Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in south asians

Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

Namratha R. Kandula, Alka M. Kanaya, Kiang Liu, Ji Young Lee, David Herrington, Stephen B. Hulley, Stephen D. Persell, Donald M. Lloyd-Jones, Mark D. Huffman

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25 Citations (Scopus)

Abstract

Background-Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results-South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5%) 10-year and low (<7.5%) 10-year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion-This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.

Original languageEnglish (US)
Article numbere001117
JournalJournal of the American Heart Association
Volume3
Issue number5
DOIs
StatePublished - Jan 1 2014

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Atherosclerosis
Cardiovascular Diseases
Coronary Vessels
Carotid Intima-Media Thickness
Calcium
African Americans
Odds Ratio
Guidelines

Keywords

  • Cardiovascular risk stratification
  • Epidemiology
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8169c84ddc2b422d90c33397086b9e20,
title = "Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in south asians: Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study",
abstract = "Background-Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results-South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5{\%}) 10-year and low (<7.5{\%}) 10-year risk; (2) high (≥39{\%}) lifetime and low (<39{\%}) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95{\%} CI, 1.2 to 3.2; women 3.14; 95{\%} CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion-This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.",
keywords = "Cardiovascular risk stratification, Epidemiology, Subclinical atherosclerosis",
author = "Kandula, {Namratha R.} and Kanaya, {Alka M.} and Kiang Liu and Lee, {Ji Young} and David Herrington and Hulley, {Stephen B.} and Persell, {Stephen D.} and Lloyd-Jones, {Donald M.} and Huffman, {Mark D.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1161/JAHA.114.001117",
language = "English (US)",
volume = "3",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in south asians

T2 - Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

AU - Kandula, Namratha R.

AU - Kanaya, Alka M.

AU - Liu, Kiang

AU - Lee, Ji Young

AU - Herrington, David

AU - Hulley, Stephen B.

AU - Persell, Stephen D.

AU - Lloyd-Jones, Donald M.

AU - Huffman, Mark D.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background-Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results-South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5%) 10-year and low (<7.5%) 10-year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion-This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.

AB - Background-Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results-South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5%) 10-year and low (<7.5%) 10-year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion-This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.

KW - Cardiovascular risk stratification

KW - Epidemiology

KW - Subclinical atherosclerosis

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U2 - 10.1161/JAHA.114.001117

DO - 10.1161/JAHA.114.001117

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