Comparing coronary artery calcium among U.S. South Asians with four racial/ethnic groups: The MASALA and MESA studies

Abstract

Objectives South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. Few studies have examined coronary artery calcium (CAC) in South Asians. Methods We created a community-based cohort of South Asians in the United States and compared the prevalence and distribution of CAC to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). We compared 803 asymptomatic South Asians free of cardiovascular disease to the four MESA racial/ethnic groups (2,622 Whites, 1,893 African Americans, 1,496 Latinos and 803 Chinese Americans). Results The age-adjusted prevalence of any CAC was similar between White and South Asian men, but was lower in South Asian women compared to White women. After adjusting for all covariates associated with CAC, South Asian men were similar to White men and had higher CAC scores compared to African Americans, Latinos and Chinese Americans. In fully adjusted models, CAC scores were similar for South Asian women compared to all women enrolled in MESA. However, South Asian women ≥70 years had a higher prevalence of any CAC than most other racial/ethnic groups. Conclusions South Asian men have similarly high CAC burden as White men, but higher CAC than other racial/ethnic groups. South Asian women appear to have similar CAC burden compared to other women, but have somewhat higher CAC burden in older age. The high burden of subclinical coronary atherosclerosis in South Asians may partly explain higher rates of cardiovascular disease in South Asians.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…In contrast, the age-adjusted prevalence of CAC was lower in South Asian females (36.8%) than in white females (42.6%) and females of other races/ethnicities. 12 …”

Neighborhood Walkability and Walking for Transport Among South Asians in the MASALA Study

“…11 To be eligible for the MASALA study, participants had to be of South Asian ancestry (defined as having at least 3 grandparents born in either India, Pakistan, Bangladesh, Nepal, or Sri Lanka), be between 40 and 84 years old, and have the ability to speak and/or read English, Hindi, or Urdu. 24 Similar to the MESA study, the MASALA study used telephone-based recruiting from areas surrounding the clinical sites that had high proportions of South Asian residents, however, MASALA did not use a formal multistage probability sampling criteria as was done in MESA. 11 MASALA used exclusion criteria identical to that used in MESA, which included having a physician diagnosed heart attack, stroke or transient ischemic attack, heart failure, angina, use of nitroglycerin, or those with a history of cardiovascular procedures or any surgery on the heart or arteries.…”

“…11 MASALA used exclusion criteria identical to that used in MESA, which included having a physician diagnosed heart attack, stroke or transient ischemic attack, heart failure, angina, use of nitroglycerin, or those with a history of cardiovascular procedures or any surgery on the heart or arteries. 24 In addition, those who were undergoing active cancer treatment or with current atrial fibrillation were also excluded. 24 Those with less than 5 years of life expectancy, those who planed to move out of the study region within 5 years, and those living in a nursing home or on a waiting list for one were also excluded.…”

“…24 In addition, those who were undergoing active cancer treatment or with current atrial fibrillation were also excluded. 24 Those with less than 5 years of life expectancy, those who planed to move out of the study region within 5 years, and those living in a nursing home or on a waiting list for one were also excluded. 11 Finally, those who weighed 300 lb (136 kg) or greater were excluded due to computed tomography scanner limitations.…”

Acculturation and Subclinical Atherosclerosis among U.S. South Asians:Findings from the MASALA study

“…Mediators considered were total caloric intake, total physical activity, exercise, tobacco and alcohol use, waist circumference, fasting glucose, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and cholesterol lowering medication use which have all been associated with atherosclerosis in this study population [19].…”