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.
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.
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DOI：
10.1161/jaha.114.001117
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发表时间：
2014-10-02
影响因子：
5.4
通讯作者：
Huffman MD
中科院分区：
文献类型：
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作者：
Kandula NR;Kanaya AM;Liu K;Lee JY;Herrington D;Hulley SB;Persell SD;Lloyd-Jones DM;Huffman MD
十年和终生心血管风险评估算法已被纳入动脉粥样硬化性心血管疾病（ASCVD）预防指南，但这些预测模型并非基于南亚人群，可能低估了印度人、巴基斯坦人、孟加拉国人、尼泊尔人和美国斯里兰卡人的风险。对于美国南亚血统个体的ASCVD风险预测和中间终点（如亚临床动脉粥样硬化）知之甚少。来自生活在美国的南亚人动脉粥样硬化介质（MASALA）研究的南亚人（n=893），年龄40至79岁，无ASCVD。使用2013年合并队列方程计算10年ASCVD预测风险。终生预测风险以风险因素负担为基础。亚临床动脉粥样硬化（冠状动脉钙[CAC]和颈动脉内膜中膜厚度[CIMT]）的基线水平在10年和终生风险层之间进行比较：(1)10年高（≥7.5%）和10年低（<7.5%）风险；(2)终生风险高（≥39%）和低（<39%）。10年预测风险高的南亚男性和女性的CAC负担明显高于10年预测风险低的男性和女性。终生预测风险高的南亚人患CAC的几率显著增加，高于0（比值比：男性1.97;95% CI, 1.2 - 3.2；女性3.14;95% CI, 1.5 - 6.6）。风险层与CIMT之间也存在关联。这项研究首次提供证据，证明来自非西班牙裔白人和非洲裔美国人样本的当代ASCVD风险评估算法可以成功识别美国南亚人动脉粥样硬化负担的实质性差异。
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. 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. 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.