Mediators Of Atherosclerosis In South Asians Living In America Research Articles

Do Religion and Spirituality Buffer the Effect of Childhood Trauma on Depressive Symptoms? Examination of a South Asian Cohort from the USA.

Asian Americans have been identified as a racial group that is disproportionately affected by childhood trauma. The goal of this study was to assess if religion/spirituality moderate the effects of childhood trauma on adult depressive symptoms among a sample of South Asians in the USA. Our analysis drew from the study on stress, spirituality, and health (SSSH) questionnaire fielded in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 990) during 2016-2018. A series of regression models with multiplicative interaction terms were conducted. Emotional neglect, emotional abuse, and physical neglect were associated with higher depressive symptoms. Higher religious attendance and negative religious coping techniques were found to exacerbate this relationship. There were two findings conditional on gender. Among men, gratitude and positive religious coping also exacerbated the relationship between childhood trauma and depressive symptoms. Negative religious coping also exacerbated the association between childhood trauma and depressive symptoms for women. This is the first community-based study of US South Asians to consider the association between various forms of childhood trauma and depressive symptom outcomes. South Asians remain an understudied group in the religion and health literature, and this study sheds light on the important differences in the function and effectiveness of religion/spirituality for those faced with early life trauma.

Abstract MP21: Differences in Cardiovascular Risk Factors Across Age Strata in Five Race and Ethnic Groups: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) and Multi-Ethnic Study of Atherosclerosis (MESA) Studies

Introduction: Few studies have comprehensively examined if South Asian Americans develop atherosclerotic cardiovascular disease (ASCVD) risk factors at younger ages than other race/ethnicity groups. We compared ASCVD risk factors across age strata by race/ethnic group from two US community cohorts. Methods: We included 1164 South Asians from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and 2262 non-Hispanic White, 1892 Black, 1496 Hispanic, and 804 Chinese adults from the Multi-Ethnic Study of Atherosclerosis (MESA) study. Participants were 40-85 years (mean = 61.4, SD = 10.3) at initial exam. Mixed-effects linear or logistic regression models were used to predict the prevalence of risk factors by race/ethnic group at ages 45, 55, 65, and 75 years. We tested whether prevalence at age 45 and trends over time were different for South Asians compared to other groups. All models controlled for education, insurance status, and baseline smoking status. Results: At age 45, South Asians had a higher prevalence of hypertension than White, Chinese, and Hispanic/Latino adults, the highest prevalence of prediabetes or diabetes, and more dyslipidemia than Black and Chinese individuals. At age 45, South Asians reported higher diet quality and more exercise than other race/ethnic groups, and they also had significantly lower alcohol use than White, Black, and Hispanic groups. In addition, the change in these risk factors over time in South Asians differed from the trends in the other race/ethnic groups, (Table). Conclusions: South Asians have a high level of clinical risk factors and lower level of behavioral risk factors at age 45 compared to other race/ethnic groups. There are also different trends in risk factors with increasing age by race/ethnic group. Understanding trends and disparities in risk and protective factors across the lifecourse can help equitably improve prevention and treatment strategies for US populations.

Abstract P479: Whole Grain and Refined Grain Intake and Associations With Adiposity, Inflammation, and Incident Type 2 Diabetes Among Adults of South Asian Ancestry in the MASALA Cohort

Background: Although growing evidence has suggested that whole grain over refined grain consumption is associated with lower measures of adiposity, no studies have examined these relationships in South Asians, who are at higher risk of less favorable adipose tissue distribution and risk of type 2 diabetes (T2D). Objective: We evaluated the associations between whole and refined grain intake with cross-sectional measures of adiposity (waist circumference, visceral, subcutaneous, hepatic, and pericardial adipose tissue), markers of inflammation (CRP, adiponectin), and incident T2D. Methods: We included 891 South Asians who completed the baseline visit in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study for cross-sectional analyses and 715 participants who completed exam 2 (~5 y after baseline). Whole and refined grain intake were determined using data from semi-quantitative food frequency questionnaires. We used multivariable linear and logistic regression models to evaluate associations between whole and refined grain intake with adiposity, inflammation, and incident T2D (among n=542 participants free of diabetes at baseline; n=48 incident cases), adjusting for several demographic, health, and lifestyle factors. Results: At baseline, participants (45% female) were on average 55 ± 9.2 (mean ± SD) years old with a BMI of 25.3 ± 3.9 kg/m 2 . Cross-sectionally, we observed that higher consumption of whole grains was associated lower pericardial fat (Beta ± SE: -2.3 ± 0.81 cm 3 , p-value=0.005) and higher refined grain intake was associated with higher percent difference in CRP (10.2 ± 4.65%, p-value=0.03) even after adjustment for BMI and other dietary factors (legumes, fruits, vegetables, and dairy). Substitution models also showed that replacing 1 serving/d of refined grain with whole grain was associated with lower pericardial fat (-3.2 ± 1.27 cm 3 , p-value=0.01) and CRP (-11.4 ± 5.38 % difference, p-value=0.02) in the fully adjusted models. Whole grain intake was also associated with greater attenuation of hepatic fat (0.71 ± 0.35 HU, p-value=0.04), but this did not remain significant after adjustment for BMI. Neither whole nor refined grain intake was associated with 5-year incident T2D. Conclusions: Higher intake of whole grain was associated with lower pericardial fat, while higher refined grain intake may be associated with higher inflammation. These observations support recommendations to consume whole grains over refined grains, especially among high-risk groups such as South Asians.

Abstract P530: Thoracic Aorta and Coronary Artery Calcification and Atherosclerotic Cardiovascular Disease Risk in South Asian Americans

Background: South Asian populations have a high risk of atherosclerotic cardiovascular disease (ASCVD). Subclinical atherosclerosis measures, including thoracic aortic calcification (TAC) and coronary artery calcification (CAC), are associated with ASCVD events, and TAC is a stronger predictor in women than men. However, no prior studies have investigated TAC in South Asians. Methods: We examined data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study from 2015-2018. TAC and CAC were measured from computerized tomography scans using the Agatston method, and scores were categorized as 0, 1-99, and 100 or greater. Ten-year ASCVD risk was calculated using the 2013 pooled cohort equations, categorized as low, intermediate, or high risk. We determined associations of traditional risk factors with TAC and CAC and used multivariable ordinal logistic regression to examine associations between TAC and CAC with ASCVD risk in stepwise models. Results: Of 958 participants, 30% had TAC scores between 1-99 and 24% had TAC ≥100. TAC and CAC were modestly correlated (r = 0.30). There was a graded prevalence of TAC and CAC scores with levels of ASCVD risk (Figure). Both TAC and CAC were associated with several traditional risk factors; however, only CAC was associated with current smoking, HDL-cholesterol, triglycerides, and diastolic blood pressure. After adjusting for age, gender, and these four additional risk factors, only TAC ≥100 remained associated with ASCVD risk (OR 3.29, 95% CI 1.86 - 2.23), while CAC and TAC <100 were not. The association between TAC and ASCVD risk was stronger for women than men (p-for-interaction <0.001). Conclusion: Though TAC and CAC are associated with traditional risk factors, high TAC levels were independently associated with ASCVD risk, especially among women. Further study is needed to determine whether high TAC scores may be predictive of ASCVD events in South Asian populations.

Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies

Background and aimsSouth Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. MethodsWe assessed the distribution of CVH metrics (inadequate: score 0–8, average: 9–10, optimal: 11–14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). ResultsWe included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14–0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19–0.53), p < 0.01]. ConclusionsOptimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.

Comparing coronary artery cross-sectional area among asymptomatic South Asian, White, and Black participants: the MASALA and CARDIA studies

BackgroundSouth Asian individuals have high risk of atherosclerotic cardiovascular disease (ASCVD). Some investigators suggest smaller coronary artery size may be partially responsible.MethodsWe compared the left anterior descending (LAD) artery cross-sectional area (CSA) (lumen and arterial wall) among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study with White and Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, adjusting for BMI, height, and other ASCVD risk factors. We used thin-slice non-contrast cardiac computed tomography to measure LAD CSA. We used linear regression models to determine whether race/ethnicity was associated with LAD CSA after adjusting for demographic factors, BMI, height, coronary artery calcium (CAC), and traditional cardiovascular risk factors.ResultsOur sample included 3,353 participants: 513 self-identified as South Asian (44.4% women), 1286 as Black (59.6% women), and 1554 as White (53.5% women). After adjusting for age, BMI, height, there was no difference in LAD CSA between South Asian men and women compared to White men and women, respectively. After full adjustment for CVD risk factors, LAD CSA values were: South Asian women (19.9 mm2, 95% CI [18.8 – 20.9]) and men (22.3 mm2, 95% CI [21.4 – 23.2]; White women (20.0 mm2, 95% CI [19.4—20.5]) and men (23.6 mm2, 95% CI [23.0—24.2]); and Black women (21.6 mm2, 95% CI [21.0 – 22.2]) and men (26.0 mm2, 95% CI [25.3 – 26.7]). Height, BMI, hypertension, CAC, and age were positively associated with LAD CSA; current and former cigarette use were inversely associated.ConclusionsSouth Asian men and women have similar LAD CSA to White men and women, and smaller LAD CSA compared to Black men and women, respectively, after accounting for differences in body size. Future studies should determine whether LAD CSA is associated with future ASCVD events.

Inverse association between total bilirubin and type 2 diabetes in U.S. South Asian males but not females.

United States South Asians constitute a fast-growing ethnic group with high prevalence of type 2 diabetes (T2D) despite lower mean BMI and other traditional risk factors compared to other races/ethnicities. Bilirubin has gained attention as a potential antioxidant, cardio-protective marker. Hence we sought to determine whether total bilirubin was associated with prevalent and incident T2D in U.S. South Asians. We conducted a cross-sectional and prospective analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Total bilirubin was categorized into gender-specific quartiles (Men: <0.6, 0.6, 0.7-0.8, >0.8; Women: <0.5, 0.5, 0.6, >0.6 mg/dl). We estimated odds of type 2 diabetes as well as other cardiovascular (CV) risk factors using multivariable logistic regression. Among a total 1,149 participants (48% female, mean [SD] age of 57 [9] years), 38% had metabolic syndrome and 24% had T2D. Men and women in the lowest bilirubin quartile had 0.55% and 0.17% higher HbA1c than the highest quartile. Men, but not women, in the lowest bilirubin quartile had higher odds of T2D compared to the highest quartile (aOR [95% CI]; Men: 3.00 [1.72,5.23], Women: 1.15 [0.57,2.31]). There was no association between bilirubin and other CV risk factors. Total bilirubin was inversely associated with T2D in SA men but not women. Longitudinal studies are needed to understand temporality of association.

Adipose tissue-derived metabolite risk scores and risk for type 2 diabetes in South Asians

BackgroundSouth Asians are at higher risk for type 2 diabetes (T2D) than many other race/ethnic groups. Ectopic adiposity, specifically hepatic steatosis and visceral fat may partially explain this. Our objective was to derive metabolite risk scores for ectopic adiposity and assess associations with incident T2D in South Asians.MethodsWe examined 550 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort study aged 40–84 years without known cardiovascular disease or T2D and with metabolomic data. Computed tomography scans at baseline assessed hepatic attenuation and visceral fat area, and fasting serum specimens at baseline and after 5 years assessed T2D. LC-MS-based untargeted metabolomic analysis was performed followed by targeted integration and reporting of known signals. Elastic net regularized linear regression analyses was used to derive risk scores for hepatic steatosis and visceral fat using weighted coefficients. Logistic regression models associated metabolite risk score and incident T2D, adjusting for age, gender, study site, BMI, physical activity, diet quality, energy intake and use of cholesterol-lowering medication.ResultsAverage age of participants was 55 years, 36% women with an average body mass index (BMI) of 25 kg/m2 and 6% prevalence of hepatic steatosis, with 47 cases of incident T2D at 5 years. There were 445 metabolites of known identity. Of these, 313 metabolites were included in the MET-Visc score and 267 in the MET-Liver score. In most fully adjusted models, MET-Liver (OR 2.04 [95% CI 1.38, 3.03]) and MET-Visc (OR 2.80 [1.75, 4.46]) were associated with higher odds of T2D. These associations remained significant after adjustment for measured adiposity.ConclusionsMetabolite risk scores for intrahepatic fat and visceral fat were strongly related to incident T2D independent of measured adiposity. Use of these biomarkers to target risk stratification may help capture pre-clinical metabolic abnormalities.

Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data: Kelly West Award Lecture 2023.

South Asian populations have a higher prevalence and earlier age of onset of type 2 diabetes and atherosclerotic cardiovascular diseases than other race and ethnic groups. To better understand the pathophysiology and multilevel risk factors for diabetes and cardiovascular disease, we established the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study in 2010. The original MASALA study cohort (n = 1,164) included 83% Asian Indian immigrants, with an ongoing expansion of the study to include individuals of Bangladeshi and Pakistani origin. We have found that South Asian Americans in the MASALA study had higher type 2 diabetes prevalence, lower insulin secretion, more insulin resistance, and an adverse body composition with higher liver and intermuscular fat and lower lean muscle mass compared with four other U.S. race and ethnic groups. MASALA study participants with diabetes were more likely to have the severe hyperglycemia subtype, characterized by β-cell dysfunction and lower body weight, and this subtype was associated with a higher incidence of subclinical atherosclerosis. We have found several modifiable factors for cardiometabolic disease among South Asians including diet and physical activity that can be influenced using specific social network members and with cultural adaptations to the U.S. context. Longitudinal data with repeat cardiometabolic measures that are supplemented with qualitative and mixed-method approaches enable a deeper understanding of disease risk and resilience factors. Studying and contrasting Asian American subgroups can uncover the causes for cardiometabolic disease heterogeneity and reveal novel methods for prevention and treatment.

Abstract 15674: Association of Diastolic Blood Pressure and Coronary Artery Calcium Score in South Asian Adults: The MASALA Study

Background: Diastolic blood pressure (DBP) is associated with coronary artery calcium (CAC). Prior evaluation of this relationship has not included South Asian populations, who experience a disproportionate burden of cardiovascular disease. Hypothesis: High DBP is associated with CAC independent of systolic BP in South Asian adults. Methods: In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the cross-sectional association of sex-specific DBP quartiles and CAC≥100 with robust Poisson regression adjusted for age, sex, systolic BP, body mass index, smoking, low- and high-density lipoprotein cholesterol, triglycerides, diabetes, lipid-lowering and hypertension (HTN) medication use. Restricted cubic splines examined the continuous association of DBP with CAC probability. Secondary analysis examined the association between baseline DBP quartile and incident CAC over median 4.7 years of follow-up. Results: Among 1164 participants (48% female, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 67% were not on HTN medications, 22% had CAC ≥100. The probability of CAC≥100 across levels of DBP is modeled in the Figure. DBP in quartiles 3 and 4 was significantly associated with CAC≥100 with adjusted prevalence ratio (PR, versus quartile 1) of 1.57 [95% CI, 1.20-2.06] and 1.50 [1.08-2.07], respectively. Among those not on HTN medication, the PR for CAC≥100 for DBP quartiles 3 and 4 was 1.98 [1.29-3.04] and 1.80 [1.00-3.24], respectively. Baseline DBP quartile was not associated with incident CAC, but those in quartile 4 had greater risk of CAC≥100 over follow-up compared to quartile 1 (RR 2.47, 1.17-5.23). Conclusion: Among South Asian adults in MASALA, having DBP in quartiles 3 or 4 was associated with a higher probability of CAC≥100. DBP may be an important clinical risk factor when assessing cardiovascular risk among South Asian adults.

Association of lipoprotein subfractions with incidence of type 2 diabetes among five U.S. Race and Ethnic groups: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) and Multi-Ethnic study of Atherosclerosis (MESA)

AimsWe examined associations between lipoprotein subfractions and prevalent and incident T2D in two race/ethnically diverse cohort studies. MethodsAdults self-identifying as White, Black, Chinese, Hispanic and South Asian-American without cardiovascular disease, with fasting serum, demographic, and clinical data at enrollment and after 5 years of follow-up were included. Lipoprotein subfractions were measured at enrollment using NMR spectrometry. LASSO regularized logistic regression models adjusted for age, sex, race/ethnicity, lipid-lowering agent use, and waist circumference assessed odds of incident T2D in pooled analyses. ResultsThere were 4474 participants with lipoprotein subfraction data at enrollment and 3839 participants without prevalent diabetes, mean age 62 years, 51 % women, with 234 incident T2D cases at 5 years. Triglycerides in small, dense LDL-5 [OR 1.26 (95 % CI 1.11,1.43)], VLDL triglycerides 1.30** [1.16,1.46] and phospholipids in VLDL-1 [OR 1.31 (1.17,1.47)] were associated with higher odds of incident T2D, while free cholesterol in large HDL-1 [OR 0.75 (95 % CI 0.63,0.89)] was inversely associated. The results were similar for prevalent diabetes and did not vary by race/ethnic group. ConclusionsComposition of lipoprotein subfractions is differentially associated with prevalent and incident T2D without difference by race/ethnic group. Assessment of lipoprotein composition may enhance targeted risk reduction for T2D.

Why Is Religious Attendance Linked to More Anxiety in U.S. South Asians? The Mediating Role of Congregational Neglect.

Previous research has identified a positive association between religious attendance and anxiety in U.S. South Asians. The current study assesses the mediating role of congregational neglect as a potential mechanism explaining this association. Analyses relied on data from the Study on Stress, Spirituality, and Health (SSSH) questionnaire in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 936), the largest community-based study of health among U.S. South Asians. Analyses were conducted using path analysis and adjusted for a variety of background characteristics. Results confirmed that higher levels of religious service attendance were associated with higher levels of anxiety. Congregational neglect was a significant mediator in this relationship, explaining 27% of the association between religious attendance and anxiety. Congregational neglect also had the second largest standardized coefficient in the model. This study provides evidence that congregational neglect plays an important intervening role in the connection between religious service attendance and anxiety among U.S. South Asians. The findings move beyond description, flagging a relevant social process which underlies the relationship. By recognizing the potential adverse effects of religious attendance on anxiety in this population, it may be possible to develop interventions aimed at enhancing social inclusion in South Asian religious communities. In addition to practical implications, this study highlights the need for further research on how communal religious participation shapes mental health in ethnic and racial minority populations in the UnitedStates.

Concordance between Dash Diet and Hypertension: Results from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

High blood pressure is an important predictor of atherosclerotic cardiovascular disease (ASCVD), particularly among South Asians, who are at higher risk for ASCVD when compared to other population groups. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is established as the best proven nonpharmacological approach to preventing hypertension in adults. Using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we calculated a DASH dietary score to examine the association between adherence to the DASH diet and its components, and prevalent and incident hypertension and systolic and diastolic blood pressure, after five years of follow-up. We found that the relative risk ratio (RRR) of incident hypertension was 67% lower among participants in the highest DASH diet score category (aRRR: 0.33; 95% CI: 0.13, 0.82; ptrend = 0.02) compared with those in the lowest DASH diet score category in fully adjusted models. These findings are consistent with previous clinical trials and large prospective cohort studies, adding to evidence that supports the diet-disease relationship established between DASH diet and hypertension. This study is the first to examine DASH diet adherence and hypertension among South Asian adults in the U.S.

Examining the Relationship Between Multilevel Resilience Resources and Cardiovascular Disease Incidence, Overall and by Psychosocial Risks, Among Participants in the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

We examined relationships between resilience resources (optimism, social support, and neighborhood social cohesion) and cardiovascular disease (CVD) incidence and assessed potential effect-measure modification by psychosocial risk factors (e.g., stress, depression) among adults without CVD in 3 cohort studies (2000-2018): the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. We fitted adjusted Cox models accounting for within-neighborhood clustering while censoring at dropout or non-CVD death. We assessed for effect-measure modification by psychosocial risks. In secondary analyses, we estimated standardized risk ratios using inverse-probability-weighted Aalen-Johansen estimators to account for confounding, dropout, and competing risks (non-CVD deaths) and obtained 95% confidence intervals (CIs) using cluster bootstrapping. For high and medium (versus low) optimism (n=6,243), adjusted hazard ratios (HRs) for incident CVD were 0.94 (95% CI: 0.78, 1.13) and 0.90 (95% CI: 0.75, 1.07), respectively. Corresponding HRs were 0.88 (95% CI: 0.74, 1.04) and 0.92 (95% CI: 0.79, 1.06) for social support (n=7,729) and 1.10 (95% CI: 0.94, 1.29) and 0.99 (95% CI: 0.85, 1.16) for social cohesion (n=7,557), respectively. Some psychosocial risks modified CVD HRs. Secondary analyses yielded similar findings. For optimism and social support, an inverse relationship was frequently most compatible with the data, but a positive relationship was also compatible. For neighborhood social cohesion, positive and null relationships were most compatible. Thus, specific resilience resources may be potential intervention targets, especially among certain subgroups.

Cardiovascular Health by Life's Essential 8 and Associations With Coronary Artery Calcium in South Asian American Adults in the MASALA Study

South Asian Americans experience high cardiovascular disease risk. We evaluated the distribution and correlates of cardiovascular health (CVH) summarized by the Life's Essential 8 (LE8) score among South Asian adults. In participants of the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study, the association of demographic, social, and cultural factors with LE8 score was evaluated with ttests and analysis of variance. The association of LE8 score with coronary artery calcium (CAC) was evaluated with adjusted logistic regression. There were 556 women (mean age 55.9 years [SD 8.7], mean LE8 score 67.2 (SD 12.6) and 608 men (mean age 57.5 years [SD 9.9], mean LE8 score 61.9 (SD 13.1). Among women and men, the LE8 CVH score was higher in participants with higher annual family income, higher educational attainment, and fewer depressive symptoms. Overall, there was 26% lower odds of any CAC for each 10-point higher LE8 score (odds ratios [OR] 0.74, 95% confidence intervals [CI] 0.66 to 0.83), with similar magnitude of association in women and men. Participants with a high LE8 CVH score had 82% lower odds of CAC (OR 0.18, 95% CI 0.09 to 0.33), and participants with an intermediate LE8 CVH score had 38% lower odds of CAC (OR 0.62, 95% CI 0.41 to 0.94) than did participants with a low LE8 CVH score, with similar findings stratified by gender. In conclusion, in this cohort of South Asian Americans, most adults had suboptimal CVH assessed by the LE8 score. Higher LE8 score correlated with lower odds of any CAC.

A South Asian Mediterranean-style diet is associated with favorable adiposity measures and lower diabetes risk: The MASALA cohort.

The Mediterranean diet is associated with lower risks for type 2 diabetes (T2D) and cardiovascular disease in certain populations, although data among diverse groups are limited. This study evaluated cross-sectional and prospective associations between a novel South Asian Mediterranean-style (SAM) diet and cardiometabolic risk among US South Asian individuals. The study included 891 participants at baseline in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Culturally relevant foods were grouped into nine categories to construct the SAM score. The study examined associations of this score with cardiometabolic risk factors and incident T2D. At baseline, higher adherence to the SAM diet was associated with lower glycated hemoglobin (-0.43% ± 0.15% per 1-unit increase in SAM score; p=0.004) and lower pericardial fat volume (-1.22 ± 0.55 cm3 ; p=0.03), as well as a lower likelihood of obesity (odds ratio [OR]: 0.88, 95% CI: 0.79-0.98) and fatty liver (OR: 0.82, 95% CI: 0.68-0.98). Over the follow-up (~5years), 45 participants developed T2D; each 1-unit increase in SAM score was associated with a 25% lower odds of incident T2D (OR: 0.75, 95% CI: 0.59-0.95). A greater intake of a SAM diet is associated with favorable adiposity measures and a lower likelihood of incident T2D.

Association of American Identity with Cardiovascular Health in South Asian Americans: The MASALA Study.

Ethnic and national identity may influence cardiovascular health (CVH)-related behaviors, such as dietary preference. To better understand how acculturation is related to CVH among South Asian American adults, we evaluated the association of self-rated American identity with CVH factors among participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Multivariable linear regression quantified the associations of self-rated American identity [1 (low American identity) to 10 (high American identity)] with CVH factors, including measures of cholesterol, blood pressure, and blood glucose. The role of diet quality, physical activity, and social support in mediating these associations was evaluated. Participants (n = 771) lived in the United States for an average of 27 (SD 11) years. The mean self-rated American identity score was 5.5 (2.4). After adjustment, a 5-point higher American identity score was associated with 6.5 mg/dL higher low-density lipoprotein cholesterol, 6.6 mg/dL higher total cholesterol, 2.9 mmHg higher systolic blood pressure, and 1.4 mmHg higher diastolic blood pressure. Accounting for diet quality, physical activity, or social support does not alter these associations. Higher self-rated American identity is associated with worse CVH factors among South Asian American adults.

Abstract P361: Cardiovascular Health in South Asian American Adults in the MASALA Study: Updated Metrics Using the Life’s Essential 8 Definitions

Introduction: The AHA Life’s Simple 7 (LS7) score was recently updated to the Life’s Essential 8 (LE8) score which revised cardiovascular health (CVH) scoring, including accounting for Asian-specific body mass index, secondhand smoke exposure, and sleep. We evaluated CVH in South Asian American participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Methods: At the MASALA baseline exam, median LE8 CVH score was calculated across levels of the LS7 score. Age- and sex-adjusted mean LE8 CVH score was compared by income, education, and country of birth using linear regression. Logistic regression evaluated the age- and sex-adjusted association of LE8 CVH with prevalent coronary artery calcium (CAC) score greater than 0. Sleep duration was not available, so the LE8 score was calculated with the 7 original CVH factors. Results: Among 1,093 South Asian American adults in the MASALA Study (48.5% female, mean age 56.7 [SD 9.4] years), mean LE8 CVH score was 68.7 (SD 11.6). The LE8 and LS7 CVH scores were significantly correlated (r=0.78, p&lt;0.01). Median (interquartile range) LE8 score across levels of LS7 score is shown in the Figure. Mean adjusted LE8 score was significantly higher (p&lt;0.01) among those with annual income ≥$75,000 vs. &lt;$75,000 (70.0 [11.6] vs. 65.7 [10.9]) and those with more vs. less than college education (69.5 [11.3] vs. 67.7 [11.8]). Mean LE8 scores significantly varied by place of birth (Bangladesh 69.3 [14.8]; India 69.2 [11.3]; Pakistan 61.0 [11.7]; Sri Lanka 63.9 [11.7]; United States 68.2 [13.7]; p&lt;0.01). A 10-point higher LE8 score was associated with lower odds of prevalent CAC (OR 0.67 [95% CI 0.58-0.76]). Odds of any CAC was higher for participants with low (score 0-49) or moderate (score 50-80) vs. high (score 80-100) CVH (low: OR 5.43 [2.51-11.77]; moderate: OR 3.23 [2.07-5.06]). Conclusions: The LE8 CVH score is highly correlated with the LS7 CVH score among South Asian American adults, varies across sociodemographic factors, and is associated with odds of prevalent CAC.

Abstract MP12: Dash Diet and Its Components is Associated With Visceral Fat Area and Hepatic Attenuation Among South Asian Adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study (2010-2013)

Introduction: South Asians (SA) are a growing population group in the US that remain understudied in research despite their high cardiometabolic risk. Compared to other ethnic groups, SA experience cardiometabolic disease onset at a younger age, and have higher abdominal, visceral and hepatic fat despite lower BMI. SA in the US have a unique dietary pattern characterized by a combination of traditional and western food items. Examining the dietary pattern of SA in relation to central adiposity may provide a tenable strategy for disease prevention and treatment. Hypothesis: We assessed the hypothesis that higher DASH diet score is associated with lower central adiposity, indicated by visceral fat area and hepatic attenuation measurements, among SA in the US. Methods: Using baseline data from 822 adults enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, we computed a Dietary Approaches to Stop Hypertension (DASH) concordance score from the FFQ validated to measure diet of South Asians in North America. Using an established method, score concordance was based on 8 components including high intake of fruit, vegetables, nuts/legumes, low-fat dairy products, whole grains; and low intake of sodium, sugar-sweetened beverages, and red/processed meats. We examined the association between the DASH score and its components with CT imaging of visceral fat area and hepatic attenuation (higher score indicates lower liver fat). Results: The overall DASH score among participants ranged from 13-35 (mean ± SD, 24.6 ± 4.4). Hepatic attenuation was 5 HU higher among participants in the highest category DASH score compared to the lowest (aβ (SE): 5 (1), 95% CI: 2, 7) in the age-adjusted model. The relationship was not significant in the fully adjusted model. Visceral fat area was 13.6 cm 2 lower among participants in the highest category of DASH score compared to the lowest (aβ (SE): -3.6 (5.1), 95% CI: -23.5, -3.7) in the model adjusted for age, sex, percent of life in US, education, BMI, physical activity, smoking, alcohol, and energy intake. When examining individual components of DASH, participants with the highest intake of low-fat dairy had hepatic attenuation 3 HU higher than those with the lowest intake, and those with the lowest intake of red/processed meat had hepatic attenuation 2 HU higher in the fully adjusted model. Participants with the lowest red/processed meat intake had visceral fat area that was 11 cm 2 lower in the fully adjusted model. Conclusions: In conclusion, our results indicate that greater adherence to DASH and some of its individual components is associated with favorable abdominal fat areas among a sample of SA adults in the US. These findings support the relationship between diet and abdominal fat accretion. Forthcoming analyses will use the DASH score to further elucidate the diet-disease relationship among SA in the US.

Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study

ObjectivesThe 2018 and 2019 U.S. guidelines for the management of cholesterol and primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of cardiovascular risk-enhancing factors (REFs), including South Asian ancestry, to refine ASCVD risk estimation. However, the associations of REFs with atherosclerosis are unclear in South Asian American adults, who have a disproportionately elevated premature coronary heart disease risk. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we investigated associations of individual REFs, or the number of REFs, with coronary artery calcium (CAC). MethodsUsing baseline and follow-up data from MASALA, we evaluated the association of REFs (family history of ASCVD, low-density lipoprotein cholesterol ≥160 mg/dL, triglycerides ≥175 mg/dL, lipoprotein(a) >50 mg/dL, high-sensitivity C-reactive protein [hsCRP] ≥2.0 mg/dL, ankle-brachial index <0.9, chronic kidney disease, metabolic syndrome), individually and combined, with baseline prevalent CAC, any CAC progression (including incident CAC and CAC progression), and annual CAC progression rates using multivariable logistic regression and generalized linear models. ResultsAmong 866 adults, mean age was 55 [SD 9] years and 47% were female. There were no significant associations of REFs with baseline prevalent CAC or any CAC progression (incident CAC and CAC progression at Exam 2) after adjustment. Among the 56% of participants who had any CAC progression, having 3+ REFs was associated with a significantly higher annual CAC progression rate (adjusted rate ratio [aRR] 1.94, 95% CI 1.39–2.72) vs. having 0 REFs. The annual CAC progression rate was 20% higher per additional REF (aRR 1.20, 95% CI 1.09–1.32). Findings were similar after excluding statin users, and among those with low 10-year ASCVD risk (<5%). ConclusionsAmong South Asian American adults, we found no association of REFs with prevalent CAC at baseline or having any CAC progression. Among those with any CAC progression, a higher number of REFs was associated with higher annual CAC progression rates.