Mediators of Atherosclerosis in South Asians Living in America

描述(由申请人提供)：南亚人(来自印度、巴基斯坦、尼泊尔、孟加拉国和斯里兰卡的个人)占世界人口的四分之一，是美国快速增长的种族群体之一。世界各地进行的几项横断面研究报告称，尽管体重指数较低，但这一民族中动脉粥样硬化、糖尿病、高血压和心血管疾病的患病率很高。然而，目前还没有对南亚人的纵向研究来确定可能解释心血管疾病高发的其他危险因素。我们对旧金山湾区的南亚男性和女性进行了一项以社区为基础的试点横断面研究。我们与参与动脉粥样硬化多种族研究(MESA)的研究人员合作，这是一项由NHLBI支持的针对四个美国种族(白人、非裔美国人、拉丁裔和华裔美国人)的前瞻性队列研究。我们使用相同的数据收集方法和措施来有效地将南亚样本与梅萨族进行比较。我们发现，南亚人具有更高的社会经济成就，吸烟和饮酒较少，BMI和腰围相对较低，高血压和糖尿病患病率较高。南亚人的颈总动脉内膜中层厚度显著高于梅萨地区的所有民族，但冠状动脉钙化评分与所有其他民族相似。我们现在建议对900名南亚人进行前瞻性队列研究，以确定与动脉粥样硬化和疾病进展相关的其他危险因素。我们将对旧金山湾区和芝加哥地区900名年龄在40岁到79岁之间、没有心血管疾病的南亚成年人进行一项双中心前瞻性队列研究，以确定亚临床动脉粥样硬化的病因关联和预后意义，并将这些发现与梅萨的其他美国种族进行比较。我们的具体目标是确定(1)传统、社会/文化/行为和新的危险因素是否与亚临床动脉粥样硬化措施相关；(2)在调整了传统、社会/行为和新的危险因素后，南亚人在MESA 5检查中的亚临床动脉粥样硬化的患病率高于四个民族。在一个探索性的目标中，我们将在两年的随访后确定亚临床动脉粥样硬化的测量是否与心血管事件相关。了解这一高危人群中动脉粥样硬化的前驱因素可能有助于深入了解心血管疾病的一般发病机制。确定与动脉粥样硬化相关的关键风险因素将为未来预防或治愈全球主要死亡原因--心血管疾病的治疗提供目标。 公共卫生相关性：南亚(印度、巴基斯坦、孟加拉国、尼泊尔和斯里兰卡)个人的心血管疾病发病率很高，这是传统心血管危险因素无法解释的。尽管南亚人占世界人口的四分之一以上，但对这一高危民族还没有进行纵向研究。我们的目标是在美国的两个中心对南亚人进行一项纵向研究，以确定与亚临床动脉粥样硬化和心血管疾病相关的风险因素。这些将为未来预防或治愈全球主要死因心血管疾病的治疗提供目标。

DESCRIPTION (provided by applicant): South Asians (individuals from India, Pakistan, Nepal, Bangladesh, and Sri Lanka) represent a quarter of the world's population and are one of the fasting growing ethnic groups in the United States. Several cross-sectional studies conducted worldwide have reported a high prevalence of atherosclerosis, diabetes, hypertension, and cardiovascular disease in this ethnic group, despite low body mass index. However, there are no longitudinal studies of South Asians to determine other risk factors that may explain the high prevalence of cardiovascular disease. We performed a pilot community-based cross-sectional study of South Asian men and women in the San Francisco Bay Area. We collaborated with investigators involved with the Multi-Ethnic Study of Atherosclerosis (MESA), an NHLBI-supported prospective cohort study of four U.S. ethnic groups (Whites, African Americans, Latinos, and Chinese Americans). We used identical methods and measures for data collection to efficiently compare the South Asian sample with the MESA ethnic groups. We found that South Asians had higher socioeconomic attainment, lower smoking and alcohol use, relatively low BMI and waist circumference, and higher hypertension and diabetes prevalence. Common carotid intima media thickness was significantly higher in the South Asians compared to all ethnic groups in MESA, but coronary artery calcium scores were similar to all other ethnic groups. We now propose a prospective cohort study of 900 South Asian individuals to determine other risk factors linked to atherosclerosis and disease progression. We will conduct a two-center prospective cohort study of 900 South Asian adults between the ages of 40 and 79 years without cardiovascular disease from the San Francisco Bay Area and Chicago area to determine etiologic associations and prognostic significance of subclinical atherosclerosis and to compare these findings with other U.S. ethnic groups in MESA. Our specific aims are to determine whether (1) traditional, social/cultural/behavioral and novel risk factors are associated with subclinical atherosclerosis measures; (2) South Asians have higher prevalence of subclinical atherosclerosis than the four ethnic groups in the MESA 5th examination after adjusting for traditional, social/behavioral, and novel risk factors. In an exploratory aim, we will determine whether measures of subclinical atherosclerosis are associated with incident cardiovascular events after 2 years of follow-up. Understanding the antecedents of atherosclerosis in this high-risk ethnic population may lend insight into the pathogenesis of cardiovascular disease in general. The identification of key risk factors that are linked to atherosclerosis will provide targets for future therapies to prevent or cure the leading cause of death worldwide - cardiovascular disease. PUBLIC HEALTH RELEVANCE: South Asian (Indian, Pakistani, Bangladeshi, Nepali, and Sri Lankan) individuals have high rates of cardiovascular disease that is not explained by traditional cardiovascular risk factors. Though South Asians represent over one-quarter of the world's population, there are no longitudinal studies in this high-risk ethnic group. We aim to establish a longitudinal study of South Asians at two U.S. centers to identify risk factors linked to subclinical atherosclerosis and incident cardiovascular disease. These will provide targets for future therapies to prevent or cure the leading cause of death worldwide, cardiovascular disease.