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Alka M Kanaya - One of the best experts on this subject based on the ideXlab platform.
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plasma protein expression profiles cardiovascular disease and religious struggles among South Asians in the masala study
Scientific Reports, 2021Co-Authors: Alka M Kanaya, Blake Victor Kent, Long Ngo, Austin M Argentieri, Simon T Dillon, Alexandra E ShieldsAbstract:Blood protein concentrations are clinically useful, predictive biomarkers of cardiovascular disease (CVD). Despite a higher burden of CVD among U.S. South Asians, no CVD-related proteomics study has been conducted in this sub-population. The aim of this study is to investigate the associations between plasma protein levels and CVD incidence, and to assess the potential influence of religiosity/spirituality (R/S) on significant protein-CVD associations, in South Asians from the MASALA Study. We used a nested case-control design of 50 participants with incident CVD and 50 sex- and age-matched controls. Plasma samples were analyzed by SOMAscan for expression of 1305 proteins. Multivariable logistic regression models and model selection using Akaike Information Criteria were performed on the proteins and clinical covariates, with further effect modification analyses conducted to assess the influence of R/S measures on significant associations between proteins and incident CVD events. We identified 36 proteins that were significantly expressed differentially among CVD cases compared to matched controls. These proteins are involved in immune cell recruitment, atherosclerosis, endothelial cell differentiation, and vascularization. A final multivariable model found three proteins (Contactin-5 [CNTN5], Low affinity immunoglobulin gamma Fc region receptor II-a [FCGR2A], and Complement factor B [CFB]) associated with incident CVD after adjustment for diabetes (AUC = 0.82). Religious struggles that exacerbate the adverse impact of stressful life events, significantly modified the effect of Contactin-5 and Complement factor B on risk of CVD. Our research is this first assessment of the relationship between protein concentrations and risk of CVD in a South Asian sample. Further research is needed to understand patterns of proteomic profiles across diverse ethnic communities, and the influence of resources for resiliency on proteomic signatures and ultimately, risk of CVD.
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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
Circulation, 2020Co-Authors: Ned Premyodhin, Matthew J Budoff, Alka M Kanaya, Namratha R Kandula, Wenjun Fan, Millie Arora, Masood Younus, Latha Palaniappan, Jamal S Rana, Nathan D WongAbstract: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. Diab...
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lipoprotein a and aortic valve calcium in South Asians compared to other race ethnic groups
Atherosclerosis, 2020Co-Authors: Minhal Makshood, Matthew J Budoff, Alka M Kanaya, Parag H Joshi, Colby Ayers, Michael Y Tsai, Michael J Blaha, Erin D Michos, Wendy S PostAbstract:Abstract Background and aims South Asians are at increased risk for cardiovascular disease (CVD). Aortic valve calcium (AVC) is associated with CVD risk and aortic stenosis. Elevated Lp(a) is a heritable risk factor for CVD and AVC. AVC prevalence and its association with Lp(a) have not been studied in South Asians. Methods Among participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 695), AVC prevalence and extent were compared to four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA) (n = 4671). Multivariable regression was performed to evaluate associations between Lp(a) and AVC stratified by race/ethnic groups, adjusting for cardiovascular risk factors. Results After age and sex adjustment, South Asians had higher median Lp(a) (17.0 mg/dL) compared to Whites (12.9 mg/dL), Hispanics (13.1 mg/dL) and Chinese Americans (12.9 mg/dL), and Blacks had highest Lp(a) levels (35.1 mg/dL). There were no differences in the odds of AVC in South Asians compared with Whites or Hispanics, after age and sex adjustment (p = 0.64 and 0.63, respectively). Odds of AVC was lower in Chinese (OR 0.35; 95%CI 0.23–0.54) and somewhat lower in Blacks compared with South Asians (OR 0.76; 0.56–1.04). There were no associations between Lp(a) and AVC presence or extent in South Asians. Lp(a) was associated with AVC only among Blacks and Whites. Conclusions Although present in Whites and Blacks, there were no associations between Lp(a) and AVC in South Asians. These differences may be due to statistic power or race specific modifying factors that influences the effect of Lp(a) particles on AVC pathogenesis.
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incidence of diabetes and prediabetes and predictors of glycemic change among South Asians in the usa the masala study
BMJ open diabetes research & care, 2020Co-Authors: Unjali P Gujral, Kiang Liu, Namratha R Kandula, K Venkat M Narayan, Alka M KanayaAbstract:Introduction South Asians have a high prevalence of type 2 diabetes mellitus (T2DM). This may be associated with high rates of conversion through the natural history of disease. However, there is a paucity of data on prediabetes and T2DM incidence and related predictors in South Asians in the USA. Research design and methods We estimated prediabetes and T2DM incidence after 5 years of follow-up in the Mediators of Atherosclerosis in South Asians Living in America study (n=481) and examined the associated correlates. We defined T2DM and prediabetes using the American Diabetes Association criteria. Prediabetes included isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT) and combined IFG and IGT. Results Overall, 152 (32%, 95% CI: 27.6 to 35.9) individuals progressed either from normal glucose tolerance to prediabetes or T2DM, or from prediabetes to T2DM. In standardised logistic regression models controlling for age and sex, only hepatic fat attenuation (increased hepatic fat) (OR: 0.67 (95% CI: 0.55 to 0.87) per SD, visceral fat area (OR: 1.36 (95% CI: 1.06 to 1.74) per SD and hypertension (OR: 2.21 (95% CI: 1.44 to 3.40) were associated with any glycemic progression. Conclusions South Asians in the USA have a high incidence of dysglycemia. Hepatic and visceral fat may be factors in glycemic progression, and prevention efforts should target ectopic fat reduction.
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why are South Asians prone to type 2 diabetes a hypothesis based on underexplored pathways
Diabetologia, 2020Co-Authors: K Venkat M Narayan, Alka M KanayaAbstract:South Asians have a high prevalence of type 2 diabetes, even at a lower BMI. This review sets out our perspective and hypothesis on the reasons for this. Emerging data from epidemiological studies indicate that South Asians may have a lower ability to secrete insulin, and thus may have less compensatory reserves when challenged with unhealthy lifestyles. Thus, insulin resistance may not be the primary driver of type 2 diabetes in this population. Furthermore, data also suggest that South Asians, on average, have lower muscle mass, and may have a specific propensity to ectopic hepatic fat accumulation and for intramyocellular fat deposition, which cause further disruption in insulin action. We hypothesise that the high diabetes susceptibility in South Asians is evolutionarily set through dual parallel and/or interacting mechanisms: reduced beta cell function and impaired insulin action owing to low lean mass, which is further accentuated by ectopic fat deposition in the liver and muscle. These areas warrant further research.
Namratha R Kandula - One of the best experts on this subject based on the ideXlab platform.
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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
Circulation, 2020Co-Authors: Ned Premyodhin, Matthew J Budoff, Alka M Kanaya, Namratha R Kandula, Wenjun Fan, Millie Arora, Masood Younus, Latha Palaniappan, Jamal S Rana, Nathan D WongAbstract: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. Diab...
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incidence of diabetes and prediabetes and predictors of glycemic change among South Asians in the usa the masala study
BMJ open diabetes research & care, 2020Co-Authors: Unjali P Gujral, Kiang Liu, Namratha R Kandula, K Venkat M Narayan, Alka M KanayaAbstract:Introduction South Asians have a high prevalence of type 2 diabetes mellitus (T2DM). This may be associated with high rates of conversion through the natural history of disease. However, there is a paucity of data on prediabetes and T2DM incidence and related predictors in South Asians in the USA. Research design and methods We estimated prediabetes and T2DM incidence after 5 years of follow-up in the Mediators of Atherosclerosis in South Asians Living in America study (n=481) and examined the associated correlates. We defined T2DM and prediabetes using the American Diabetes Association criteria. Prediabetes included isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT) and combined IFG and IGT. Results Overall, 152 (32%, 95% CI: 27.6 to 35.9) individuals progressed either from normal glucose tolerance to prediabetes or T2DM, or from prediabetes to T2DM. In standardised logistic regression models controlling for age and sex, only hepatic fat attenuation (increased hepatic fat) (OR: 0.67 (95% CI: 0.55 to 0.87) per SD, visceral fat area (OR: 1.36 (95% CI: 1.06 to 1.74) per SD and hypertension (OR: 2.21 (95% CI: 1.44 to 3.40) were associated with any glycemic progression. Conclusions South Asians in the USA have a high incidence of dysglycemia. Hepatic and visceral fat may be factors in glycemic progression, and prevention efforts should target ectopic fat reduction.
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private religion spirituality self rated health and mental health among us South Asians
Quality of Life Research, 2020Co-Authors: Blake Victor Kent, Alka M Kanaya, Namratha R Kandula, Samuel Stroope, Ying Zhang, Alexandra E ShieldsAbstract:Connections between private religion/spirituality and health have not been assessed among US South Asians. The aim of this study was to examine the relationship between private religion/spirituality and self-rated and mental health in a community-based sample of US South Asians. Data from the Mediators of atherosclerosis in South Asians living in America (MASALA) study (collected 2010–2013 and 2015–2018) and the attendant study on stress, spirituality, and health (n = 881) were analyzed using OLS regression. Self-rated health measured overall self-assessed health. Emotional functioning was measured using the mental health inventory-3 index (MHI-3) and Spielberger scales assessed trait anxiety and trait anger. Private religion/spirituality variables included prayer, yoga, belief in God, gratitude, theistic and non-theistic spiritual experiences, closeness to God, positive and negative religious coping, divine hope, and religious/spiritual struggles. Yoga, gratitude, non-theistic spiritual experiences, closeness to God, and positive coping were positively associated with self-rated health. Gratitude, non-theistic and theistic spiritual experiences, closeness to God, and positive coping were associated with better emotional functioning; negative coping was associated with poor emotional functioning. Gratitude and non-theistic spiritual experiences were associated with less anxiety; negative coping and religious/spiritual struggles were associated with greater anxiety. Non-theistic spiritual experiences and gratitude were associated with less anger; negative coping and religious/spiritual struggles were associated with greater anger. Private religion/spirituality is associated with self-rated and mental health. Opportunities may exist for public health and religious care professionals to leverage existing religion/spirituality for well-being among US South Asians.
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obstructive sleep apnea risk and subclinical atherosclerosis in South Asians living in the united states
Sleep Health, 2020Co-Authors: Rupinder Deol, Alka M Kanaya, Kathryn A Lee, Namratha R KandulaAbstract:Abstract 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 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.
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self rated religiosity spirituality and four health outcomes among us South Asians findings from the study on stress spirituality and health
Journal of Nervous and Mental Disease, 2020Co-Authors: Samuel Stroope, Alka M Kanaya, Namratha R Kandula, Blake Victor Kent, Ying Zhang, Alexandra E ShieldsAbstract:Almost no research exists on the relationship between religiosity/spirituality (R/S) and health in the US South Asian population. Using data from the joint Study on Stress, Spirituality, and Health and Mediators of Atherosclerosis Among South Asians Living in America Study (MASALA), this article examined associations between self-rated R/S and self-rated health, emotional functioning, trait anxiety, and trait anger in a community-based sample (n = 933) from the Chicago and San Francisco Bay areas. Ordinary least squares regression was used to analyze categorical differences in levels of R/S and ordinal trends for R/S, adjusting for potential confounders. Being slightly or moderately religious/spiritual was associated with lower levels of self-rated health compared with being very religious/spiritual, and being slightly or moderately religious/spiritual was associated with higher levels of anxiety. In both cases, there was no significant difference between very religious/spiritual individuals and non-religious/spiritual individuals, suggesting a curvilinear relationship. Self-rated R/S was not significantly associated with emotional functioning or anger. In sum, high-R/S and low-R/S individuals had salutary associations with self-rated health and anxiety compared with individuals with slight/moderate levels of R/S. It is important for clinicians and policy makers to recognize the role R/S can play in the health status of South Asians living in the United States.
Matthew J Budoff - One of the best experts on this subject based on the ideXlab platform.
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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
Circulation, 2020Co-Authors: Ned Premyodhin, Matthew J Budoff, Alka M Kanaya, Namratha R Kandula, Wenjun Fan, Millie Arora, Masood Younus, Latha Palaniappan, Jamal S Rana, Nathan D WongAbstract: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. Diab...
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lipoprotein a and aortic valve calcium in South Asians compared to other race ethnic groups
Atherosclerosis, 2020Co-Authors: Minhal Makshood, Matthew J Budoff, Alka M Kanaya, Parag H Joshi, Colby Ayers, Michael Y Tsai, Michael J Blaha, Erin D Michos, Wendy S PostAbstract:Abstract Background and aims South Asians are at increased risk for cardiovascular disease (CVD). Aortic valve calcium (AVC) is associated with CVD risk and aortic stenosis. Elevated Lp(a) is a heritable risk factor for CVD and AVC. AVC prevalence and its association with Lp(a) have not been studied in South Asians. Methods Among participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 695), AVC prevalence and extent were compared to four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA) (n = 4671). Multivariable regression was performed to evaluate associations between Lp(a) and AVC stratified by race/ethnic groups, adjusting for cardiovascular risk factors. Results After age and sex adjustment, South Asians had higher median Lp(a) (17.0 mg/dL) compared to Whites (12.9 mg/dL), Hispanics (13.1 mg/dL) and Chinese Americans (12.9 mg/dL), and Blacks had highest Lp(a) levels (35.1 mg/dL). There were no differences in the odds of AVC in South Asians compared with Whites or Hispanics, after age and sex adjustment (p = 0.64 and 0.63, respectively). Odds of AVC was lower in Chinese (OR 0.35; 95%CI 0.23–0.54) and somewhat lower in Blacks compared with South Asians (OR 0.76; 0.56–1.04). There were no associations between Lp(a) and AVC presence or extent in South Asians. Lp(a) was associated with AVC only among Blacks and Whites. Conclusions Although present in Whites and Blacks, there were no associations between Lp(a) and AVC in South Asians. These differences may be due to statistic power or race specific modifying factors that influences the effect of Lp(a) particles on AVC pathogenesis.
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association between lipoprotein a with aortic valve calcium in South Asians and comparison to other race ethnic groups
Journal of the American College of Cardiology, 2020Co-Authors: Minhal Makshood, Matthew J Budoff, Parag H Joshi, Colby Ayers, Michael J Blaha, Erin D Michos, Alka Kanaya, Michael Tsai, Wendy S PostAbstract:South Asians (SAs) are at increased risk for atherosclerotic cardiovascular disease (ASCVD). Aortic valve calcium (AVC) is associated with risk for both ASCVD and aortic stenosis. Elevated Lp(a) is heritable and an independent risk factor for ASCVD. Genetic variations in the LPA gene are associated
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incidence and progression of coronary artery calcium in South Asians compared with 4 race ethnic groups
Journal of the American Heart Association, 2019Co-Authors: Alka M Kanaya, Michael J Blaha, Feng Lin, Namratha R Kandula, Kiang Liu, David M Herrington, Eric Vittinghoff, Matthew J BudoffAbstract:Background South Asians have a relatively high prevalence of coronary artery calcium ( CAC ) compared with other race/ethnic groups. We determined CAC incidence and progression among South Asians, and compared them with 4 race/ethnic groups. Methods and Results Data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study were used to calculate CAC incidence and progression rates and any CAC change. Data from the MESA (Multi-Ethnic Study of Atherosclerosis) were used to compare the CAC incidence and progression rates. A total of 698 South Asians had repeat CAC measurements after 4.8±0.8 years. Among those with no CAC at baseline, the age-adjusted CAC incidence was 8.8% (95% CI, 6.8-10.8%) in men and 3.6% (2.5-4.8%) in women. The median annual CAC progression was 26 (interquartile range, 11-62) for men and 13 (interquartile range, 4-34) for women. Compared with MESA , age-adjusted CAC incidence was similar in South Asian men compared with white, black, and Latino men, but significantly higher than Chinese men (11.1% versus 5.7%, P=0.008). After adjusting for age, diabetes mellitus, hypertension, and statin medication use, Chinese, black, and Latino men had significantly less CAC change compared with South Asian men, but there were no differences between South Asian and white men. There was no difference in CAC incidence or progression between South Asian women and women in MESA . Conclusions South Asian men had greater CAC change than Chinese, black, and Latino men but similar change to that of whites after adjusting for traditional risk factors.
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comparing coronary artery calcium among u s South Asians with four racial ethnic groups the masala and mesa studies
Atherosclerosis, 2014Co-Authors: Alka M Kanaya, Michael J Blaha, Namratha R Kandula, Kiang Liu, David M Herrington, Susan K Ewing, Shweta Srivastava, Swapna S Dave, Matthew J BudoffAbstract:Objectives 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.
Kiang Liu - One of the best experts on this subject based on the ideXlab platform.
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incidence of diabetes and prediabetes and predictors of glycemic change among South Asians in the usa the masala study
BMJ open diabetes research & care, 2020Co-Authors: Unjali P Gujral, Kiang Liu, Namratha R Kandula, K Venkat M Narayan, Alka M KanayaAbstract:Introduction South Asians have a high prevalence of type 2 diabetes mellitus (T2DM). This may be associated with high rates of conversion through the natural history of disease. However, there is a paucity of data on prediabetes and T2DM incidence and related predictors in South Asians in the USA. Research design and methods We estimated prediabetes and T2DM incidence after 5 years of follow-up in the Mediators of Atherosclerosis in South Asians Living in America study (n=481) and examined the associated correlates. We defined T2DM and prediabetes using the American Diabetes Association criteria. Prediabetes included isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT) and combined IFG and IGT. Results Overall, 152 (32%, 95% CI: 27.6 to 35.9) individuals progressed either from normal glucose tolerance to prediabetes or T2DM, or from prediabetes to T2DM. In standardised logistic regression models controlling for age and sex, only hepatic fat attenuation (increased hepatic fat) (OR: 0.67 (95% CI: 0.55 to 0.87) per SD, visceral fat area (OR: 1.36 (95% CI: 1.06 to 1.74) per SD and hypertension (OR: 2.21 (95% CI: 1.44 to 3.40) were associated with any glycemic progression. Conclusions South Asians in the USA have a high incidence of dysglycemia. Hepatic and visceral fat may be factors in glycemic progression, and prevention efforts should target ectopic fat reduction.
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body composition and diabetes risk in South Asians findings from the masala and mesa studies
Diabetes Care, 2019Co-Authors: Elena Flowers, Feng Lin, Namratha R Kandula, Matthew A Allison, Jeffrey J Carr, Jingzhong Ding, Ravi V Shah, Kiang Liu, David M Herrington, Alka M KanayaAbstract:OBJECTIVE South Asians have a higher prevalence of type 2 diabetes compared with other race/ethnic groups. Body composition is associated with the risk for type 2 diabetes. Differences in body composition between South Asians and other race/ethnic groups are one hypothesized mechanism to explain the disproportionate prevalence of type 2 diabetes in this population. RESEARCH DESIGN AND METHODS This study used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multi-Ethnic Study of Atherosclerosis (MESA) cohorts to determine whether body composition mediated the elevated prevalence of impaired fasting glucose and type 2 diabetes in South Asians. Participants (n = 2,615) with complete body composition data were included. Ordinal logistic regression models were calculated to determine the odds for glycemic impairment in South Asians compared with the MESA cohort. RESULTS In multivariate models, South Asians had a significantly higher prevalence of glycemic impairment and type 2 diabetes compared with all four race/ethnic groups included in the MESA (P CONCLUSIONS We did not identify strong evidence that accounting for body composition explains differences in the risk for type 2 diabetes. Future prospective studies of the MESA and MASALA cohorts are needed to understand how adipose tissue impacts the risk for type 2 diabetes and how to best assess this risk.
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incidence and progression of coronary artery calcium in South Asians compared with 4 race ethnic groups
Journal of the American Heart Association, 2019Co-Authors: Alka M Kanaya, Michael J Blaha, Feng Lin, Namratha R Kandula, Kiang Liu, David M Herrington, Eric Vittinghoff, Matthew J BudoffAbstract:Background South Asians have a relatively high prevalence of coronary artery calcium ( CAC ) compared with other race/ethnic groups. We determined CAC incidence and progression among South Asians, and compared them with 4 race/ethnic groups. Methods and Results Data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study were used to calculate CAC incidence and progression rates and any CAC change. Data from the MESA (Multi-Ethnic Study of Atherosclerosis) were used to compare the CAC incidence and progression rates. A total of 698 South Asians had repeat CAC measurements after 4.8±0.8 years. Among those with no CAC at baseline, the age-adjusted CAC incidence was 8.8% (95% CI, 6.8-10.8%) in men and 3.6% (2.5-4.8%) in women. The median annual CAC progression was 26 (interquartile range, 11-62) for men and 13 (interquartile range, 4-34) for women. Compared with MESA , age-adjusted CAC incidence was similar in South Asian men compared with white, black, and Latino men, but significantly higher than Chinese men (11.1% versus 5.7%, P=0.008). After adjusting for age, diabetes mellitus, hypertension, and statin medication use, Chinese, black, and Latino men had significantly less CAC change compared with South Asian men, but there were no differences between South Asian and white men. There was no difference in CAC incidence or progression between South Asian women and women in MESA . Conclusions South Asian men had greater CAC change than Chinese, black, and Latino men but similar change to that of whites after adjusting for traditional risk factors.
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less favorable body composition and adipokines in South Asians compared with other us ethnic groups results from the masala and mesa studies
International Journal of Obesity, 2016Co-Authors: Arti D Shah, Feng Lin, Namratha R Kandula, Matthew A Allison, Jeffrey J Carr, Kiang Liu, David M Herrington, Alka M KanayaAbstract:Less favorable body composition and adipokines in South Asians compared with other US ethnic groups: results from the MASALA and MESA studies
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association of 10 year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians findings from the mediators of atherosclerosis in South Asians living in america masala study
Journal of the American Heart Association, 2014Co-Authors: Namratha R Kandula, Alka M Kanaya, Kiang Liu, David M Herrington, Stephen B Hulley, Ji Young Lee, Stephen D Persell, Donald M Lloydjones, Mark D HuffmanAbstract:Background Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5%) 10-year and low (<7.5%) 10-year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.
Raj Bhopal - One of the best experts on this subject based on the ideXlab platform.
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do cardiometabolic behavioural and socioeconomic factors explain the healthy migrant effect in the uk linked mortality follow up of South Asians compared with white europeans in the newcastle heart project
Journal of Epidemiology and Community Health, 2017Co-Authors: Louise Hayes, Martin White, Nigel Unwin, Richard J Q Mcnally, Anh Tran, Raj BhopalAbstract:Background Immigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK. Methods A linked 17–21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709) men and women, aged 25–74 years, recruited between 1993 and 1997. Poisson regression was used to estimate mortality rate ratios (MRRs) for all-cause mortality. Sensitivity analysis explored the possible effect of differences between ethnic groups in loss to follow-up. The impact of adjustment for established risk factors on MRRs was studied. Results South Asians had lower all-cause age-adjusted and sex-adjusted mortality than Europeans (MRR 0.70; 95% CI 0.58 to 0.85). There was higher loss to follow-up in South Asians. Sensitivity analyses demonstrated that this did not account for the observed lower mortality. Adjustment for cardiometabolic, behavioural and socioeconomic characteristics attenuated but did not eliminate the mortality differences between South Asians and Europeans, although CIs now cross 1 (MRR 0.79; 95% CI 0.55 to 1.13). Conclusions South Asians had lower all-cause mortality compared with European origin individuals living in Newcastle upon Tyne that were not accounted for by incomplete mortality data. It is possible that such migrants to the UK have the resources and motivation to move in search of better opportunities and may be healthier and wealthier than those who remain in their country of origin. These findings challenge us to better understand and measure the factors contributing to their survival advantage.
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recruiting South Asians to a lifestyle intervention trial experiences and lessons from podosa prevention of diabetes obesity in South Asians
Trials, 2011Co-Authors: Anne Douglas, Raj Bhopal, Naveed Sattar, Jason M R Gill, R S Bhopal, John F Forbes, Julia Lawton, John A Mcknight, Gordon D Murray, Anu SharmaAbstract:Background: Despite the growing emphasis on the inclusion of ethnic minority patients in research, there is little published on the recruitment of these populations especially to randomised, community based, lifestyle intervention trials in the UK. Methods: We share our experience of recruitment to screening in the PODOSA (Prevention of Diabetes and Obesity in South Asians) trial, which screened 1319 recruits (target 1800) for trial eligibility. A multi-pronged recruitment approach was used. Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practices. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations. Participants were encouraged to refer friends and family throughout the recruitment period. Results: Health care professionals referred only 55 potential participants. The response to written invitations via general practitioners was 5.2%, lower than reported in other general populations. Community orientated, personal approaches for recruitment were comparatively effective yielding 1728 referrals (82%) to the screening stage. Conclusions: The PODOSA experience shows that a community orientated, personal approach for recruiting South Asian ethnic minority populations can be successful in a trial setting. We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches. Researchers should consider prioritising approaches that minimise interference with professionals’ work and, particularly in the current economic climate, keep costs to a minimum. The lessons learned in PODOSA should contribute to future community based trials in South Asians.
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facilitating the recruitment of minority ethnic people into research qualitative case study of South Asians and asthma
PLOS Medicine, 2009Co-Authors: Aziz Sheikh, Raj Bhopal, Laila Halani, Gopalakrishnan Netuveli, Martyn R Partridge, Josip Car, Chris Griffiths, Mark L LevyAbstract:Background There is international interest in enhancing recruitment of minority ethnic people into research, particularly in disease areas with substantial ethnic inequalities. A recent systematic review and meta-analysis found that UK South Asians are at three times increased risk of hospitalisation for asthma when compared to white Europeans. US asthma trials are far more likely to report enrolling minority ethnic people into studies than those conducted in Europe. We investigated approaches to bolster recruitment of South Asians into UK asthma studies through qualitative research with US and UK researchers, and UK community leaders.
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is there equity of service delivery and intermediate outcomes in South Asians with type 2 diabetes analysis of darts database and summary of uk publications
Journal of Public Health, 2009Co-Authors: Colin Fischbacher, Raj Bhopal, Markus Steiner, Andrew D Morris, James W T ChalmersAbstract:Background There are doubts whether diabetes care is equitable across UK ethnic groups. We examined processes and outcomes in South Asians with diabetes and reviewed the UK literature. Methods We used name search methods to identify South Asians in a regional diabetes database. We compared prevalence rates, processes and outcomes of care between November 2003 and December 2004. We used standard literature search techniques. Results The prevalence of diabetes in South Asians was 3–4 times higher than non-South Asians. South Asians were 1.11 times (95% confidence interval 1.06, 1.16) more likely to have a structured review. South Asian women were 1.10 times more likely to have a record of body mass index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00, 1.06) among South Asians, retinopathy 1.36 times more common (95% CI 1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87). Conclusions We found evidence of equity in many aspects of diabetes care for South Asians in Tayside. The finding of higher HbA1c and more retinopathy among South Asians needs explanation and a service response. These findings from a region with a small non-White population largely support the recent findings from other parts of the UK.
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why might South Asians be so susceptible to central obesity and its atherogenic consequences the adipose tissue overflow hypothesis
International Journal of Epidemiology, 2007Co-Authors: Allan D Sniderman, Raj Bhopal, Dorairaj Prabhakaran, Nizal Sarrafzadegan, Andre TchernofAbstract:Abstract The rates of coronary disease have accelerated dramatically amongst South Asians, driven to an important extent by the atherogenic dyslipidemia and type 2 diabetes that have become so common amongst them. These precursors of vascular disease appear at lower absolute amounts of adipose tissue in South Asians than in whites. In this paper, we set out a new hypothesis--the adipose tissue overflow hypothesis--to account for these findings. The adipose tissue mass within our bodies can be divided into three different compartments: superficial subcutaneous adipose tissue, deep subcutaneous adipose tissue and visceral adipose tissue. The superficial subcutaneous adipose tissue compartment is the primary compartment, is present throughout the body, and constitutes the vast majority of the adipose tissue in the lower limb. With energy excess, the secondary adipose tissue compartments--the deep subcutaneous (mainly upper body) and the visceral adipose tissue compartments--become more prominent. Superficial subcutaneous adipose tissue is relatively inert metabolically, whereas the other two compartments are characterized by higher transmembrane fatty acid flux rates and thus are more closely linked to dyslipidemia and dysglycemia. We hypothesize that the superficial subcutaneous adipose tissue compartment is larger in whites than in South Asians. If so, as obesity develops, South Asians exhaust the storage capacity of their superficial subcutaneous adipose tissue compartment before whites do and that is why they develop the metabolic complications of upper body obesity at lower absolute masses of adipose tissue than white people.
