Introduction

The aim of this study was to investigate associations between cumulative biological risk and subclinical atherosclerosis in South Asian immigrants.

Methods

Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, including 858 participants at baseline (mean age = 56 [standard deviation = 9] years, 46% women). A cumulative biological risk score was derived using nine biomarkers across cardiovascular, immune, and metabolic systems with a possible score range of 0-9. Common and internal carotid artery intima media thickness (CIMT) and coronary artery calcium (CAC) were used as indicators of subclinical atherosclerosis.

Results

Higher cumulative biological risk score was significantly associated with higher common and internal CIMT and higher odds of CAC at baseline. The odds of new CAC after 5 years of follow-up were 31% higher per 1-point increase in cumulative biological risk score, and the higher cumulative biological risk score was also associated with CAC progression.

Conclusions

Among South Asian immigrants, cumulative biological risk was directly associated with subclinical atherosclerosis and its progression.

Objectives

The objective of this study was to examine the association between high risk of obstructive sleep apnea (OSA) and subclinical atherosclerosis among South Asians in the United States.

Design

A secondary analysis of cross-sectional data.

Setting/participants

A community-based cohort of 906 men and women participating in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

Measurements

The Berlin Questionnaire was used to screen for OSA risk. Coronary artery calcium (CAC), common carotid artery intima-media thickness (IMT), and internal carotid artery IMT were used as measures of subclinical atherosclerosis.

Results

The majority of participants (59%) with high OSA risk had CAC scores >0 compared with only 41% of participants with low OSA risk (P <.001). The high OSA risk group was older (P =.005), male (P =.04), had higher body mass index (P <.001) and had greater common carotid artery IMT (0.96 ± 0.27 mm) and internal carotid artery IMT (1.33 ± 0.42 mm) measurements. Snoring, sleep-disordered breathing (SDB), and high OSA risk were associated with subclinical atherosclerosis. However, only high OSA risk remained significant in multivariable models after controlling for demographic and clinical factors that included hypertension (HTN), obesity, diabetes, and dyslipidemia.

Conclusions

High OSA risk, which includes overlapping comorbidities of HTN and obesity, was not associated with the time living in the US but was associated with subclinical atherosclerosis markers. These cardiovascular disease risk factors should include evaluation of the spectrum of SDB among all adults, including South Asian men and women.

Objective: To investigate associations between a vegetarian diet and depression among South Asians in the United States.Design: Data from 892 South Asians (age range 40-83 y, 47% women) enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study were included. A vegetarian diet was defined as no intake of meat, poultry or fish in the previous year as reported on a validated food frequency questionnaire. Depressive symptomology was assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D) and depression was classified as CES-D score ≥16. Multivariable logistic regression was used and covariates included age, sex, study site, education, smoking, body mass index, acculturation, intentional exercise, alcohol and energy intake, and antidepressant medication use.Results: Our study demonstrated 43% lower odds of depression among vegetarians (p = 0.023).Conclusions: Vegetarian diet was found to be inversely associated with the prevalence of depression. Longitudinal examinations confirming these findings are needed.

Aims

To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States.

Methods

A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA.

Results

Almost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups (p = .007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI > 27.5 kg/m². In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors.

Conclusions

The risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.

South Asians, a fast growing ethnic group in the US, have an increased risk for cardiovascular disease compared to the general population. We examined the prevalence and distribution of the American Heart Association's Life's Simple 7 cardiovascular health (CVH) metrics using data from Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and cross-sectional associations between number of CVH metrics in the ideal range with subclinical atherosclerosis assessed using coronary artery calcium (CAC) measured using cardiac computed tomography and carotid intima media thickness (CIMT) measured using high-resolution B-mode ultrasonography. CAC was modeled as Agatston scores=0, 1-400 and >400; CIMT was examined continuously and as internal CIMT>1.5mm. In the MASALA cohort (N=875; mean age: 55years; 53% men; living in greater San Francisco and Chicago areas; October 2010-March 2013) without prevalent coronary heart disease, no participant had all 7 metrics in ideal range; approximately 20% of the participants had at least 5 metrics in ideal range. Higher number of CVH metrics in the ideal range was inversely associated with subclinical atherosclerosis. A 1 unit increase in the number of CVH metrics in the ideal range was associated with 32% lower odds of CAC=1-400 (vs. CAC=0; OR=0.68, 95% CI: 0.60, 0.78) and 28% lower odds of internal CIMT>1.5mm (OR=72, 95% CI: 0.61, 0.85). These data show the prevalence of CVH metrics among South Asians in the US, and provide empirical evidence on inverse associations of meeting ideal levels for higher number of metrics and subclinical atherosclerosis.

Acculturation may influence diet pattern, a risk factor for cardiometabolic disease. We assessed whether strength of traditional cultural beliefs and practices, a robust measure of acculturation, affects diet pattern among South Asians in America. With data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we used ordinal logistic regression to assess the association between strength of traditional cultural beliefs, 6 cultural practices and diet pattern. Of 892 participants, 47% were women. Weaker traditional cultural beliefs [OR(95%CI) 1.07(1.04,1.10)] and cultural practices (p < 0.05) were associated with consuming more of the Animal Protein dietary pattern and less [0.95(0.93,0.97)] of the Fried snacks, Sweets, High-fat dairy (FSHD) pattern (P < 0.05). South Asians in America with stronger traditional cultural beliefs and practices were more likely to consume the FSHD pattern. Prevention programs may consider dietary pattern modification as part of comprehensive risk reduction in South Asians.

The menopausal transition is a time of accelerating risk of cardiovascular disease (CVD), and promoting cardiovascular health during midlife is an important period of time to prevent CVD in women. The association of menopause with cardiovascular risk factors or subclinical atherosclerosis has not previously been evaluated in South Asian American women, a population with a disproportionately higher CVD burden compared with other race/ethnic groups. The objective of this study was to evaluate the association of menopause with CVD risk factors and subclinical cardiometabolic disease markers. We studied women aged 40 to 84 years from the Mediators of Atherosclerosis in South Asians Living in America study. The association of self-reported menopausal status with multiple demographic and clinical variables was assessed with linear and logistic regression adjusted for age and cardiovascular health behaviors. In a secondary ("age-restricted") analysis, postmenopausal participants outside the age range of premenopausal participants were excluded. In the age-restricted sample, menopause was associated with a higher adjusted odds of hypertension (odds ratio = 1.19, 95% confidence interval [CI] 1.02 to 1.41), and higher systolic blood pressure (β = 6.34, 95% CI 0.82 to 11.87), and significantly higher subcutaneous fat area (β = 42.8, 95% CI 5.8 to 91.4). No significant associations between menopause and ectopic fat deposition, coronary artery calcium, or carotid intima-media thickness were observed. In South Asian American women in the Mediators of Atherosclerosis in South Asians Living in America study, menopause was associated with cardiovascular risk factors and higher subcutaneous fat deposition. Menopausal status is an important factor to examine and address CVD risk factors.

Background

Following a vegetarian diet is considered to be beneficial for overall health and is associated with a lower risk of chronic disease.

Objective

This study examined whether South Asians in the United States who consume a vegetarian diet have a lower prevalence of cardiometabolic risk factors.

Methods

Data from the Mediators of Atherosclerosis in South Asians Living in America study, which included 892 South Asians (47% women), with an age range of 40-83 y and a mean ± SD age of 55 ± 9.4 y, were used. Participants were classified as vegetarian if they reported no consumption of meat, poultry, or fish in the previous year on a validated and culturally appropriate food-frequency questionnaire. Adjusted linear and logistic regression models were used to examine associations of a vegetarian diet with cardiometabolic risk factors.

Results

Thirty-eight percent of the cohort participants were classified as vegetarian. Vegetarians reported more frequent weekly eating occasions of whole grains (median frequency/wk: 10 compared with 9, P = 0.012) and beans and legumes (median frequency/wk: 8.5 compared with 5.1, P < 0.001), and less frequent weekly eating occasions of sweets and desserts (median frequency/wk: 1.9 compared with 2.3, P < 0.001). Consuming a vegetarian diet was associated with lower body mass index (P = 0.023), fasting glucose (P = 0.015), insulin resistance (P = 0.003), total cholesterol (P = 0.027), and LDL cholesterol (P = 0.004) and lower odds of fatty liver (OR: 0.43; 95% CI: 0.23, 0.78, P = 0.006). The odds of having any coronary artery calcium were lower for vegetarian men (OR: 0.53; 95% CI: 0.32, 0.87, P = 0.013); however, no significant associations were observed among women.

Conclusions

Among US South Asians, a vegetarian diet was associated with fewer cardiometabolic risk factors overall and with less subclinical atherosclerosis among men.

Background

South Asians are the second fastest growing ethnic group in the United States, and they have a high risk for cardiovascular disease (CVD). Moderate alcohol consumption has been associated with lower CVD risk in some race/ethnic groups, but the association of alcohol consumption and atherosclerosis in South Asians has not been investigated.

Methods and results

We used data from 906 South Asian participants who participated in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort (2010-2012). Alcohol consumption was ascertained via questionnaire, coronary artery calcium (CAC) was measured with computed tomography, and common carotid artery intima-media thickness (cIMT) was measured using B-mode ultrasonography. We used multivariable regression models to examine cross-sectional associations of alcohol consumption with the presence and amount of CAC and cIMT. Compared with never drinkers, participants consuming 4-7 drinks/week had a 63% decreased odds of any CAC after adjusting for potential confounders and mediators. Participants consuming 4-7 drinks/week had significantly lower odds of CAC score between 1 and 300 [OR (95% CI): 0.34 (0.16-0.72)]. A similar inverse association was seen for the odds of CAC>300 [OR (95% CI): 0.28 (0.07-0.97)]. Alcohol consumption of >7 drinks/week was associated with a 0.096 mm increase in common-cIMT.

Conclusion

There was an inverse association between the amount of alcohol intake and CAC among South Asians while a positive association was found between alcohol consumption and common-cIMT. Long-term follow-up of the MASALA cohort will examine prospective associations of alcohol intake with the progression of subclinical atherosclerosis, incident CVD events, and mortality.