title: 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.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Namratha R
authors.initials: NR
authors.lastname: Kandula
authors.affiliation: University of California, San Francisco, CA (A.M.K., S.B.H.).
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Wake Forest University Medical Center, Winston-Salem, NC (D.H.).
authors.forename: David
authors.initials: D
authors.lastname: Herrington
authors.affiliation: University of California, San Francisco, CA (A.M.K., S.B.H.).
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hulley
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Persell
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.affiliation: Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.).
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008017:Life Expectancy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
keywords: cardiovascular risk stratification; epidemiology; subclinical atherosclerosis