{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:30:06Z","timestamp":1786714206961,"version":"build-2736575974"},"reference-count":21,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Heart Foundation of New Zealand Research Fellowship","award":["2024"],"award-info":[{"award-number":["2024"]}]},{"name":"Hutt Valley Heart Trust","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Lottery Health NZ","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"P\u016btahi Manawa | Healthy Hearts Aotearoa New Zealand","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Heart Foundation of New Zealand","award":["1892"],"award-info":[{"award-number":["1892"]}]},{"name":"Heart Foundation of New Zealand","award":["2032"],"award-info":[{"award-number":["2032"]}]},{"name":"Heart Foundation of New Zealand","award":["2057"],"award-info":[{"award-number":["2057"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiovascular disease remains a leading cause of preventable mortality in Aotearoa New Zealand (NZ), with M\u0101ori continuing to experience earlier onset, higher hospitalisation rates and greater mortality than non-M\u0101ori. Despite this inequity, community-based data describing cardiac structure, function and circulating cardiovascular biomarkers in older M\u0101ori are very limited, particularly for those over 65 years. The Hauora Manawa m\u014d ng\u0101 Kaum\u0101tua me ng\u0101 Wh\u0101nau (Heart Health of Older M\u0101ori and Families; Kaum\u0101tua Manawa) study aims to examine associations between ethnicity and age on cardiac structure, function and plasma cardiovascular biomarkers in M\u0101ori and to evaluate the suitability of current clinical reference standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Kaum\u0101tua 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 M\u0101ori communities in Canterbury, NZ, with study clinics conducted at marae to ensure cultural safety for participants. Adults aged \u226518 years are recruited using convenience sampling, with a primary focus on M\u0101ori aged \u226565 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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 M\u0101ori Governance R\u014dp\u016b (Group) to ensure alignment with tikanga M\u0101ori (M\u0101ori 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN12626000348358.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120784","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:40:38Z","timestamp":1786711238000},"page":"e120784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Hauora Manawa m\u014d ng\u0101 Kaum\u0101tua me ng\u0101 Wh\u0101nau: a co-designed community-based cohort study of cardiovascular health among older M\u0101ori in Canterbury, New Zealand\u2014a study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8241-5709","authenticated-orcid":false,"given":"Andree","family":"Pearson","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Te R\u016bnanga o Te Ng\u0101i Tahu, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanita","family":"Kane","sequence":"additional","affiliation":[{"name":"M\u0101ori\/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard W","family":"Troughton","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand"},{"name":"Cardiology, Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"Pearson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynley K","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7379-8922","authenticated-orcid":false,"given":"Ellen","family":"Woodcock","sequence":"additional","affiliation":[{"name":"M\u0101ori\/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Pemberton","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"McKerchar","sequence":"additional","affiliation":[{"name":"Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maira","family":"Patu","sequence":"additional","affiliation":[{"name":"M\u0101ori\/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081405403328000_16.8.e120784.1","first-page":"46","article-title":"The contribution of avoidable mortality to the life expectancy gap in M\u0101ori and Pacific populations in New Zealand-a decomposition analysis","volume":"132","author":"Walsh","year":"2019","journal-title":"N Z Med J"},{"key":"2026081405403328000_16.8.e120784.2","unstructured":"Ministry of Health NZ . Tatau kahukura: M\u0101ori health chart book 2024. 2024."},{"key":"2026081405403328000_16.8.e120784.3","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2023-322795"},{"key":"2026081405403328000_16.8.e120784.4","doi-asserted-by":"crossref","DOI":"10.1186\/s44263-025-00212-3","article-title":"CVD risk assessment by ethnicity in Aotearoa New Zealand: a national observational study","volume":"3","author":"Selak","year":"2025","journal-title":"BMC Glob Public Health"},{"key":"2026081405403328000_16.8.e120784.5","article-title":"Assessing the gaps in cardiovascular disease risk assessment and management in primary care for M\u0101ori and Pacific peoples in Aotearoa New Zealand- a systematic review","volume":"56","author":"Wheeler","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"2026081405403328000_16.8.e120784.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2011-000799","article-title":"A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand","volume":"2","author":"Cameron","year":"2012","journal-title":"BMJ Open"},{"key":"2026081405403328000_16.8.e120784.7","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1071\/HC11072","article-title":"Adjusting protocols in clinical research: finding the point of cultural\/clinical fusion","volume":"3","author":"Pitama","year":"2011","journal-title":"J Prim Health Care"},{"key":"2026081405403328000_16.8.e120784.8","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv103"},{"key":"2026081405403328000_16.8.e120784.9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1741-6612.2012.00626.x","article-title":"Which cardiovascular risk factors are associated with cardiovascular disease and predict future events in advanced age in New Zealand?","volume":"33","author":"Teh","year":"2014","journal-title":"Australas J Ageing"},{"key":"2026081405403328000_16.8.e120784.10","first-page":"19","article-title":"New Echocardiography Reference Ranges for Aotearoa (NewERA) Study: the application of international echocardiographic reference values to linear measurements of the hearts of healthy, young M\u0101ori and Pacific adults may not detect cardiac enlargement","volume":"135","author":"Whalley","year":"2022","journal-title":"N Z Med J"},{"key":"2026081405403328000_16.8.e120784.11","doi-asserted-by":"crossref","DOI":"10.1161\/circ.142.suppl_3.16095","article-title":"Abstract 16095: Plasma NT-proBNP Concentrations are Two-fold Lower in Pacific versus European Population Samples: Evidence for Glycosylation Impacting Assay Detection and\/or ProBNP Processing","volume":"142","author":"Faatoese","year":"2020","journal-title":"Circulation"},{"key":"2026081405403328000_16.8.e120784.12","doi-asserted-by":"crossref","first-page":"2976","DOI":"10.1002\/ehf2.15314","article-title":"Lower NT-proBNP plasma concentrations in Pacific peoples with heart failure","volume":"12","author":"Pearson","year":"2025","journal-title":"ESC Heart Fail"},{"key":"2026081405403328000_16.8.e120784.13","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-48553-y","article-title":"Contrasting signals of cardiovascular health among natriuretic peptides in subjects without heart disease","volume":"9","author":"Prickett","year":"2019","journal-title":"Sci Rep"},{"key":"2026081405403328000_16.8.e120784.14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jchf.2023.07.018","article-title":"Natriuretic Peptide Normative Levels and Deficiency: The National Health and Nutrition Examination Survey","volume":"12","author":"Shetty","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026081405403328000_16.8.e120784.15","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacadv.2024.100940","article-title":"Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels","volume":"3","author":"Dudum","year":"2024","journal-title":"JACC Adv"},{"key":"2026081405403328000_16.8.e120784.16","doi-asserted-by":"publisher","DOI":"10.1161\/atvbaha.120.315291"},{"key":"2026081405403328000_16.8.e120784.17","doi-asserted-by":"crossref","DOI":"10.1016\/j.atherosclerosis.2025.120516","article-title":"Lipoprotein(a) concentrations and secondary outcomes following first-time acute coronary syndrome: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)","volume":"410","author":"Legget","year":"2025","journal-title":"Atherosclerosis"},{"key":"2026081405403328000_16.8.e120784.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-019-0815-8","article-title":"Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement","volume":"19","author":"Huria","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"2026081405403328000_16.8.e120784.19","first-page":"118","article-title":"Meihana model: A clinical assessment framework","volume":"36","author":"Pitama","year":"2007","journal-title":"NZ J Psychol"},{"key":"2026081405403328000_16.8.e120784.20","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"2026081405403328000_16.8.e120784.21","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGENETICS.111.960336"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:40:42Z","timestamp":1786711242000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,14]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-120784"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120784","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}