Characterization of Cardiovascular Risk Factors and Subclinical Vascular Dysfunction in South Asians Open Access

Kumar, Saket (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/vx021f171?locale=en
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Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death in the United States. Prevalence of cardiovascular risk factors differs among races, and South Asians tend to have higher rates of CVD and diabetes. The aims of the study are to estimate the prevalence of cardiovascular risk factors in South Asian immigrants, and compare indices of vascular function by pulse wave velocity (PWV), augmentation index (Aix), and carotid intima-media thickness (CIMT) between South Asians, Caucasians, and African Americans.

Methods: 715 South Asians, 1032 Caucasians, and 620 African Americans were included in the study. Study participants were enrolled at community health fairs (CHF) or as part of the Center for Health Discovery and Well Being (CHDWB) at Emory University. Questionnaire responses, blood test results, PWV, Aix, and CIMT were obtained from study subjects. Independent t-tests and chi-tests were used to compare clinical characteristics between races. Multivariable analysis was used to determine predictors of arterial stiffness and atherosclerosis, including the influence of race, on the complete sample size and a healthy subset of each race.

Results: Multivariable analysis of the complete sample size indicated that the South Asian race predicted significantly higher Aix values (p<0.001). Analysis of healthy subsets showed similar results for Aix (p<0.001), and that the South Asian race correlated with lower PWV compared to the Caucasian (p=0.04) and African American (p=0.003) races. Healthy South Asian subjects (n=33) had lower CIMT than healthy African American subjects (n=77) (0.54±0.10mm vs. 0.60±0.12mm, p=0.03).

Conclusions: The analysis suggests South Asians may have stiffer arteries than Caucasians and African Americans due to higher Aix, but lower atherosclerosis compared to African Americans through CIMT. These findings suggest that South Asians have a unique cardiovascular risk factor profile that warrant further study to determine whether the effectiveness of therapies established for other races is equivalent in this population. Future studies with larger sample sizes and standardized recruiting methods are necessary for more conclusive results.

Table of Contents

Background…………………………………………………………………………………….…1

Study Aims……………………………………………………………………………………..…6

Hypothesis………………………………………………………………………………………...6

Methodology and Experimental Design……….………………………………………………….7

Subject Enrollment…………………………………………………………………..……7

Community Health Fair (CHF)- South Asian Immigrant Group…………………7

Criteria………………………………………………………………………...…8

Center for Health Discovery and Well Being (CHDWB)……………………….8

Data Collection…………………………………………………………………………..9

Questionnaire………………………………………………………………….…9

Vitals and Baseline Measurements……………………………………………....10

Blood Tests……………………………………………………………………....10

Arterial Characterization Tests……………………………………………….….11

Arterial Stiffness Testing……………………………………………...…11

Carotid Intima-Media Thickness………………………………………...12

Statistical Analysis……………………………………………………………….13

Results……………………………………………………………………………………………14

Clinical Characteristics of Subjects………………….……………………………….….14

Multivariable Analysis for All Subjects………………………………………………....15

Vascular Function in Healthy Subjects…………………………………………………..17

Clinical Characteristics of Healthy Subjects……………………………………………..18

Comparison of Arterial Stiffness and Atherosclerosis in Healthy Subjects……………..19

Multivariable Analysis of Healthy Subjects……..………………………………………21

Discussion………………………………………………………………………………………..23

Research Adviser……………………………………………………………………………..….26

References………………………………………………………………………………………..27

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