The MASALA study: Preliminary Results

1. The MASALA study:Preliminary Results Alka M. Kanaya, M.D. Mediators of Atherosclerosis in South Asians Living in America

3. Census 2010 • Total “Asian”:  14.7M (5%) • Asians  43% from Census 2000 • Top three Asian subgroups: • Chinese: 3.3M • Asian Indian: 2.8M • Filipino: 2.6M

4. Asian subgroups in U.S.(% of total Asian population) Japanese Japan- ese Filipinos Korean Chinese Vietnamese Asian Indian Chinese Other Filipino U.S. Census, 2010

5. Asian heterogeneity

6. Rosenberg, Plos Genetics, 2006

7. Background: South Asians • Relatively lower BMI • More central abdominal obesity • High prevalence DM (17%) • High risk of early CHD • …no population-based U.S. data • …no longitudinal cohort data at all

8. SHARE study • 1996-98, population-based XSA (n=985) • Random sampling from Hamilton, Toronto, and Edmonton, Canada • South Asians (n=342), Europeans (n=326), Chinese (n=317) • Existing CVD: SA 9%, Eur 5%, Chin 2% • Carotid IMT: SA 0.72, Eur 0.75, Chin 0.69 mm Anand, Lancet, 2000

9. SHARE model for CVD Variable OR (95% CI) Ethnicity- European • -South Asian • -Chinese 1.0 4.51 (1.46 – 13.89) 1.05 (0.30 – 3.63) Fram. Risk score-low • -moderate • -high 1.0 2.49 (0.67 – 9.20) 5.28 (1.45 – 19.16) Mean carotid IMT 8.49 (2.89 – 27.80) PAI-1 1.04 (1.01 – 1.08) Lp(a) 1.29 (1.01 – 1.08) * Adjusted for homocysteine, fibrinogen, years in Canada

10. MASALA Ages 40-79 yrs N = 900 Two sites (UCSF and NWU) Pilot study (n=150; 2006-2007) Current: Nov. 2010- MESA Ages 45-84 yrs N = 6,500 6 sites (Columbia, Hopkins, NWU, Minnesota, UCLA, Wake Forest) Started in 2000: exam 5 now Design

11. MASALA sites & investigators • Coord. Center: UCSF (Kanaya, Hulley) • Clinical sites: • UCSF (Kanaya) • NWU (Kandula & Liu) • Reading Centers: • Carotid IMT: WFUMC (Herrington) • CAC scores: Harbor-UCLA (Budoff)

12. Eligibility Criteria • Inclusion: • Age 40 to 79 years (older if from pilot sample) • Self-identified as South Asian • Speaks/reads English, Hindi, or Urdu • Exclusion: (same as MESA) • Prior history of CHD, CVD, CHF, a. fib, angina, cardiac procedures or surgery, PM/defibrillator • Active cancer treatment; <5 y life expectancy • Impaired cognition • Plans to move out of area in next 5 yrs; • Nursing home resident or on waiting list

13. Clinical Measurements • Weight, height, waist, hip • Seated BP • Ankle-brachial index • 2-hour OGTT; 3 sample (0, 30, 120) • Abdominal CT (visceral/subQ fat) • Basic chemistry, lipoproteins, inflammatory factors, adipokines • Genetic samples storage (DNA & RNA)

14. Questionnaire Measures • Demographic information • Medical history; family history • Medication use • Psychosocial information • Physical activity • Sleep; neighborhood characteristics • Diet-FFQ (SHARE study) • Acculturation/health beliefs

15. Subclinical Atherosclerosis • Coronary artery calcium (CT) • Carotid intima media thickness (US) • Ankle-brachial index

16. MASALA sample so far

17. Birth Country

18. MASALA Demographic Info

19. MESA Comparison * p<0.001 in comparison to South Asians

20. SES variables % ≤HS <BS =BS >BS <40 40- 75- >100 75 100 Education Family Income ($K)

21. SES: MESA Comparison * p<0.001 in comparison to South Asians, adjusted by sex and age

22. Lifestyle Factors * p<0.001 in comparison to South Asians, adjusted by sex and age

23. South Asian foods

24. Diet composition: pilot study • Type of diet: • Lacto-vegetarian: 21% • Lacto-ovo-vegetarian: 21% • Meat eater (but no beef): 27% • Meat eater (+ beef): 31% • Macronutrient Composition by FFQ: • Total calories: 1,918 ± 693 kcal/day • CHO, % energy intake: 52 ± 5% • Protein, % energy intake: 14 ± 3% • Total fat, % energy intake: 35 ± 8%

25. Anthropometry * p<0.001 in comparison to South Asians, adjusted by sex and age

26. Anthropometry vs. DEXApilot study results Shah, Intl Jo Obesity, 2011

27. * % Hypertension * p<0.001 in comparison to South Asians, adjusted by sex and age

28. Cholesterol * p<0.001 in comparison to South Asians, adjusted by sex and age

29. Diabetes Prevalence

30. Diabetes Prevalence

31. Diabetes comparisons *Defined by hypoglycemic med use or FPG ≥126 mg/dl Pre-DM: fasting glucose 100-125 mg/dl ** p<0.05 compared to South Asians; adjusted by sex and age

32. Higher Diabetes Prevalence • After adjusting for age, sex, education, income, BMI, waist, South Asians have higher odds of DM than each MESA groups • Odds of DM per ethnic group compared to South Asians: OR (95% CI) • White: 0.11 (0.08 – 0.15) • African American: 0.30 (0.22 – 0.42) • Latino: 0.27 (0.19 – 0.38) • Chinese American: 0.40 (0.28 -0.57)

33. Subclinical CVD Coronary Artery Calcium

34. CAC comparisons * p<0.05 in comparison to South Asians, adjusted by sex and age †p<0.001

35. CAC in Men * p<0.05 in comparison to South Asians, adjusted by age †p<0.001

36. CAC in Women No significant differences in comparison to South Asians, adjusted by age

37. Carotid IMT

38. Mean Intima Media Thickness * p<0.001 in comparison to South Asians, adjusted by sex and age

39. Conclusions: South Asians • High SES, low smoking and low-moderate alcohol use • Very low physical activity • Less overweight, but fatty body composition • Higher diabetes prevalence, despite less overweight. • Some differences in CAC for men. • Higher CIMT than other groups. • Very different phenotype than other 4 MESA groups.

40. Short-term Goals • Start annual phone f/u in Oct 2011 • Complete enrollment by Nov 2012 • Renewal planned for Fall 2012 • Ancillary proposals • Baseline papers • Your input is much appreciated…

41. Long-term Goals …long life and good health

42. Participant website: www.masalastudy.org Funded by grant #1R01HL093009

43. MV models* for IMT *adjusted for age, sex, current smoking, BMI and hypertension