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Calcium specks may help detect heart disease in South Asians



The calcium mirrors in the walls of the heart arteries could be an important prognostic marker of early cardiovascular diseases in South Asians and could help guide treatment in this population, according to a study by UC San Francisco researchers .

In a study of nearly 700 patients with ethnic origins from India, Pakistan, Bangladesh, Sri Lanka, Nepal and Bhutan, UCSF researchers found that men from southern Asia had the same high rates of change in the calcification of the walls of their arteries over a five-year-old as white men, the group with the highest rates of cardiovascular disease.

South Asians are known to have a high probability of developing cardiovascular disease and account for over 60 percent of patients with cardiovascular disease worldwide. They also develop risk factors such as hypertension, cholesterol and diabetes at a young age compared to other racial and ethnic groups. However, it is not clear which clinical factors can help determine those at highest risk.

"While South Asians have high rates of cardiovascular disease, there are few prospective studies in the world that have focused on determining risk factors," said lead author Alka Kanaya, MD, internist at UCSF Health and professor of medicine at UCSF. "The presence and change of coronary artery calcium can be useful for predicting risk in this ethnic population and can better guide the judicious use of statins and other preventive therapies."

Early calcification signs of the coronary arteries (CAC), in which calcium spots appear in the artery walls, can be detected through a computerized tomography (CT) scan. In other ethnic groups, it has been shown that high CAC scores are an early sign of those at high risk for developing cardiovascular disease.

The American Heart Association recently recommended CAC testing in individuals with intermediate cardiac risk to determine whether to be treated with cholesterol-lowering drugs. These guidelines classify South Asians as a high-risk group.

The study, which appears online on January 1

1, 2019, in the Journal of the American Heart Association (JAHA), is among the results that are generated by the Mediators of Atherosclerosis study in South Asians Living in America (MASALA). Led by Kanaya, MASALA is the first long-term study in this population that aims to better understand the factors that lead to heart disease and guide prevention and treatment. Since the study began in 2010, it has enrolled over 1100 South Asian immigrants living in the Bay Area of ​​San Francisco and the Chicago area, many of whom have spent decades in the United States.

In the JAHA study, Kanaya and her colleagues measured the calcification in 698 MASALA patients from CT scans taken five years later. They compared the incidence and rates of progression of CAC with other populations using data from the multiethnic study of atherosclerosis (MESA), a study similar to MASALA that is studying the potential factors of atherosclerosis in more than 6,800 participants of six US cities.

Researchers found that men in southern Asia had a higher calcification rate than women in southern Asia, 8.8% to 3.6%, respectively. After taking into account age differences, diabetes, hypertension and statin use, CAC increases were similar in men in South Asia compared to white men, but 122%, 64% and 54% more compared to African Americans, Latinos and Chinese Americans, respectively. There was no significant difference in the amount of CAC change among women in different ethnic / racial groups.

"Both the loading and progression of the CAC have been shown to be independent predictors of coronary disease in white, black, Latin and American Chinese," said Kanaya. "The next step for us is to determine if the load and / or progression of the CAC preach those at highest risk of having a heart attack or stroke among South Asians."

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Co-authors: senior author Matthew Budoff, UCLA Medical Center; Eric Vittinghoff and Feng Lin, UCSF; Namratha Kandula and Kiang Liu, Northwestern University; David Herrington, Wake Forest University Medical Center; and Michael Blaha, Johns Hopkins University.

Funding: The MASALA study is supported by the National Institutes of Health 1R01HL093009, 2R01HL093009, R01HL120725 and K24HL112827 and UCSF with grants UL1RR024131, UL1TR001872 and P30DK09 8722. The MESA study was funded by contracts N01-HC-95159, N01-HC -95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01 -HC-95167, N01-HC-95168 and N01-HC-95169 of the National Institute of Heart, Lung and Blood and grants UL1-TR-000040 and UL1-TR-001079 from the NCRR.

Disclosures: The authors do not report conflicts of interest.

About UCSF: UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, university education in life sciences and professions health and excellence in patient care. It includes the best specialization schools in dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a pre-eminent biomedical research enterprise. It also includes UCSF Health, which includes three high-level hospitals – UCSF Medical Center and UCSF Benioff Children & # 39; s Hospitals in San Francisco and Oakland – as well as the Langley Porter Psychiatric Hospital and clinics, the UCSF Benioff Children & # children 39; if the UCSF Faculty Practice. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. The UCSF faculty also provides all medical care to the public Zuckerberg San Francisco General Hospital and Trauma Center and the SF VA medical center. The UCSF Fresno Medical Education program is a major branch of the University of California, the School of Medicine in San Francisco. Please visit http: // www. ucsf. edu / news .

AVAILABLE MEDIA: Infographic about the risk of heart disease of South Asia is available here.

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