Parag H. Joshi
South Asian patients with a family history of CHD had an elevated risk for coronary artery calcification, independent of traditional risk factors, according to a letter published in JACC: Cardiovascular Imaging.
“Using CAC as a marker of who has developed advanced levels of plaque in their arteries, we found that family history was a strong predictor in South Asians,” Parag H. Joshi, MD, MHS, assistant professor of internal medicine at UT Southwestern Medical Center in Dallas and a Cardiology Today Next Gen Innovator, said in an interview. “It’s a very easy variable to capture when you see a patient, so if you see a patient with South Asian descent, we don’t know a lot about how to accurately gauge their risk, so getting family history information may be a really important aspect of this.”
MASALA, MESA data
Jaideep Patel, MD, assistant clinical professor in the department of internal medicine at Virginia Commonwealth University School of Medicine in Richmond, and colleagues analyzed data from 7,197 participants (mean age, 61 years; 47% men) from the MASALA and MESA studies, including those who are South Asian, non-Hispanic white, black, Hispanic and Chinese-American.
Baseline CAC measurements and self-reported family histories of CHD were assessed. Family history was also added to the American College of Cardiology/American Heart Association pooled cohort equation.
Family history of CHD was seen in 43% of all participants and 47% of South Asians. Non-Hispanic white participants had the highest prevalence of family history, followed by South Asians.
A CAC score greater than zero was seen in 49% of participants and 25% had a score greater than 300.
The risk factor-adjusted OR for the presence of CAC in patients with a family history was 1.58 (95% CI, 1.47-1.76).
Family history, CAC scores
The link between family history and prevalent CAC was strongest among non-Hispanic white, black, Asian-American and Hispanic participants.
After adjustment, family history was independently associated with a CAC score greater than 300 in South Asian participants.
“We don’t have a great risk score for South Asians just yet,” Joshi told Cardiology Today. “Hopefully, this study will give us that, and based on what we’re seeing here, there’s a suggestion that maybe family history will be an important component of that.”
Family history increased the pooled cohort equation in differentiating patients with a CAC score greater than 300 in South Asian (C statistic increased from 0.853 to 0.863; P = .001), black, non-Hispanic white and Hispanic participants. Net reclassification improvement for CAC greater than 300 improved with the presence of family history in South Asians (38.9%; 95% CI, 14.6-62.6), Hispanic and non-Hispanic white participants.
“The main questions that this stimulates is: No. 1, while we recognize that a high calcium score is a strong predictor of risk, we’d like to see if the actual events line up with that, meaning once we’ve accumulated that information as this study matures and we follow up patients for longer, does family history of heart disease in South Asians actually predict the events,” Joshi told Cardiology Today. “Another question would be how does this integrate into the clinical realm when treating this high-risk population of South Asians in the U.S. It’s hard to study that systematically, but trying to make inroads into incorporating that into risk prediction and the decision-making for treatment is going to be really important.” – by Darlene Dobkowski
Patel and Joshi report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.