TY - JOUR
T1 - Implications of the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines and potential value of the coronary artery calcium score among South Asians in the US
T2 - The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study
AU - Haque, Waqas
AU - Grandhi, Gowtham R.
AU - Kanaya, Alka M.
AU - Kandula, Namratha R.
AU - Nasir, Khurram
AU - Al Rifai, Mahmoud
AU - Uddin, S. M.Iftekhar
AU - Fedeli, Ugo
AU - Sattar, Naveed
AU - Blumenthal, Roger S.
AU - Blaha, Michael J.
AU - Cainzos-Achirica, Miguel
N1 - Funding Information:
The project described was supported by Grant Numbers R01HL093009 and 2R01HL093009 from the National Heart, Lung, And Blood Institute and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health , through UCSF-CTSI Grant Numbers UL1RR024131 and UL1TR001872 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, And Blood Institute or the National Institutes of Health. The authors thank the other investigators, the staff, and the participants of the MASALA study for their valuable contributions.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/10
Y1 - 2021/10
N2 - Background and aims: South Asian (SA) ethnicity is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, the implications of considering SA ethnicity as a “risk-enhancing factor” per recent American College of Cardiology/American Heart Association guidelines are not fully understood. Methods: We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a community-based cohort study of individuals of SA ancestry living in the US. The Pooled Cohort Equations were used to estimate 10-year ASCVD risk. Metabolic risk factors and coronary artery calcium (CAC) scores were assessed. Results: Among 1114 MASALA participants included (median age 56 years, 48% women), 28% were already using a statin at baseline, 25% had prevalent diabetes, and 59% qualified for 10-year ASCVD risk assessment for statin allocation purposes. The prevalence of low, borderline, intermediate, and high estimated ASCVD risk was 65%, 11%, 20% and 5%, respectively. Among participants at intermediate risk, 30% had CAC = 0 and 37% had CAC>100, while among participants at borderline risk, 54% had CAC = 0 and 13% had CAC>100. Systematic consideration of intermediate and, particularly, of borderline risk individuals as statin candidates would enrich the statin-consideration group with CAC = 0 participants up to 35%. Prediabetes and abdominal obesity were highly prevalent across all estimated risk strata, including among those with CAC = 0. Conclusions: Our findings suggest that systematic consideration of borderline risk SAs as statin candidates might result in considerable overtreatment, and further risk assessment with CAC may help better personalize statin allocation in these individuals. Early, aggressive lifestyle interventions aimed at reducing the risk of incident diabetes should be strongly recommended in US SAs, particularly among those considered candidates for statin therapy for primary prevention. Longitudinal studies are needed to confirm the favorable prognosis of CAC = 0 in SAs.
AB - Background and aims: South Asian (SA) ethnicity is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, the implications of considering SA ethnicity as a “risk-enhancing factor” per recent American College of Cardiology/American Heart Association guidelines are not fully understood. Methods: We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a community-based cohort study of individuals of SA ancestry living in the US. The Pooled Cohort Equations were used to estimate 10-year ASCVD risk. Metabolic risk factors and coronary artery calcium (CAC) scores were assessed. Results: Among 1114 MASALA participants included (median age 56 years, 48% women), 28% were already using a statin at baseline, 25% had prevalent diabetes, and 59% qualified for 10-year ASCVD risk assessment for statin allocation purposes. The prevalence of low, borderline, intermediate, and high estimated ASCVD risk was 65%, 11%, 20% and 5%, respectively. Among participants at intermediate risk, 30% had CAC = 0 and 37% had CAC>100, while among participants at borderline risk, 54% had CAC = 0 and 13% had CAC>100. Systematic consideration of intermediate and, particularly, of borderline risk individuals as statin candidates would enrich the statin-consideration group with CAC = 0 participants up to 35%. Prediabetes and abdominal obesity were highly prevalent across all estimated risk strata, including among those with CAC = 0. Conclusions: Our findings suggest that systematic consideration of borderline risk SAs as statin candidates might result in considerable overtreatment, and further risk assessment with CAC may help better personalize statin allocation in these individuals. Early, aggressive lifestyle interventions aimed at reducing the risk of incident diabetes should be strongly recommended in US SAs, particularly among those considered candidates for statin therapy for primary prevention. Longitudinal studies are needed to confirm the favorable prognosis of CAC = 0 in SAs.
KW - Atherosclerosis
KW - Cardiovascular disease
KW - Coronary artery calcium
KW - Diabetes
KW - Guidelines
KW - Prediabetes
KW - Risk assessment
KW - South Asian
KW - Statins
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U2 - 10.1016/j.atherosclerosis.2021.08.030
DO - 10.1016/j.atherosclerosis.2021.08.030
M3 - Article
C2 - 34481175
AN - SCOPUS:85113918944
SN - 0021-9150
VL - 334
SP - 48
EP - 56
JO - Atherosclerosis
JF - Atherosclerosis
ER -