Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study: Objectives, Methods, and Cohort Description

Abstract

Background South Asians (individuals from India, Pakistani, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. There are no prospective cohort studies investigating antecedents of cardiovascular disease in South Asians. Methods The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study is investigating the prevalence, correlates and outcomes associated with subclinical cardiovascular disease (CVD) in a population-based sample of South Asian men and women between ages 40 – 79 years from two U.S. clinical field centers. This cohort is similar in methods and measures to the Multi-Ethnic Study of Atherosclerosis to allow for efficient cross-ethnic comparisons. Measurements obtained at the baseline examination include sociodemographic information, lifestyle and psychosocial factors, standard CVD risk factors, oral glucose tolerance testing, electrocardiogram, assessment of microalbuminuria, ankle and brachial blood pressures, carotid intima media wall thickness using ultrasonagraphy, coronary artery calcium measurement and abdominal visceral fat using computed tomography. Blood samples will be assayed for biochemical risk factors. Results Between October 2010 and March 2013 we enrolled 906 South Asians with mean age of 55±9 years, 46% women, 98% immigrants who have lived 27±11 years in the US. Conclusions The sociodemographic characteristics of this cohort are representative of US South Asians. Participants are being followed with annual telephone calls for identification of CVD events including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, congestive heart failure, therapeutic interventions for CVD, and mortality.

Endogenous Sex Steroid Hormones, Lipid Subfractions, and Ectopic Adiposity in Asian Indians

“…1 Both native and migrant Asian Indians have a high prevalence of diabetes, hypertension, and cardiovascular disease (CVD). 2 However, Asian Indians develop these conditions at relatively low body mass indices compared with other racial/ethnic groups.…”

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

“…The traditional cultural beliefs scale was originally developed in an Asian Indian sample of primarily Hindu and Sikh participants [15], and may not adequately measure traditional cultural beliefs in other South Asian groups or those of other religious affiliation. Moreover, the South Asians included in MASALA were recruited from two geographic locations in the U.S. and the high socioeconomic attainment of this cohort as described previously [17] limit the generalizability of these findings to all immigrant South Asians. We may have missed the full range of acculturation in our sample, for example not having enough limited English proficient participants, and therefore may have underestimated the expected associations in all U.S. South Asians.…”

“…Study methods have been previously reported [17]. Briefly, to be eligible for the MASALA study, participants had to (1) selfidentify with South Asian ethnicity, (2) be between ages of 40 and 84 years, and (3) be able to speak and/or read English, Hindi or Urdu, the main languages spoken by immigrants from South Asia.…”

“…Journal of Clinical and Experimental Research in Cardiology Carotid intima media thickness: High-resolution B-mode ultrasonography was conducted for measurement of right and left internal and common carotid artery intima-media thickness (cIMT). Complete details of the protocol have been published and vascular technicians at both study sites were trained and certified on the scanning protocol by the reading center [17]. Briefly, the vascular technician located the bifurcation of the carotid artery, and identified the maximal wall thickening in the near or far wall, in the carotid bulb or internal carotid artery.…”

“…Coronary artery calcium Agatston scores: Cardiac CT scans were performed using a gated-cardiac CT scanner, as previously described [17]. Participants were examined in the supine position and a scout image was taken to determine the level of the carina and the first scan was set 1 cm below the carina.…”