Key result
Optimal blood pressure control was associated with lower CAC incidence in South Asians (OR 0.30, 95% CI 0.14-0.63, p<0.01), with no racial difference in LS7-related CAC progression (p-interaction=0.17).
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Why the study?
South Asian adults have a higher risk of ASCVD than other racial and ethnic groups, and whether Life's Simple 7 cardiovascular health metrics predict coronary artery calcium incidence and progression in asymptomatic South Asians compared with other racial and ethnic groups was uncertain.
Does achieving optimal Life's Simple 7 cardiovascular health metrics reduce the incidence and progression of coronary artery calcium in asymptomatic South Asian adults compared with other racial and ethnic groups?
Cohort (n=7,624)
Yes
Does achieving optimal Life's Simple 7 cardiovascular health metrics reduce the incidence and progression of coronary artery calcium in asymptomatic South Asian adults compared with other racial and ethnic groups?
Odds Ratio: 0.3 (95% CI 0.14–0.63)
p-value: p=<0.01
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Critically, the guideline frames ancestry as one component of a broader risk discussion: South Asian ancestry should raise clinical suspicion and prompt closer assessment of CKM features, metabolic syndrome, family history, Lp(a) level, apo B level, and CAC scoring when appropriate, but should not, by itself, mandate statin therapy.”
Optimal Life's Simple 7 cardiovascular health metrics—especially blood pressure and glucose control—are similarly associated with lower coronary artery calcium incidence and progression in South Asian adults as in other racial and ethnic groups, underscoring the value of primordial and primary risk factor optimization in this high-risk population.
Background and aims: South 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. Methods: We 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). Results: We 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]. Conclusions: Optimal 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.
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Jain et al. (2024) conducted a cohort in Subclinical coronary atherosclerosis (coronary artery calcium incidence and progression) (n=7,624). Optimal cardiovascular health metrics (Life's Simple 7 score 11-14) and optimal blood pressure control vs. Inadequate (score 0-8) or average (score 9-10) cardiovascular health metrics; South Asian adults compared with Non-Hispanic White and Other racial/ethnic groups was evaluated on Coronary artery calcium (CAC) incidence (CAC > 0 at follow-up among those with baseline CAC = 0) associated with optimal blood pressure control in South Asians (OR 0.30, 95% CI 0.14-0.63, p=<0.01). Optimal blood pressure control was associated with lower CAC incidence in South Asians (OR 0.30, 95% CI 0.14-0.63, p<0.01), with no racial difference in LS7-related CAC progression (p-interaction=0.17).
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