Background and aims

South Asian (SA) ethnicity is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, the implications of considering SA ethnicity as a “risk-enhancing factor” per recent American College of Cardiology/American Heart Association guidelines are not fully understood.

Methods

We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a community-based cohort study of individuals of SA ancestry living in the US. The Pooled Cohort Equations were used to estimate 10-year ASCVD risk. Metabolic risk factors and coronary artery calcium (CAC) scores were assessed.

Results

Among 1114 MASALA participants included (median age 56 years, 48% women), 28% were already using a statin at baseline, 25% had prevalent diabetes, and 59% qualified for 10-year ASCVD risk assessment for statin allocation purposes. The prevalence of low, borderline, intermediate, and high estimated ASCVD risk was 65%, 11%, 20% and 5%, respectively. Among participants at intermediate risk, 30% had CAC = 0 and 37% had CAC>100, while among participants at borderline risk, 54% had CAC = 0 and 13% had CAC>100. Systematic consideration of intermediate and, particularly, of borderline risk individuals as statin candidates would enrich the statin-consideration group with CAC = 0 participants up to 35%. Prediabetes and abdominal obesity were highly prevalent across all estimated risk strata, including among those with CAC = 0.

Conclusions

Our findings suggest that systematic consideration of borderline risk SAs as statin candidates might result in considerable overtreatment, and further risk assessment with CAC may help better personalize statin allocation in these individuals. Early, aggressive lifestyle interventions aimed at reducing the risk of incident diabetes should be strongly recommended in US SAs, particularly among those considered candidates for statin therapy for primary prevention. Longitudinal studies are needed to confirm the favorable prognosis of CAC = 0 in SAs.

中文翻译：

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2019 年美国心脏病学会/美国心脏协会一级预防指南的意义和美国南亚人冠状动脉钙化评分的潜在价值：居住在美国的南亚人动脉粥样硬化的介质 (MASALA) 研究

背景和目标

南亚 (SA) 种族与动脉粥样硬化性心血管疾病 (ASCVD) 的风险增加有关。然而，根据最近的美国心脏病学会/美国心脏协会指南，将 SA 种族视为“风险增强因素”的含义尚未完全理解。

方法

我们使用了居住在美国的南亚人动脉粥样硬化介质 (MASALA) 研究的数据，这是一项以社区为基础的对居住在美国的 SA 血统个体的队列研究。合并队列方程用于估计 10 年 ASCVD 风险。评估代谢危险因素和冠状动脉钙（CAC）评分。

结果

在 1114 名 MASALA 参与者中（中位年龄 56 岁，48% 为女性），28% 在基线时已经使用他汀类药物，25% 患有糖尿病，59% 符合 10 年 ASCVD 风险评估以进行他汀类药物分配的目的。估计的低、临界、中等和高 ASCVD 风险的患病率分别为 65%、11%、20% 和 5%。在处于中等风险的参与者中，30% 的 CAC = 0 和 37% 的 CAC>100，而在处于临界风险的参与者中，54% 的 CAC = 0 和 13% 的 CAC>100。系统地考虑中间风险个体，特别是临界风险个体作为他汀类药物候选者，将使 CAC = 0 参与者的他汀类药物考虑组增加 35%。糖尿病前期和腹部肥胖在所有估计的风险层中都非常普遍，包括 CAC = 0 的人群。

结论

我们的研究结果表明，系统地考虑临界风险 SA 作为他汀类药物候选者可能会导致相当大的过度治疗，而 CAC 的进一步风险评估可能有助于更好地个性化这些个体的他汀类药物分配。在美国，特别是那些被认为适合他汀类药物治疗以进行一级预防的人，应强烈推荐旨在降低糖尿病发病风险的早期积极生活方式干预措施。需要纵向研究来确认 SA 中 CAC = 0 的良好预后。