Research Article| Volume 234, ISSUE 1, P102-107, May 2014

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


      • Coronary artery calcium (CAC) prevalence was similar among South Asian & White men.
      • CAC was higher in South Asian men than African American, Latino and Chinese men.
      • South Asian women had similar CAC prevalence compared to all MESA women.
      • South Asian women ≥70 years had higher CAC prevalence than all other women.



      South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. Few studies have examined coronary artery calcium (CAC) in South Asians.


      We created a community-based cohort of South Asians in the United States and compared the prevalence and distribution of CAC to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). We compared 803 asymptomatic South Asians free of cardiovascular disease to the four MESA racial/ethnic groups (2622 Whites, 1893 African Americans, 1496 Latinos and 803 Chinese Americans).


      The age-adjusted prevalence of any CAC was similar between White and South Asian men, but was lower in South Asian women compared to White women. After adjusting for all covariates associated with CAC, 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 women enrolled in MESA. However, South Asian women ≥70 years had a higher prevalence of any CAC than most other racial/ethnic groups.


      South Asian men have similarly high CAC burden as White men, but higher CAC than other racial/ethnic groups. South Asian women appear to have similar CAC burden compared to other women, but have somewhat higher CAC burden in older age. The high burden of subclinical coronary atherosclerosis in South Asians may partly explain higher rates of cardiovascular disease in South Asians.


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        • U.S. Census Bureau
        2010 census–demographic profile data.
        • Balarajan R.
        Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales.
        Brit Med J. Mar 9 1991; 302: 560-564
        • McKeigue P.M.
        • Marmot M.G.
        Mortality from coronary heart disease in Asian communities in London.
        Brit Med J. Oct 8 1988; 297: 903
        • Tillin T.
        • Hughes A.D.
        • Mayet J.
        • et al.
        The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians and African Caribbeans. SABRE (Southall and Brent revisited) – a prospective population based study.
        J Am Coll Cardiol. 2013; 61: 1777-1786
        • Hajra A.
        • Li Y.
        • Siu S.
        • et al.
        Risk of coronary disease in the South Asian American population.
        J Am Coll Cardiol. Aug 13 2013; 62: 644-645
        • Palaniappan L.
        • Wang Y.
        • Fortmann S.P.
        Coronary heart disease mortality for six ethnic groups in California, 1990–2000.
        Ann Epidemiol. Aug 2004; 14: 499-506
        • O'Rourke R.A.
        • Brundage B.H.
        • Froelicher V.F.
        • et al.
        American College of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease.
        J Am Coll Cardiol. Jul 2000; 36: 326-340
        • Greenland P.
        • Bonow R.O.
        • Brundage B.H.
        • et al.
        ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography).
        Circulation. Jan 23 2007; 115: 402-426
        • Budoff M.J.
        • Achenbach S.
        • Blumenthal R.S.
        • et al.
        Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology.
        Circulation. Oct 17 2006; 114: 1761-1791
        • Taylor A.J.
        • Cerqueira M.
        • Hodgson J.M.
        • et al.
        ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.
        Circulation. Nov 23 2010; 122: e525-e555
        • Bild D.E.
        • Detrano R.
        • Peterson D.
        • et al.
        Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Circulation. Mar 15 2005; 111: 1313-1320
        • McClelland R.L.
        • Chung H.
        • Detrano R.
        • Post W.
        • Kronmal R.A.
        Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA).
        Circulation. Jan 3 2006; 113: 30-37
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • et al.
        Coronary calcium as a predictor of coronary events in four racial or ethnic groups.
        N Engl J Med. Mar 27 2008; 358: 1336-1345
        • Hatwalkar A.
        • Agrawal N.
        • Reiss D.S.
        • Budoff M.J.
        Comparison of prevalence and severity of coronary calcium determined by electron beam tomography among various ethnic groups.
        Am J Cardiol. May 15 2003; 91: 1225-1227
        • Wasnik A.
        • Raut A.
        • Morani A.
        Coronary calcium scoring in asymptomatic Indian population: correlation with age, gender and risk factors–a prospective study on 500 subjects.
        Indian Heart J. May-Jun 2007; 59: 232-238
        • Jain P.
        • Kooner J.S.
        • Raval U.
        • Lahiri A.
        Prevalence of coronary artery calcium scores and silent myocardial ischaemia was similar in Indian Asians and European whites in a cross-sectional study of asymptomatic subjects from a U.K. population (LOLIPOP-IPC).
        J Nucl Cardiol. May 2011; 18: 435-442
        • Kanaya A.M.
        • Kandula N.
        • Herrington D.
        • et al.
        Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study: objectives, methods, and cohort Description.
        Clin Cardiol. Nov 5 2013; ([Epub])
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • et al.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am J Epidemiol. Nov 1 2002; 156: 871-881
        • Ainsworth B.E.
        • Irwin M.L.
        • Addy C.L.
        • Whitt M.C.
        • Stolarczyk L.M.
        Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study.
        J Womens Health Gend Based Med. Jul-Aug 1999; 8: 805-813
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. June 1972; 18: 499-502
        • Greenland S.
        Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies.
        Am J Epidemiol. Aug 15 2004; 160: 301-305
        • Zou G.
        A modified poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. Apr 1 2004; 159: 702-706
        • Koulaouzidis G.
        • Nicoll R.
        • Charisopoulou D.
        • McArthur T.
        • Jenkins P.J.
        • Henein M.Y.
        Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors.
        Int J Cardiol. Sep 10 2013; 167: 2472-2476
        • Tillin T.
        • Dhutia H.
        • Chambers J.
        • et al.
        South Asian men have different patterns of coronary artery disease when compared with European men.
        Int J Cardiol. Oct 13 2008; 129: 406-413
        • Dhawan J.
        • Bray C.L.
        Angiographic comparison of coronary artery disease between Asians and Caucasians.
        Postgrad Med J. Sep 1994; 70: 625-630
        • Sahni D.
        • Jit I.
        Origin and size of the coronary arteries in the north-west Indians.
        Indian Heart J. Jul-Aug 1989; 41: 221-228
        • Lip G.Y.
        • Rathore V.S.
        • Katira R.
        • Watson R.D.
        • Singh S.P.
        Do Indo-Asians have smaller coronary arteries?.
        Postgrad Med J. Aug 1999; 75: 463-466
        • Makaryus A.N.
        • Dhama B.
        • Raince J.
        • et al.
        Coronary artery diameter as a risk factor for acute coronary syndromes in Asian-Indians.
        Am J Cardiol. Sep 15 2005; 96: 778-780
        • Yusuf S.
        • Reddy S.
        • Ounpuu S.
        • Anand S.
        Global burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.
        Circulation. Dec 4 2001; 104: 2855-2864

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