South Asians (individuals from India, Pakistan, Nepal, Bangladesh, and Sri Lanka) represent a quarter of the world's population and are one of the fasting growing ethnic groups in the United States. Several cross-sectional studies conducted worldwide have reported a high prevalence of atherosclerosis, diabetes, hypertension, and cardiovascular disease in this ethnic group, despite low body mass index. However, there are no longitudinal studies of South Asians to determine other risk factors that may explain the high prevalence of cardiovascular disease. We performed a pilot community-based cross-sectional study of South Asian men and women in the San Francisco Bay Area. We collaborated with investigators involved with the Multi-Ethnic Study of Atherosclerosis (MESA), an NHLBI-supported prospective cohort study of four U.S. ethnic groups (Whites, African Americans, Latinos, and Chinese Americans). We used identical methods and measures for data collection to efficiently compare the South Asian sample with the MESA ethnic groups. We found that South Asians had higher socioeconomic attainment, lower smoking and alcohol use, relatively low BMI and waist circumference, and higher hypertension and diabetes prevalence. Common carotid intima media thickness was significantly higher in the South Asians compared to all ethnic groups in MESA, but coronary artery calcium scores were similar to all other ethnic groups. We now propose a prospective cohort study of 900 South Asian individuals to determine other risk factors linked to atherosclerosis and disease progression. We will conduct a two-center prospective cohort study of 900 South Asian adults between the ages of 40 and 79 years without cardiovascular disease from the San Francisco Bay Area and Chicago area to determine etiologic associations and prognostic significance of subclinical atherosclerosis and to compare these findings with other U.S. ethnic groups in MESA.
Our specific aims are to determine whether (1) traditional, social/cultural/behavioral and novel risk factors are associated with subclinical atherosclerosis measures;(2) South Asians have higher prevalence of subclinical atherosclerosis than the four ethnic groups in the MESA 5th examination after adjusting for traditional, social/behavioral, and novel risk factors. In an exploratory aim, we will determine whether measures of subclinical atherosclerosis are associated with incident cardiovascular events after 2 years of follow-up. Understanding the antecedents of atherosclerosis in this high-risk ethnic population may lend insight into the pathogenesis of cardiovascular disease in general. The identification of key risk factors that are linked to atherosclerosis will provide targets for future therapies to prevent or cure the leading cause of death worldwide - cardiovascular disease.

Public Health Relevance

South Asian (Indian, Pakistani, Bangladeshi, Nepali, and Sri Lankan) individuals have high rates of cardiovascular disease that is not explained by traditional cardiovascular risk factors. Though South Asians represent over one-quarter of the world's population, there are no longitudinal studies in this high-risk ethnic group.
We aim to establish a longitudinal study of South Asians at two U.S. centers to identify risk factors linked to subclinical atherosclerosis and incident cardiovascular disease. These will provide targets for future therapies to prevent or cure the leading cause of death worldwide, cardiovascular disease.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL093009-04
Application #
8438463
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Aviles-Santa, Larissa
Project Start
2010-04-01
Project End
2014-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
4
Fiscal Year
2013
Total Cost
$677,254
Indirect Cost
$160,909
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Jin, Yichen; DiPietro, Loretta; Kandula, Namratha R et al. (2018) Associations Between Television Viewing and Adiposity Among South Asians. J Racial Ethn Health Disparities 5:1059-1062
Kanaya, Alka M (2018) India's Call to Action-Prioritize Chronic Cardiovascular Disease. JAMA Intern Med 178:373-374
Mehta, Anurag; Patel, Jaideep; Al Rifai, Mahmoud et al. (2018) Inflammation and coronary artery calcification in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Atherosclerosis 270:49-56
Kandula, Namratha R; Cooper, Andrew J; Schneider, John A et al. (2018) Personal social networks and organizational affiliation of South Asians in the United States. BMC Public Health 18:218
Deol, Rupinder; Lee, Kathryn A; Kandula, Namratha R et al. (2018) Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States. Obes Med 9:1-6
Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Kanaya, Alka M et al. (2018) Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups: Comparing MASALA and MESA. Atherosclerosis 279:122-129
Needham, Belinda L; Mukherjee, Bhramar; Bagchi, Pramita et al. (2018) Acculturation Strategies and Symptoms of Depression: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Immigr Minor Health 20:792-798
Mongraw-Chaffin, Morgana; Gujral, Unjali P; Kanaya, Alka M et al. (2018) Relation of Ectopic Fat with Atherosclerotic Cardiovascular Disease Risk Score in South Asians Living in the United States (from the Mediators of Atherosclerosis in South Asians Living in America [MASALA] Study). Am J Cardiol 121:315-321
Bharmal, Nazleen H; McCarthy, William J; Gadgil, Meghana D et al. (2018) The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Relig Health 57:33-46
Nadimpalli, Sarah; Keita, Akilah; Wang, Jeremy et al. (2017) Are Experiences of Discrimination Related to Poorer Dietary Intakes Among South Asians in the MASALA Study? J Nutr Educ Behav 49:872-876.e1

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