Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups: Comparing MASALA and MESA

South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year AS...

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Published in:	Atherosclerosis Vol. 279; pp. 122 - 129
Main Authors:	Al Rifai, Mahmoud, Cainzos-Achirica, Miguel, Kanaya, Alka M., Kandula, Namratha R., Dardardi, Zeina, Joshi, Parag H., Patel, Jaideep, Budoff, Matthew, Yeboah, Joseph, Guallar, Eliseo, Blumenthal, Roger S., Blaha, Michael J.
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01.12.2018
Subjects:	Aged Aged, 80 and over Asian Asian People Atherosclerosis Black or African American Cardiovascular disease Cardiovascular Diseases - diagnostic imaging Cardiovascular Diseases - ethnology Coronary artery calcium Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - ethnology Decision Support Techniques Emigrants and Immigrants Ethnicity Female Hispanic or Latino Humans Male Middle Aged Predictive Value of Tests Prevalence Prognosis Prospective Studies Race/ethnicity Racial Groups Risk Risk Assessment Risk Factors South Asian Time Factors United States - epidemiology Vascular Calcification - diagnostic imaging Vascular Calcification - ethnology White People United States AA ACC MESA CAC ASCVD MASALA Cardiovascular disease Risk South Asian Coronary artery calcium SA CT PCE Race/ethnicity Atherosclerosis AHA NHW CA
ISSN:	0021-9150, 1879-1484, 1879-1484
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Abstract	South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group. •The performance of the pooled cohort equations (PCE) among South Asians (SAs) is uncertain.•In the absence of 10-year follow-up for ASCVD events, coronary artery calcium may be used as a surrogate outcome.•We studied the prevalence of CAC across strata of ASCVD risk in SAs as well as in other 4 races/ethnicities.•There was a higher odds of CAC = 0 among low and intermediate risk SAs as compared to NHWs.•The PCE may overestimate risk in low and intermediate risk in SAs living in the US even to a greater extent than in NHWs.
AbstractList	South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group. •The performance of the pooled cohort equations (PCE) among South Asians (SAs) is uncertain.•In the absence of 10-year follow-up for ASCVD events, coronary artery calcium may be used as a surrogate outcome.•We studied the prevalence of CAC across strata of ASCVD risk in SAs as well as in other 4 races/ethnicities.•There was a higher odds of CAC = 0 among low and intermediate risk SAs as compared to NHWs.•The PCE may overestimate risk in low and intermediate risk in SAs living in the US even to a greater extent than in NHWs. South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00-2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65-1.38) and CAC >100 (OR 0.86, 95% CI 0.61-1.22). Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group. South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups.BACKGROUND AND AIMSSouth Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups.We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum.METHODSWe studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum.SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00-2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65-1.38) and CAC >100 (OR 0.86, 95% CI 0.61-1.22).RESULTSSAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00-2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65-1.38) and CAC >100 (OR 0.86, 95% CI 0.61-1.22).Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.CONCLUSIONSOur results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.
Author	Joshi, Parag H. Cainzos-Achirica, Miguel Blaha, Michael J. Al Rifai, Mahmoud Kandula, Namratha R. Guallar, Eliseo Kanaya, Alka M. Budoff, Matthew Blumenthal, Roger S. Dardardi, Zeina Patel, Jaideep Yeboah, Joseph
AuthorAffiliation	1 Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA 4 RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain 10 Division of Cardiology, Los Angeles Biomedical Research Institute, Torrance, CA, USA 2 Department of Internal Medicine, University of Kansas School of Medicine − Wichita, KS, USA 13 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA 7 Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, 20 Chicago, IL, USA 12 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA 6 Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, USA 5 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA 11 Department of Cardiology, Wake
AuthorAffiliation_xml	– name: 13 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA – name: 9 Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA – name: 1 Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA – name: 4 RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain – name: 2 Department of Internal Medicine, University of Kansas School of Medicine − Wichita, KS, USA – name: 11 Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, NC, USA – name: 6 Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, USA – name: 7 Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, 20 Chicago, IL, USA – name: 3 Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain – name: 5 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA – name: 12 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA – name: 8 Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA – name: 10 Division of Cardiology, Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Keywords	AA ACC MESA CAC ASCVD MASALA Cardiovascular disease Risk South Asian Coronary artery calcium SA CT PCE Race/ethnicity Atherosclerosis AHA NHW CA
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Snippet	South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance...
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SubjectTerms	Aged Aged, 80 and over Asian Asian People Atherosclerosis Black or African American Cardiovascular disease Cardiovascular Diseases - diagnostic imaging Cardiovascular Diseases - ethnology Coronary artery calcium Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - ethnology Decision Support Techniques Emigrants and Immigrants Ethnicity Female Hispanic or Latino Humans Male Middle Aged Predictive Value of Tests Prevalence Prognosis Prospective Studies Race/ethnicity Racial Groups Risk Risk Assessment Risk Factors South Asian Time Factors United States - epidemiology Vascular Calcification - diagnostic imaging Vascular Calcification - ethnology White People
Title	Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups: Comparing MASALA and MESA
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