Distribution and Correlates of Incident Heart Failure Risk in South Asian Americans: The MASALA Study

Nilay S. Shah*, Anubha Agarwal, Mark D. Huffman, Deepak K. Gupta, Clyde W. Yancy, Sanjiv J. Shah, Alka M. Kanaya, Hongyan Ning, Donald M. Lloyd-Jones, Namratha R. Kandula, Sadiya S. Khan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: South Asian Americans experience disproportionately high burden of cardiovascular diseases. Estimating predicted heart failure (HF) risk distribution may facilitate targeted prevention. We estimated the distribution of 10-year predicted risk of incident HF in South Asian Americans and evaluated the associations with social determinants of health and clinical risk factors. Methods and Results: In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we calculated 10-year predicted HF risk using the Pooled Cohort Equations to Prevent Heart Failure multivariable model. Distributions of low (<1%), intermediate (1%–5%), and high (≥5%) HF risk, identified overall and by demographic and clinical characteristics, were compared. We evaluated age- and sex-adjusted associations of demographic characteristics and coronary artery calcium with predicted HF risk category using ordinal logistic regression. In 1159 participants (48% women), with a mean age of 57 ± 9 years, 40% had a low, 37% had an intermediate, and 24% had a high HF risk. Significant differences in HF risk distribution existed across demographic (income, education, birthplace) and clinical (diabetes, hypertension, body mass index, coronary artery calcium) groups (P < .01). Significant associations with high predicted HF risk were observed for a family of income 75,000/year or more (adjusted odds ratio 0.5 [95% confidence interval (CI) 0.4–0.7]), college education (0.6 [95% CI 0.4–0.9]), birthplace in another South Asian country (1.9 [95% CI 1.2–3.2], vs. born in India), and prevalent coronary artery calcium (2.6 [95% CI 1.9–3.6]). Conclusions: Almost two-thirds of South Asian Americans in the MASALA cohort are at intermediate or high predicted 10-year HF risk, with varying risk across demographic and clinical characteristics.

Original languageEnglish (US)
Pages (from-to)1214-1221
Number of pages8
JournalJournal of Cardiac Failure
Issue number11
StatePublished - Nov 2021


  • Heart failure
  • epidemiology
  • primary prevention
  • race and ethnicity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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