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

Nilay S. Shah; Anubha Agarwal; Mark Daniel 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

doi:10.1016/j.cardfail.2021.05.013

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

Nilay S. Shah^*, Anubha Agarwal, Mark Daniel 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 journal › Article › peer-review

Abstract

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 language	English (US)
Pages (from-to)	1214-1221
Number of pages	8
Journal	Journal of Cardiac Failure
Volume	27
Issue number	11
DOIs	https://doi.org/10.1016/j.cardfail.2021.05.013
State	Published - Nov 2021

Funding

The project described was supported by grant number 5R01HL093009 from the National Heart, Lung, and Blood Institute (NHLBI) and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1RR024131. This project is also supported in part by NHLBI grant F32HL149187 (NSS); by the American Heart Association grant #19TPA34890060 (SSK); by the NIH's National Center for Advancing Translational Sciences grant KL2TR001424 (SSK); and by the NIH's National Institute on Aging, grant P30AG059988 (SSK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. In the past 3 years, MDH received funding from the World Heart Federation to serve as its senior program advisor for the Emerging Leaders program, which has been supported by Boehringer Ingelheim, Novartis, Bupa, and AstraZeneca. MDH also received support from the American Heart Association, Verily, and AstraZeneca, and the American Medical Association for work unrelated to this research. The George Institute for Global Health's wholly owned enterprise, George Health Enterprises, has received investment funds to develop fixed-dose combination products containing aspirin, statin and blood pressure lowering drugs. AA and MDH plan to submit patents for HF polypills. SJS has received research grants from Actelion, AstraZeneca, Corvia, Novartis, and Pfizer; and has served as a consultant, scientific advisory board member, and/or executive committee/steering committee member for Abbott, Actelion, AstraZeneca, Amgen, Axon Therapeutics, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Cardiora, CVRx, Cytokinetics, Eisai, GSK, Ionis, Ironwood, Merck, MyoKardia, Novartis, Pfizer, Sanofi, Shifamed, Tenax, and United Therapeutics. SJS is supported by grants from the National Institutes of Health (R01HL107577, R01HL127028, R01HL140731, and R01HL149423) and the American Heart Association (#16SFRN28780016). The project described was supported by grant number 5R01HL093009 from the National Heart, Lung, and Blood Institute (NHLBI) and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1RR024131. This project is also supported in part by NHLBI grant F32HL149187 (NSS); by the American Heart Association grant #19TPA34890060 (SSK); by the NIH's National Center for Advancing Translational Sciences grant KL2TR001424 (SSK); and by the NIH's National Institute on Aging, grant P30AG059988 (SSK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Keywords

Heart failure
epidemiology
primary prevention
race and ethnicity

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cardfail.2021.05.013

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@article{dee5f37bc16b49a09a6d844a03447f87,

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

abstract = "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.",

keywords = "Heart failure, epidemiology, primary prevention, race and ethnicity",

author = "Shah, {Nilay S.} and Anubha Agarwal and Huffman, {Mark Daniel} and Gupta, {Deepak K.} and Yancy, {Clyde W.} and Shah, {Sanjiv J.} and Kanaya, {Alka M.} and Hongyan Ning and Lloyd-Jones, {Donald M.} and Kandula, {Namratha R.} and Khan, {Sadiya S.}",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2021",

month = nov,

doi = "10.1016/j.cardfail.2021.05.013",

language = "English (US)",

volume = "27",

pages = "1214--1221",

journal = "Journal of Cardiac Failure",

issn = "1071-9164",

publisher = "Elsevier B.V.",

number = "11",

}

TY - JOUR

T1 - Distribution and Correlates of Incident Heart Failure Risk in South Asian Americans

T2 - The MASALA Study

AU - Shah, Nilay S.

AU - Agarwal, Anubha

AU - Huffman, Mark Daniel

AU - Gupta, Deepak K.

AU - Yancy, Clyde W.

AU - Shah, Sanjiv J.

AU - Kanaya, Alka M.

AU - Ning, Hongyan

AU - Lloyd-Jones, Donald M.

AU - Kandula, Namratha R.

AU - Khan, Sadiya S.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - Heart failure

KW - epidemiology

KW - primary prevention

KW - race and ethnicity

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SN - 1071-9164

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JO - Journal of Cardiac Failure

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IS - 11

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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