extensive research has led to many important findings about heart disease and unique risk factors in native populations. It is a project funded by the National Heart, Lung, and Blood Ins