Abstract MP079: Coronary Artery Calcium Incidence and Progression Among South Asians: Results From the MASALA Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Alka M Kanaya ◽  
Namratha Kandula ◽  
David Herrington ◽  
Kiang Liu ◽  
Matthew Budoff
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Ethnic Groups ◽  
South Asian ◽  
Coronary Artery Calcium ◽  
South Asians ◽  
Agatston Score ◽  
Visceral Fat Area ◽  
Asian Men

Background: South Asians have a high burden of cardiovascular disease. We have reported that South Asians have similarly high prevalence of coronary artery calcium (CAC) compared to non-Hispanic Whites, and higher CAC than other U.S. ethnic minority groups. No studies have determined the incidence or progression of CAC among South Asians. Methods: We used data from a community-based cohort of South Asians (MASALA) and calculated change in CAC Agatston score between Exam 1 (2010-2013) and Exam 2 (2015-2016) among 379 South Asians. We calculated the average annual incident CAC for those with no CAC at Exam 1, and CAC progression among those with CAC at Exam 1. We compared these findings to the previously reported CAC incidence and progression in the Multi-Ethnic Study of Atherosclerosis (MESA). We also determined factors associated with a ≥100 change in CAC score. Results: We used data from 240 men and 139 women with repeat CAC measured after 4.5±0.7 years of follow-up. Among those with no detectable CAC at baseline, 6.8% developed incident CAC annually (9.2% of men and 4.4% of women), which was similar to MESA race/ethnic groups. Among those with known CAC at baseline, the median annual CAC progression was 23 (interquartile range, 8-56). The table shows the distribution of annual CAC progression. South Asians overall, but particularly South Asian men, had significantly higher annual CAC progression compared to the reported average in MESA (overall median 18, 4-53). Established risk factors (age, male sex, diabetes and hypertension), pericardial fat volume and visceral fat area were associated with greater CAC progression. Conclusions: These preliminary results suggest that South Asian men have significantly greater CAC progression compared to other race/ethnic groups. Longer follow-up of MASALA will determine whether CAC score or CAC progression are important predictors of cardiovascular disease events.

Abstract P319: Comparing Coronary Artery Calcium among U.S. South Asians with Four Racial/Ethnic Groups: The MASALA and MESA Studies

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Alka M Kanaya ◽  
Namratha R Kandula ◽  
David Herrington ◽  
Kiang Liu ◽  
Michael J Blaha ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ethnic Groups ◽  
South Asian ◽  
Coronary Artery Calcium ◽  
South Asians ◽  
Chinese Americans ◽  
Asian Women ◽  
South Asian Women ◽  
Asian Men ◽  
Racial Ethnic

Background: South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease (CVD) which cannot be fully explained by traditional risk factors. We created a community-based cohort of South Asians (MASALA) and compared the prevalence of coronary artery calcium (CAC) to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: We compared 803 South Asians to the four racial/ethnic groups (2,622 Whites, 1,893 African Americans, 1,496 Latinos and 803 Chinese Americans), all free of CVD. We created pooled multivariate Poisson models to examine the effect of race/ethnicity with CAC after adjusting for sex, age, clinical site, education, smoking, BMI, diabetes, hypertension, HDL-, LDL-cholesterol, and cholesterol lowering medication use. Results: The age-adjusted prevalence of any CAC was similar between White and South Asian men (68%), but was lower in Latino (58%), Chinese American (58%) and African American men (51%). South Asian women had similar CAC prevalence as other ethnic minority women but significantly lower than White women (37% vs. 43%, p<0.05). The figure shows the mean CAC scores among each of the five racial/ethnic groups by 5-year increments in age. After adjusting for all covariates, 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 MESA groups. However, South Asian women ≥70 years had a higher prevalence of any CAC than all other racial/ethnic groups. Conclusions: South Asian men are more similar to Whites than the other race/ethnic groups in MESA. The high burden of subclinical atherosclerosis in South Asians may partly explain higher rates of CVD in South Asians. Follow-up data from the MASALA study will determine whether CAC is associated with incident CVD among South Asians and if this relationship differs from that observed in other racial/ethnic groups.

Abstract 163: Association of Diabetes With Coronary Artery Calcium in South Asians, African Americans, Caucasians, Chinese, and Hispanics: The Multi-Ethnic Study of Atherosclerosis (MESA) and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ned Premyodhin ◽  
Wenjun Fan ◽  
Millie Arora ◽  
Masood Younus ◽  
Matthew J Budoff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
African Americans ◽  
Ethnic Groups ◽  
Coronary Artery Calcium ◽  
South Asians ◽  
Subclinical Atherosclerosis ◽  
Study Cohort ◽  
Atherosclerotic Cardiovascular Disease ◽  
Normal Glucose

Introduction: South Asians (SA) have increased atherosclerotic cardiovascular disease (ASCVD) risk and SA ethnicity is considered a “risk-enhancing factor” in the latest prevention guidelines. Diabetes mellitus (DM) is common in SA, but it is not known how pre-DM or DM may contribute to subclinical atherosclerosis in SA compared to other ethnic groups. We examined the association of pre-DM and DM to coronary artery calcium (CAC) in SA compared to 4 other ethnic groups. Methods: We studied data from SA, African Americans (AA), non-Hispanic whites (NHW), Chinese (CH), and Hispanics (HS) aged 45-84 without known ASCVD. SA were taken exclusively from MASALA and other groups from MESA. The prevalence of CAC 0, 1-99, 100-399, and 400+ were examined among those who were normoglycemic, pre-DM and DM. Multiple logistic regression adjusted for age, sex, smoking, cholesterol, and blood pressure identified the associations of pre-DM and DM (compared to normal glucose) on the odds of any CAC > 0 and significant CAC ≥ 100 by ethnicity. Results: Of the 7587 included individuals, mean age was 62±10 years, with 48% men, 10% SA, 25% AA, 34% NHW, 11% CH and 20% HS. The prevalence of pre-DM and DM varied significantly (p < 0.01) across ethnic groups: SA (25% and 21%), AA (15% and 18%), NHW (11% and 6%), CH (17% and 13%) and HS (15% and 17%). The prevalence of any CAC and CAC ≥ 100 in those with DM were highest in NHW (80% and 48%) and SA (72% and 41%). Pre-DM was only associated with CAC ≥ 100 in NHW (OR = 1.5, p < 0.01). Compared to other groups, SA with DM (compared to those normoglycemic) had the highest odds ratios (ORs) for CAC > 0 (OR = 3.35, p < 0.01) and CAC ≥ 100 (OR = 3.10, p < 0.01) (p = 0.01 and 0.07 for ethnicity interactions, respectively) (Table). Conclusions: Diabetes was associated with higher odds of any or significant CAC among SA compared to other ethnic groups. Ongoing longitudinal follow-up of the MASALA study cohort might help explain if DM contributes to the often premature ASCVD outcomes in SA.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

scholarly journals Associations of recreational and non-recreational physical activity with coronary artery calcium density vs. volume and cardiovascular disease events: the Multi-Ethnic Study of Atherosclerosis

2019 ◽  
Author(s):  
Isac C Thomas ◽  
Michelle L Takemoto ◽  
Nketi I Forbang ◽  
Britta A Larsen ◽  
Erin D Michos ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Standard Deviation ◽  
Coronary Artery Calcium ◽  
Recreational Physical Activity ◽  
Cvd Risk ◽  
Ethnic Study ◽  
Subclinical Marker

Abstract Aims  The benefits of physical activity (PA) on cardiovascular disease (CVD) are well known. However, studies suggest PA is associated with coronary artery calcium (CAC), a subclinical marker of CVD. In this study, we evaluated the associations of self-reported recreational and non-recreational PA with CAC composition and incident CVD events. Prior studies suggest high CAC density may be protective for CVD events. Methods and results  We evaluated 3393 participants of the Multi-Ethnic Study of Atherosclerosis with prevalent CAC. After adjusting for demographics, the highest quintile of recreational PA was associated with 0.07 (95% confidence interval 0.01–0.13) units greater CAC density but was not associated with CAC volume. In contrast, the highest quintile of non-recreational PA was associated with 0.08 (0.02–0.14) units lower CAC density and a trend toward 0.13 (−0.01 to 0.27) log-units higher CAC volume. There were 520 CVD events over a 13.7-year median follow-up. Recreational PA was associated with lower CVD risk (hazard ratio 0.88, 0.79–0.98, per standard deviation), with an effect size that was not changed with adjustment for CAC composition or across levels of prevalent CAC. Conclusion  Recreational PA may be associated with a higher density but not a higher volume of CAC. Non-recreational PA may be associated with lower CAC density, suggesting these forms of PA may not have equivalent associations with this subclinical marker of CVD. While PA may affect the composition of CAC, the associations of PA with CVD risk appear to be independent of CAC.

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

2014 ◽  
Vol 234 (1) ◽  
pp. 102-107 ◽  
Author(s):  
Alka M. Kanaya ◽  
Namratha R. Kandula ◽  
Susan K. Ewing ◽  
David Herrington ◽  
Kiang Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ethnic Groups ◽  
Coronary Artery Calcium ◽  
South Asians ◽  
Racial Ethnic

scholarly journals Incidence and Progression of Coronary Artery Calcium in South Asians Compared With 4 Race/Ethnic Groups

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Alka M. Kanaya ◽  
Eric Vittinghoff ◽  
Feng Lin ◽  
Namratha R. Kandula ◽  
David Herrington ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ethnic Groups ◽  
Coronary Artery Calcium ◽  
South Asians

Abstract P270: Associations of Lipoprotein-associated Phospholipase A 2 Mass and Activity with Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Nancy S Jenny ◽  
Robyn McClelland ◽  
Neal Jorgensen ◽  
Parveen Garg ◽  
Gregory Burke ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiac Computed Tomography ◽  
Prevalence Ratio ◽  
Hdl Cholesterol ◽  
Phospholipase A ◽  
Lipid Lowering ◽  
Agatston Score ◽  
Ethnic Study

Background: Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is an inflammatory enzyme localized in atherosclerotic lesions. However, associations of Lp-PLA 2 with coronary artery calcium (CAC), used as a marker of lesion progression, have not been extensively studied and may vary by sex and type of Lp-PLA 2 assay. Methods: We examined these associations in 5486 White, Black, Chinese and Hispanic men and women in the Multi-Ethnic Study of Atherosclerosis (MESA). At baseline, mean age was 62 years; all were free of clinical cardiovascular disease. CAC, by cardiac computed tomography, was assessed at baseline (2000-02) and follow-up; half the cohort at exam 2 (2002-04), the remainder at exam 3 (2004-05). 2758 had CAC (Agatston score>0) at baseline; of those with no baseline CAC, 372 (13.6%) had incident CAC (CAC>0) at follow-up. Lp-PLA 2 mass and activity were measured by immunoassay and enzymatic assay, respectively. Longitudinal models were adjusted for age, sex, ethnicity, smoking, diabetes, obesity, total and HDL cholesterol, blood pressure, hypertension, lipid-lowering medications and time between CAC measures. Results: Each standard deviation (SD 36.5 nmol/min/ml) increase in Lp-PLA 2 activity was associated with CAC presence (prevalence ratio 1.03; p=0.01) in the whole group at baseline and incidence in those with no CAC at baseline (odds ratio 1.17; p=0.02). Activity was not associated with CAC progression (increase in Agatston score over time) in the whole group (β=1.32; p>0.4). Lp-PLA 2 mass was not associated with CAC presence or incidence (SD 45.6 ng/ml; associations p>0.2). The only association that differed significantly by sex was that for mass and progression (p interaction 0.01). Mass was associated with CAC progression in women (β=4.99; p=0.004) but not men (β=-0.20; p>0.9). Conclusions: In this multi-ethnic cohort, associations of Lp-PLA 2 with CAC varied by sex and Lp-PLA 2 assay type. Lp-PLA 2 activity was associated with CAC presence and incidence, but not progression. Mass was associated with CAC progression in women only. Additional research is needed to support the clinical utility of Lp-PLA 2 in monitoring atherosclerosis progression.

Abstract P126: Comparing Cardiovascular Risk Factor Progression Between South Asian Men and Women With Diabetes: A Longitudinal Analysis From the Masala Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Manasi Deshpandey ◽  
Chiung-Yu Huang ◽  
Namratha Kandula ◽  
Alka M Kanaya
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
South Asian ◽  
Ldl Cholesterol ◽  
South Asians ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Men And Women ◽  
Asian Men

Introduction: South Asians have a high incidence of type 2 diabetes(DM) and cardiovascular disease (CVD). Women with DM may have greater CVD risk compared to men with DM and women without DM. No study has determined whether the incidence or progression of coronary artery calcium (CAC) score, a measure of atherosclerosis burden, differs between South Asian men and women with DM. Hypothesis: We hypothesize that CAC progression is greater in women with DM as compared to men with DM and women without DM. Methods: We used the data from the MASALA study, a community-based prospective cohort of South Asians from 2 clinical sites without CVD at baseline. We conducted a longitudinal analysis of diabetic participants who were reassessed after 5 years and compared with those without diabetes. We classified incident CAC as any CAC at exam 2 in a participant who had no CAC at baseline. To examine the progression of CVD risk factors over time, we compared change in CAC score, waist circumference, systolic and diastolic blood pressure, HbA1c and lipid levels amongst the diabetic and non-diabetic population by sex. We conducted multivariable linear regression models stratified by diabetes status to determine whether sex was independently associated with change in CAC score and other CVD risk factors. Results: Of 749 participants who were seen in follow-up, 176 (23%) had diabetes at baseline, 65% were men, and mean age was 58 years. Approximately 64% women with DM vs. 28% men with DM had CAC=0, and men had higher median CAC score (49 (IQR 0-247) vs. 0 (IQR 0-46, p<0.001). After mean follow-up of 4.8±0.8 years, incident CAC did not differ between men and women with diabetes (p=0.85). Progression of CAC was greater in men with DM (94, IQR 13-290) compared to women with DM (0, IQR 0-30) (p <0.001). Baseline statin and aspirin use was lower in women with DM (statins: 37% in women vs. 56% in men, p<0.001; aspirin 16% in women vs. 43% in men, p<0.001). In multivariable models, the fold-change in CAC in women (0.22, 95% CI 0.10 - 0.47) was lower than in men (4.54, 95% CI 2.08 - 9.89) and comparable to women without DM (0.30 95%CI 0.21 -0.43), after adjusting for age, baseline CAC, systolic and diastolic blood pressure, total and LDL cholesterol, duration of diabetes, smoking and any medication use (statin, diabetes, or hypertension med). Sex was not associated with change in any CVD risk factor among those with diabetes; but women without DM had greater change in total and LDL cholesterol and waist circumference than men without DM. Conclusion: In this South Asian population, change in CAC score was lower in women with DM than in men with DM, and was comparable to women without DM. These results suggest among South Asians with DM, overall CVD risk may be greater in men than in women.Continued follow-up of the MASALA cohort will determine whether there are sex differences in CVD outcomes.

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