78 results on '"Nilay S Shah"'
Search Results
2. Obesity and Cardiovascular Risk Among South Asian Americans
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Ashwini Deshpande, Nilay S. Shah, and Namratha R. Kandula
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Pharmacology ,Pharmacology (medical) - Published
- 2023
3. Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population
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Nilay S. Shah, Xiaoning Huang, Lucia C. Petito, Michael P. Bancks, Hongyan Ning, Natalie A. Cameron, Kiarri N. Kershaw, Namratha R. Kandula, Mercedes R. Carnethon, Donald M. Lloyd-Jones, and Sadiya S. Khan
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities. Methods: In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0–14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. Results: Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P P P Conclusions: Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.
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- 2023
4. Heterogeneity in Obesity Prevalence Among Asian American Adults
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Nilay S. Shah, Cecily Luncheon, Namratha R. Kandula, Sadiya S. Khan, Liping Pan, Cathleen Gillespie, Fleetwood Loustalot, and Jing Fang
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Adult ,Cross-Sectional Studies ,Asian ,Prevalence ,Internal Medicine ,Humans ,Obesity ,General Medicine ,Article ,United States ,Body Mass Index - Abstract
BACKGROUND: Obesity increases the risk for metabolic and cardiovascular disease, and this risk occurs at lower body mass index (BMI) thresholds in Asian adults than in White adults. The degree to which obesity prevalence varies across heterogeneous Asian American subgroups is unclear because most obesity estimates combine all Asian Americans into a single group. OBJECTIVE: To quantify obesity prevalence in Asian American subgroups among U.S. adults using both standard BMI categorizations and categorizations tailored to Asian populations. DESIGN: Cross-sectional. SETTING: United States, 2013 to 2020. PARTICIPANTS: The analytic sample included 2 882 158 adults aged 18 years or older in the U.S. Behavioral Risk Factor Surveillance System surveys (2013 to 2020). Participants self-identified as non-Hispanic White ([NHW] n = 2 547 965); non-Hispanic Black ([NHB] n = 263 136); or non-Hispanic Asian ([NHA] n = 71 057), comprising Asian Indian (n = 13 916), Chinese (n = 11 686), Filipino (n = 11 815), Japanese (n = 12 473), Korean (n = 3634), and Vietnamese (n = 2618) Americans. MEASUREMENTS: Obesity prevalence adjusted for age and sex calculated using both standard BMI thresholds (≥30 kg/m(2)) and BMI thresholds modified for Asian adults (≥27.5 kg/m(2)), based on self-reported height and weight. RESULTS: Adjusted obesity prevalence (by standard categorization) was 11.7% (95% CI, 11.2% to 12.2%) in NHA, 39.7% (CI, 39.4% to 40.1%) in NHB, and 29.4% (CI, 29.3% to 29.5%) in NHW participants; the prevalence was 16.8% (CI, 15.2% to 18.5%) in Filipino, 15.3% (CI, 13.2% to 17.5%) in Japanese, 11.2% (CI, 10.2% to 12.2%) in Asian Indian, 8.5% (CI, 6.8% to 10.5%) in Korean, 6.5% (CI, 5.5% to 7.5%) in Chinese, and 6.3% (CI, 5.1% to 7.8%) in Vietnamese Americans. The prevalence using modified criteria (BMI ≥27.5 kg/m(2)) was 22.4% (CI, 21.8% to 23.1%) in NHA participants overall and 28.7% (CI, 26.8% to 30.7%) in Filipino, 26.7% (CI, 24.1% to 29.5%) in Japanese, 22.4% (CI, 21.1% to 23.7%) in Asian Indian, 17.4% (CI, 15.2% to 19.8%) in Korean, 13.6% (CI, 11.7% to 15.9%) in Vietnamese, and 13.2% (CI, 12.0% to 14.5%) in Chinese Americans. LIMITATION: Body mass index estimates rely on self-reported data. CONCLUSION: Substantial heterogeneity in obesity prevalence exists among Asian American subgroups in the United States. Future studies and public health efforts should consider this heterogeneity. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute.
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- 2022
5. Trends in De Novo Hypertensive Disorders of Pregnancy Among Asian and Hispanic Population Subgroups in the United States, 2011 to 2019
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Nilay S. Shah, Katharine A. Harrington, Xiaoning Huang, Natalie A. Cameron, Lynn M. Yee, and Sadiya S. Khan
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Cross-Sectional Studies ,Asian People ,Pregnancy ,Brief Report ,Ethnicity ,Humans ,Female ,Hispanic or Latino ,Hypertension, Pregnancy-Induced ,Cardiology and Cardiovascular Medicine ,United States - Abstract
IMPORTANCE: De novo hypertensive disorders of pregnancy (HDP) are associated with adverse maternal and offspring outcomes. Heterogeneity among racial and ethnic subgroups may be masked with aggregate reporting of race and ethnicity, such as Asian or Pacific Islander or Hispanic. OBJECTIVE: To determine patterns in de novo HDP rates among individuals in Asian and Hispanic subgroups with a first live birth in the United States in the period 2011 through 2019. DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional analysis used data from 2011 through 2019 for individuals aged 15 to 44 years with singleton first live births obtained from the US National Center for Health Statistics natality database. EXPOSURES: Stratification by self-report of maternal race and ethnicity: Hispanic/Latina (overall and Hispanic/Latina subgroups [Central/South American, Cuban, Mexican, and Puerto Rican]), non-Hispanic Asian and Pacific Islander (overall and non-Hispanic Asian subgroups [Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese]), non-Hispanic Black, non-Hispanic White. MAIN OUTCOMES AND MEASURES: De novo HDP was defined as new-onset hypertension during pregnancy (gestational hypertension or preeclampsia). Age-standardized rates of HDP (per 1000 live births) and respective mean annual percent change in race and ethnicity groups and subgroups were calculated. RESULTS: Among 13 238 918 individuals, the mean (SD) age was 26.3 (5.8) years. Overall, HDP rates increased 7.3% per year (95% CI, 6.5%-8.1%), from 57.2 (95% CI, 56.8-57.6) per 1000 live births in 2011 to 99.7 (95% CI, 99.2-100.2) per 1000 live births in 2019. Rates of HDP significantly increased in all racial and ethnic groups and subgroups over the study period. The highest HDP prevalence among non-Hispanic Asian subgroups in 2019 was in Filipina individuals (92.5 [95% CI, 86.3-98.8] per 1000 live births), and the highest among Hispanic/Latina subgroups in 2019 was in Puerto Rican individuals (98.6 [95% CI, 94.2-102.9] per 1000 live births) with significant heterogeneity observed among subgroups across the study period. CONCLUSIONS AND RELEVANCE: Rates of HDP among individuals with a singleton first live birth increased in the United States from 2011 to 2019 across all race and ethnicity subgroups, with considerable heterogeneity in HDP rates in non-Hispanic Asian and Hispanic/Latina subgroups.
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- 2023
6. Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease
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Nilay S. Shah, Hongyan Ning, Lucia C. Petito, Kiarri N. Kershaw, Michael P. Bancks, Jared P. Reis, Jamal S. Rana, Stephen Sidney, David R. Jacobs, Catarina I. Kiefe, Mercedes R. Carnethon, Donald M. Lloyd-Jones, Norrina B. Allen, and Sadiya S. Khan
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Adult ,Black or African American ,Male ,Young Adult ,Adolescent ,Cardiovascular Diseases ,Risk Factors ,Physiology (medical) ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,White People ,Race Factors - Abstract
Background: Racial differences in cardiovascular disease (CVD) are likely related to differences in clinical and social factors. The relative contributions of these factors to Black-White differences in premature CVD have not been investigated. Methods: In Black and White adults aged 18 to 30 years at baseline in the CARDIA study (Coronary Artery Risk Development in Young Adults), the associations of clinical, lifestyle, depression, socioeconomic, and neighborhood factors across young adulthood with racial differences in incident premature CVD were evaluated in sex-stratified, multivariable-adjusted Cox proportional hazards models using multiply imputed data assuming missing at random. Percent reduction in the β estimate (log-hazard ratio [HR]) for race quantified the contribution of each factor group to racial differences in incident CVD. Results: Among 2785 Black and 2327 White participants followed for a median 33.9 years (25th–75th percentile, 33.7–34.0), Black (versus White) adults had a higher risk of incident premature CVD (Black women: HR, 2.44 [95% CI, 1.71–3.49], Black men: HR, 1.59 [1.20–2.10] adjusted for age and center). Racial differences were not statistically significant after full adjustment (Black women: HR, 0.91 [0.55–1.52], Black men: HR 1.02 [0.70–1.49]). In women, the largest magnitude percent reduction in the β estimate for race occurred with adjustment for clinical (87%), neighborhood (32%), and socioeconomic (23%) factors. In men, the largest magnitude percent reduction in the β estimate for race occurred with an adjustment for clinical (64%), socioeconomic (50%), and lifestyle (34%) factors. Conclusions: In CARDIA, the significantly higher risk for premature CVD in Black versus White adults was statistically explained by adjustment for antecedent multilevel factors. The largest contributions to racial differences were from clinical and neighborhood factors in women, and clinical and socioeconomic factors in men.
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- 2022
7. Statin Use and Eligibility for Primary Prevention of Atherosclerotic Cardiovascular Disease Among Adults at Borderline or Intermediate Risk in the United States
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Michael M. Hammond, Natalie A. Cameron, Hongyan Ning, Imani Bah, Kaitlyn Beltrame, Sadiya S. Khan, and Nilay S. Shah
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Cardiology and Cardiovascular Medicine - Published
- 2023
8. Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study
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Harini Shah, Emma Garacci, Supreeti Behuria, Miguel Cainzos-Achirica, Namratha R. Kandula, Alka M. Kanaya, and Nilay S. Shah
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Risk ,Aging ,Prevention ,General Medicine ,Cardiovascular disease ,Atherosclerosis ,Cardiovascular ,Coronary artery calcium ,Heart Disease ,Good Health and Well Being ,Clinical Research ,South Asian ,2.1 Biological and endogenous factors ,Aetiology ,Heart Disease - Coronary Heart Disease - Abstract
ObjectivesThe 2018 and 2019U.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 ≥160mg/dL, triglycerides ≥175mg/dL, lipoprotein(a) >50mg/dL, high-sensitivity C-reactive protein [hsCRP] ≥2.0mg/dL, ankle-brachial index
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- 2023
9. Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups
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Nilay S. Shah, Sadiya S. Khan, Mercedes R. Carnethon, Adrian M. Bacong, and Latha P. Palaniappan
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Cardiology and Cardiovascular Medicine - Published
- 2023
10. Abstract P360: Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health: The MESA and MASALA Studies
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Nilay S Shah, Xiaoning Huang, Lucia Petito, Michael Bancks, Alka M Kanaya, Sameera Talegawkar, Saaniya Farhan, Mercedes R Carnethon, Donald Lloyd-Jones, Norrina B Allen, Namratha Kandula, and Sadiya S Khan
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities. Methods: In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results: Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p Conclusions: In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.
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- 2023
11. Abstract 39: Association of Cardiovascular Health With Time Lived Free of Coronary Artery Calcium
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Nilay S Shah, Xiaoning Huang, Natalie Cameron, Lucia Petito, Norrina B Allen, Mercedes R Carnethon, Philip Greenland, Donald Lloyd-Jones, and Sadiya S Khan
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC. Methods: In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years). Results: Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B). Conclusions: High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.
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- 2023
12. Abstract P361: Cardiovascular Health in South Asian American Adults in the MASALA Study: Updated Metrics Using the Life’s Essential 8 Definitions
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Nilay S Shah, Bridget M Hussain, Sameera Talegawkar, Yichen Jin, Namratha Kandula, and Alka M Kanaya
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
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 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.
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- 2023
13. Abstract P353: Association of United States Nativity With Cardiovascular Health Among Race and Ethnic Groups
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Michael M Hammond, Cheryl Mensah, Ruth-Alma N Turkson-Ocran, Sadiya S Khan, and Nilay S Shah
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Lived experiences based on self-identified race and ethnicity or place of birth are important determinants of cardiovascular health (CVH). However, the association of US nativity with CVH among different race and ethnic subgroups is not well studied. Hypothesis: We hypothesized that CVH will be higher among adults born outside the US compared with adults born in the US. Methods: We included participants aged ≥18 years from the National Health Interview Survey from 2011 through 2018. CVH was calculated based on 5 available metrics: hypertension, diabetes, cholesterol, smoking, and body mass index calculated from self-reported height and weight. Scores ranged from 0 (low CVH) to 10 (high CVH). Nativity was classified as born in or outside the US. Survey-weighted linear regression models examined the association between CVH and US nativity, adjusting for age and sex and stratified by race and ethnic subgroups. Results: Of 117,894 participants (representing 120,295,032 US adults), 51% were female and the mean (SE) age was 45 (0.1) years. Overall, among all combined race and ethnic subgroups, participants born outside the US had significantly higher CVH compared with participants born in the US (beta +0.42; 95% CI: +0.38, +0.46). Hispanic adults (beta +40; 95% CI: +0.32, +0.49), Non-Hispanic Black adults (beta +0.89; 95% CI: +0.77, +1.01), Non-Hispanic Asian adults (beta +0.39; 95% CI: +0.24, +0.54), and Non-Hispanic White adults (beta +0.36; 95% CI: +0.28, +0.45) all had significantly higher CVH compared with adults who were born in the US. The age-and sex-adjusted CVH scores by U.S. nativity for overall race and ethnic groups, Hispanic American subgroups, and Asian American subgroups are shown in the Figure. Conclusion: Overall CVH is significantly higher among people born outside the US compared with those born in the US. Among race and ethnic subgroups, people born outside the US had higher CVH compared with those born within the US, except for Asian Indian adults. Figure. Age-and-sex adjusted CVH scores by US nativity.
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- 2023
14. Hypertension-Related Cardiovascular Mortality in Asian American Subgroups
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Nilay S. Shah, Daichi Shimbo, Paul Muntner, Mark D. Huffman, Namratha R. Kandula, Matthew T. Mefford, Donald M. Lloyd-Jones, and Sadiya S. Khan
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Epidemiology ,Public Health, Environmental and Occupational Health - Published
- 2023
15. Body mass index in young adulthood and mid-life cardiovascular risk factors in South Asian American adults: The MASALA study
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Saihej P. Basra, Sadiya S. Khan, Namratha R. Kandula, Alka M. Kanaya, and Nilay S. Shah
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Cardiology and Cardiovascular Medicine ,Research Brief - Abstract
The association of self-reported BMI at age 20, at age 40, the highest BMI within the past 3 years, and current BMI with current mid-life cardiovascular risk factors and coronary artery calcium (CAC) was evaluated among 1148 South Asian American participants (mean age 57 years) in the MASALA study. A 1 kg/m(2) higher BMI at age 20 was associated with higher odds of hypertension (aOR 1.07, 95% CI 1.03–1.12), pre-diabetes/diabetes (aOR 1.05 [1.01–1.09]), and prevalent CAC (aOR 1.06 [1.02–1.11]) in mid-life. Associations were similar for all BMI measures. Weight across young adulthood is associated with mid-life cardiovascular health in South Asian American adults.
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- 2023
16. Physical Activity and TV Viewing Parenting Practices for Toddlers among South Asians in the UK: Born in Bradford 1000 Study
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Soyang Kwon, Namratha R. Kandula, Pooja S Tandon, and Nilay S. Shah
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Background Children and adults of South Asian (SA) origin in the UK have been found to have suboptimal levels of physical activity (PA). PA habits in early childhood tend to sustain through adulthood. Parents play an important role in establishing these habits in young children. The primary aim of this study was to compare PA and television (TV) viewing parenting practices for young children between SA British (SAB) and White British (WB) parents living in the UK. Methods We conducted a secondary analysis of the Born in Bradford (BiB) 1000 study, using survey data at child ages 24 and 36 months. The study sample included three groups of mothers (n = 1,149): foreign-born SAB (n = 458), UK-born SAB (n = 276), and WB (n = 455). Mothers completed a survey about parenting practices (i.e., PA-supportive, PA-restrictive, allowing TV viewing at mealtimes, limiting TV viewing) at child age 24 months and child PA and TV viewing behaviors at child ages 24 and 36 months. Parenting practices were compared among the three groups. Multivariable linear regression analyses compared children’s weekly walking frequency and daily TV viewing hours by parenting practices in the three groups. Results The foreign-born SAB group showed the lowest frequencies of PA-supportive parenting practices (verbal encouragement: 3.7 ± 3.1 times/week; logistic support: 1.5 ± 1.8 times/week) and the highest frequencies of PA-restrictive parenting practices (7.8 ± 7.7 times/week) among the three groups (p
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- 2022
17. Distribution and Correlates of Incident Heart Failure Risk in South Asian Americans: The MASALA Study
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Sadiya S. Khan, Deepak K. Gupta, Hongyan Ning, Sanjiv J. Shah, Namratha R. Kandula, Donald M. Lloyd-Jones, Alka M. Kanaya, Nilay S. Shah, Clyde W. Yancy, Mark D. Huffman, and Anubha Agarwal
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medicine.medical_specialty ,India ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Aged ,Heart Failure ,Asian ,business.industry ,Odds ratio ,Middle Aged ,Atherosclerosis ,medicine.disease ,Confidence interval ,Heart failure ,Cohort ,Ordered logit ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Demography - Abstract
BACKGROUND South Asian Americans experience disproportionately high burden of cardiovascular diseases. Estimating predicted heart failure (HF) risk distribution may facilitate targeted prevention. We estimated the distribution of 10-year predicted risk of incident HF in South Asian Americans and evaluated the associations with social determinants of health and clinical risk factors. METHODS AND RESULTS In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we calculated 10-year predicted HF risk using the Pooled Cohort Equations to Prevent Heart Failure multivariable model. Distributions of low (
- Published
- 2021
18. The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders
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Emily L. Lam, Namratha R. Kandula, and Nilay S. Shah
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Health (social science) ,Sociology and Political Science ,Health Policy ,Anthropology ,Public Health, Environmental and Occupational Health - Published
- 2022
19. Age at Diagnosis of CVDs by Race and Ethnicity in the U.S., 2011 to 2020
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Kristen Lee, Xiaoning Huang, Michael C. Wang, Nilay S. Shah, and Sadiya S. Khan
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Article - Published
- 2022
20. Abstract P321: Hypertension-related Cardiovascular Mortality In Asian American Subgroups
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Nilay S Shah, Daichi Shimbo, Paul Muntner, Mark D Huffman, Namratha Kandula, Matthew Mefford, Donald Lloyd-Jones, and Sadiya Khan
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Internal Medicine - Abstract
Introduction: Cardiovascular disease (CVD) mortality rates are heterogenous among Asian American subgroups. To inform more precise prevention strategies, we identified patterns of hypertension-related CVD mortality in Asian American subgroups. Methods: Among deaths with CVD (ICD-10: I00-I99) as the underlying cause and hypertensive disease (ICD-10: I10-I15) as underlying or contributing cause in 2018-2021 mortality data from CDC WONDER with concurrent population estimates from the IPUMS Current Population Survey, we calculated age standardized mortality rates (ASMR) and proportional mortality for non-Hispanic Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Hispanic adults, with non-Hispanic White as the reference. Results: There were 37,746, 95,404, and 867,599 deaths in non-Hispanic Asian, Hispanic and non-Hispanic White groups, respectively. Among non-Hispanic Asian females, ASMR ranged from 41.6 (95% CI 40.0-43.3) per 100,000 population in Japanese to 52.6 (51.0-54.2) per 100,000 in Filipina women. Among non-Hispanic Asian males, ASMR ranged from 45.8 (43.3-48.2) per 100,000 in Korean to 81.0 (78.5-83.5) in Filipino men (Table). Proportional mortality was higher for all Asian American subgroups vs. non-Hispanic White individuals. Proportional mortality ratios ranged from 1.11 (Korean males) to 1.38 (Filipino males; Chinese and Filipina females), vs. non-Hispanic White individuals. Conclusions: There was substantial variation in hypertension-related cardiovascular mortality among Asian American subgroups. All Asian subgroups had higher proportional mortality compared with non-Hispanic White individuals.
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- 2022
21. Clinical programs for cardiometabolic health for South Asian patients in the United States: A review of key program components
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Reeti K. Gulati, Mustafa Husaini, Rajesh Dash, Jaideep Patel, and Nilay S. Shah
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- 2023
22. Self-Reported Diabetes Prevalence in Asian American Subgroups: Behavioral Risk Factor Surveillance System, 2013–2019
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Cecily Luncheon, Fleetwood Loustalot, Namratha R. Kandula, Pyone Cho, Jing Fang, and Nilay S. Shah
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Population ,01 natural sciences ,Behavioral Risk Factor Surveillance System ,03 medical and health sciences ,0302 clinical medicine ,Asian americans ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,education ,Original Research ,education.field_of_study ,Asian ,business.industry ,Asian Indian ,010102 general mathematics ,Diabetes prevalence ,medicine.disease ,Obesity ,United States ,Confidence interval ,Cross-Sectional Studies ,Self Report ,business ,Demography - Abstract
BACKGROUND: Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians aggregated into a single group, but the Asian American population is heterogenous. OBJECTIVE: To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention. DESIGN: Serial cross-sectional analysis. PARTICIPANTS: Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA, N=57,001), comprising Asian Indian (N=11,089), Chinese (N=9458), Filipino (N=9339), Japanese (N=10,387), and Korean Americans (N=2843), compared to non-Hispanic White (NHW, N=2,143,729) and non-Hispanic Black (NHB, N=215,957) Americans. MAIN MEASURES: Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status. KEY RESULTS: Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2–9.3) in NHA, compared to 14.3% (14.0–14.6) in NHB and 10.0% (10.0–10.1) in NHW (p
- Published
- 2021
23. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S
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Anandita Agarwala, Priyanka Satish, Mahmoud Al Rifai, Anurag Mehta, Miguel Cainzos-Achirica, Nilay S. Shah, Alka M. Kanaya, Garima V. Sharma, Dave L. Dixon, Roger S. Blumenthal, Pradeep Natarajan, Khurram Nasir, Salim S. Virani, and Jaideep Patel
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- 2023
24. Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups
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Yuemeng LI, Alicia ZHU, Austin LE, Jaiveer SINGH, Latha P. PALANIAPPAN, Malathi SRINIVASAN, Nilay S. SHAH, Sally S. WONG, Tali ELFASSY, Javier VALERO-ELIZONDO, and Eugene YANG
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General Medicine - Abstract
This cross-sectional study aims to better understand the heterogeneous associations of acculturation level on CV risk factors among disaggregated Asian subgroups. We hypothesize that the association between acculturation level and CV risk factors will differ significantly by Asian subgroup.We used the National Health Interview Survey (NHIS), a nationally representative US survey, years 2014-18. Acculturation was defined using: (a) years in the US, (b) US citizenship status, and (c) level of English proficiency. We created an acculturation index, categorized into low vs. high (scores of 0-3 and 4, respectively). Self-reported CV risk factors included diabetes, high cholesterol, hypertension, obesity, tobacco use, and sufficient physical activity. Rao-Scott Chi Square was used to compare age-standardized, weighted prevalence of CV risk factors between Asian subgroups. We used logistic regression analysis to assess associations between acculturation and CV risk factors, stratified by Asian subgroup.The study sample consisted of 6,051 adults ≥ 18 years of age (53.9% female; mean age 46.6 [SE 0.33]). The distribution by race/ethnicity was Asian Indian 26.9%, Chinese 22.8%, Filipino 18.1%, and other Asian 32.3%. The association between acculturation and CV risk factors differed by Asian subgroups. From multivariable adjusted models, high vs. low acculturation was associated with: high cholesterol amongst Asian Indian (OR=1.57, 95% CI: 1.11, 2.37) and other Asian (OR=1.48, 95% CI: 1.10, 2.01) adults, obesity amongst Filipino adults (OR= 1.62, 95% CI: 1.07, 2.45), and sufficient physical activity amongst Chinese (OR= 1.54, 95% CI: 1.09, 2.19) and Filipino adults (OR=1.58, 95% CI: 1.10, 2.27).This study demonstrates that acculturation is heterogeneously associated with higher prevalence of CV risk factors among Asian subgroups. More studies are needed to better understand these differences that can help to inform targeted, culturally specific interventions.
- Published
- 2023
25. Distribution of 10- and 30-Year Predicted Risks for Heart Failure in the US Population: National Health and Nutrition Examination Surveys 2015 to 2018
- Author
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Zachary H. Hughes, Hongyan Ning, Sanjiv J. Shah, Clyde W. Yancy, John T. Wilkins, Donald M. Lloyd-Jones, Sadiya S. Khan, and Nilay S. Shah
- Subjects
Heart Failure ,Risk Factors ,Prevalence ,Humans ,Nutrition Surveys ,Cardiology and Cardiovascular Medicine ,Risk Assessment ,United States ,Article - Published
- 2022
26. Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups
- Author
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Nilay S. Shah, Kevin Xi, Kristopher I. Kapphahn, Malathi Srinivasan, Timothy Au, Vedant Sathye, Vaibhav Vishal, Han Zhang, and Latha P. Palaniappan
- Subjects
Heart Failure ,Male ,Cerebrovascular Disorders ,Asian ,Asian People ,Prevalence ,Myocardial Ischemia ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,Article ,Minority Groups ,United States - Abstract
Background: Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. Methods: Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. Results: Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). Conclusions: There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.
- Published
- 2022
27. Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018
- Author
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Leah Rethy, Thanh-Huyen T. Vu, Nilay S. Shah, Mercedes R. Carnethon, Tara Lagu, Mark D. Huffman, Clyde W. Yancy, Donald M. Lloyd-Jones, and Sadiya S. Khan
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Background: Multisociety guidelines recommend a goal systolic blood pressure (BP) Methods: We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001–2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c. Results: Uncontrolled BP was present in 48% (95% CI, 49%–56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%–58%] compared with 47% [43%–51%], P Conclusions: We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF sample with significant differences in BP control by race and ethnicity.
- Published
- 2022
28. Relation of Menopause With Cardiovascular Risk Factors in South Asian American Women (from the MASALA Study)
- Author
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Aishwarya Vijay, Namratha R. Kandula, Alka M. Kanaya, Sadiya S. Khan, and Nilay S. Shah
- Subjects
Aging ,Clinical Trials and Supportive Activities ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Carotid Intima-Media Thickness ,Article ,Asian People ,Risk Factors ,Clinical Research ,2.3 Psychological ,Humans ,Aetiology ,Heart Disease - Coronary Heart Disease ,Nutrition ,Asian ,Contraception/Reproduction ,Prevention ,Atherosclerosis ,Estrogen ,Heart Disease ,Good Health and Well Being ,Cardiovascular System & Hematology ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Female ,Menopause ,social and economic factors ,Cardiology and Cardiovascular Medicine - Abstract
The menopausal transition is a time of accelerating risk of cardiovascular disease (CVD), and promoting cardiovascular health during midlife is an important period of time to prevent CVD in women. The association of menopause with cardiovascular risk factors or subclinical atherosclerosis has not previously been evaluated in South Asian American women, a population with a disproportionately higher CVD burden compared with other race/ethnic groups. The objective of this study was to evaluate the association of menopause with CVD risk factors and subclinical cardiometabolic disease markers. We studied women aged 40 to 84 years from the Mediators of Atherosclerosis in South Asians Living in America study. The association of self-reported menopausal status with multiple demographic and clinical variables was assessed with linear and logistic regression adjusted for age and cardiovascular health behaviors. In a secondary ("age-restricted") analysis, postmenopausal participants outside the age range of premenopausal participants were excluded. In the age-restricted sample, menopause was associated with a higher adjusted odds of hypertension (odds ratio=1.19, 95% confidence interval [CI] 1.02 to 1.41), and higher systolic blood pressure (β=6.34, 95% CI 0.82 to 11.87), and significantly higher subcutaneous fat area (β=42.8, 95% CI 5.8 to 91.4). No significant associations between menopause and ectopic fat deposition, coronary artery calcium, or carotid intima-media thickness were observed. In South Asian American women in the Mediators of Atherosclerosis in South Asians Living in America study, menopause was associated with cardiovascular risk factors and higher subcutaneous fat deposition. Menopausal status is an important factor to examine and address CVD risk factors.
- Published
- 2022
29. Abstract 072: Statin Eligibility And Use For Primary Prevention Among US Adults Across Strata Of Atherosclerotic Cardiovascular Disease Risk
- Author
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Michael M Hammond, Natalie Cameron, Imani Bah, Kaitlyn Beltrame, Sadiya Khan, and Nilay S Shah
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: In 2019, primary prevention guidelines broadened consideration for statin eligibility among those at borderline to intermediate risk for atherosclerotic cardiovascular disease (ASCVD) in the presence of a risk-enhancing factor (REF). However, the proportion of US adults affected by these guidelines, particularly among those estimated to be at borderline to intermediate risk for ASCVD, is unclear. Objectives: To determine the contemporary prevalence of statin use and eligibility among US adults at low, borderline, intermediate, and high ten-year risk of ASCVD in the presence of ASCVD risk-enhancing factors. Methods: We included participants age ≥ 20 years from the National Health and Nutrition Examination Survey from 2015-2018. Ten-year ASCVD risk was classified based on the Pooled Cohort Equations as: low Results: Of 1350 participants (representing 37,705,137 US adults), 46% were female and mean (SE) age was 58 (0.6) years. Of these 39%, 15%, 31% and 15% were in the low, borderline, intermediate, and high ASCVD risk groups, respectively. Among adults at borderline and intermediate ASCVD risk, 89% and 90% had at least one risk-enhancing factor, respectively. Of these adults, 88% and 91% were not on a statin, respectively. Odds of statin use for individuals with risk-enhancing factors is shown in the Table. Conclusion: A large proportion of adults with borderline/intermediate ASCVD risk were not taking a statin despite a high prevalence of risk-enhancing factors.
- Published
- 2022
30. Abstract 11518: Association of Individual- and Neighborhood-Level Determinants Across Young Adulthood with Racial Disparity in Premature Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults Study
- Author
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Nilay S Shah, Hongyan Ning, Lucia Petito, Kiarri N Kershaw, Michael Bancks, Reis P Jared, Stephen Sidney, Jamal S Rana, David R Jacobs, Catarina I KIEFE, Mercedes Carnethon, Don Lloyd-jones, Norrina Allen, and Sadiya Khan
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Black adults experience higher rates of cardiovascular disease (CVD) compared with White adults, particularly across young adulthood. To identify intervention targets to reduce disparities, we quantified the contribution of individual- and neighborhood-level determinants across young adulthood to Black-White differences in incidence of premature CVD. Methods: In Black and White adults (baseline age 18-30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, the associations of clinical, lifestyle, psychosocial, socioeconomic, and neighborhood determinants with racial disparities in incident CVD were evaluated with sex-stratified Cox proportional hazards models adjusted for time-updated risk factors. Percent reduction in the ß estimate (log-hazard ratio [HR]) for race quantified the contribution of each risk factor group, individually and combined, to incident CVD racial disparities. Results: In 1707 Black and 2001 White young adults followed for median 33.9 (IQR 33.7-34.0) years, Black adults had higher risk of incident CVD than White adults (Figure). The fully adjusted model yielded significant attenuation of the disparity: HR 1.22 (0.68-2.21) for Black vs. White women, HR 1.42 (0.91-2.23) for Black vs. White men. In women, clinical risk factors were associated with the largest percent reduction in the ß estimate (83%) for race. In men, socioeconomic, lifestyle and clinical risk factors were each associated with significant percent reductions in ß estimates (45%, 37%, and 28%, respectively). Conclusions: In CARDIA, risk for premature CVD was no longer significantly higher in Black vs. White adults after adjustment for upstream determinants across multiple domains. The largest contribution to racial disparities was from clinical factors in women and socioeconomic factors in men. These findings may inform earlier-life interventions to reduce disparities in premature CVD.
- Published
- 2021
31. Outcomes in patients hospitalized for COVID-19 among Asian, Pacific Islander, and Hispanic subgroups in the American Heart Association COVID-19 registry
- Author
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Fatima Rodriguez, Lucia C. Petito, Jeffrey J. Hsu, Nilay S. Shah, Sadiya S. Khan, Namratha R. Kandula, Gina M. Giase, and Daniel R. Wang
- Subjects
Coronavirus disease 2019 (COVID-19) ,Asian ,Asian Indian ,business.industry ,Prevention ,Vietnamese ,Ethnic group ,Hispanic ,COVID-19 ,Clinical Research Study ,Cardiovascular ,language.human_language ,Pacific Islander ,Good Health and Well Being ,Clinical Research ,language ,Pacific islanders ,Medicine ,In patient ,Asian pacific islander ,business ,Mace ,Demography ,disparities - Abstract
Background : Coronavirus disease 2019 (COVID-19) data from race/ethnic subgroups remain limited, potentially masking subgroup-level heterogeneity. We evaluated differences in outcomes in Asian American/Pacific Islander (AAPI) and Hispanic/Latino subgroups compared with non-Hispanic White patients hospitalized with COVID-19. Methods : In the American Heart Association COVID-19 registry including 105 US hospitals, mortality and major adverse cardiovascular events in adults age ≥18 years hospitalized with COVID-19 between March-November 2020 were evaluated. Race/ethnicity groups included AAPI overall and subgroups (Chinese, Asian Indian, Vietnamese, and Pacific Islander), Hispanic/Latino overall and subgroups (Mexican, Puerto Rican), compared with non-Hispanic White (NHW). Results : Among 13,511 patients, 7% were identified as AAPI (of whom 17% were identified as Chinese, 9% Asian Indian, 8% Pacific Islander, and 7% Vietnamese); 35% as Hispanic (of whom 15% were identified as Mexican and 1% Puerto Rican); and 59% as NHW. Mean [SD] age at hospitalization was lower in Asian Indian (60.4 [17.4] years), Pacific Islander (49.4 [16.7] years), and Mexican patients (57.4 [16.9] years), compared with NHW patients (66.9 [17.3] years, p
- Published
- 2021
32. Cardiovascular risk factor profiles in North and South Indian and Pakistani Americans: The MASALA Study
- Author
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Neha K. Reddy, Vaidehi Kaushal, Alka M. Kanaya, Namratha R. Kandula, Unjali P. Gujral, and Nilay S. Shah
- Subjects
Male ,media_common.quotation_subject ,Immigration ,Population ,Ethnic group ,Disease ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Article ,Risk Factors ,Diabetes mellitus ,Prevalence ,Medicine ,Humans ,Pakistan ,Obesity ,Risk factor ,education ,Metabolic and endocrine ,Nutrition ,media_common ,education.field_of_study ,Asian ,business.industry ,Prevention ,Diabetes ,medicine.disease ,Atherosclerosis ,United States ,Stroke ,Good Health and Well Being ,Cross-Sectional Studies ,Cardiovascular System & Hematology ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Public Health and Health Services ,Female ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia ,Demography - Abstract
South Asians in the United States have disproportionately high burden of cardiovascular disease compared to other race/ethnic groups but are a heterogenous population, so we evaluated differences in prevalence and adjusted odds of cardiovascular risk factors including diabetes, hypertension, dyslipidemia, and obesity between North Indian, South Indian, and Pakistani immigrants in the United States in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Given cultural differences among residents of Indian regions, for example in dietary patterns, we categorized Indian participants as North or South Indian. In 1,018 participants (728 North Indian [47% women], 223 South Indian [43% women], 67 Pakistani [52% women]), unadjusted diabetes and obesity prevalence was highest in Pakistani participants (33% and 48%, respectively); hypertension prevalence was highest in North Indian participants (54%); dyslipidemia prevalence was highest in South Indian and Pakistani participants (55%); and South Indian participants had a higher odds of dyslipidemia (OR 1.77, 95% CI 1.27, 2.47) compared with North Indian participants in fully adjusted models. As differences in cardiovascular risk factors were observed across South Asian American subgroups, identifying the determinants of suboptimal cardiovascular health within South Asian American subgroups may help to better tailor cardiovascular disease prevention strategies.
- Published
- 2021
33. Rural-Urban Temporal Trends for Sudden Cardiac Death in the United States, 1999-2019
- Author
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Zachary H. Hughes, Nilay S. Shah, Yoshihiro Tanaka, Michael M. Hammond, Rod Passman, and Sadiya S. Khan
- Subjects
Rural Population ,Death, Sudden, Cardiac ,Urban Population ,Humans ,United States - Published
- 2021
34. Cardiovascular health and subclinical atherosclerosis in second generation South Asian Americans: The MASALA study
- Author
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Namratha R. Kandula, Nilay S. Shah, Juned Siddique, Mark D. Huffman, and Alka M. Kanaya
- Subjects
medicine.medical_specialty ,South asia ,RD1-811 ,Cardiovascular health ,Population ,Cardiovascular risk factors ,Research Brief ,Cardiovascular ,Cardiovascular System ,Risk Factors ,Total cholesterol ,Internal medicine ,medicine ,Prevalence ,Diseases of the circulatory (Cardiovascular) system ,Humans ,education ,Lipoprotein cholesterol ,education.field_of_study ,Asian ,business.industry ,Prevention ,Second generation ,Atherosclerosis ,United States ,Good Health and Well Being ,Asian Americans ,Cardiovascular System & Hematology ,RC666-701 ,Subclinical atherosclerosis ,South Asian Americans ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe cardiovascular health (CVH) in second-generation (U.S.-born) South Asian Americans in the MASALA study, a population for whom CVH is not previously described. CVH factors in second-generation (N=21) compared with first-generation (N=495) South Asian Americans included: total cholesterol (199±31 versus 191±35mg/dL, p=0.25), low-density lipoprotein cholesterol (121±27 versus 115±30mg/dL, p=0.41), triglycerides (163±197 versus 138±72mg/dL, p=0.10), diet score (66±8 versus 70±6 points, p=0.06), BMI (27.6±4.9 versus 26.2±4.1kg/m2, p=0.12), and CAC prevalence (26.3% versus 23.9%, p=0.34). Age- and sex-adjusted differences were not statistically significant. Further investigation of CVH in this risk-enhanced population may help identify differences between second-generation and first-generation immigrant South Asians in the U.S.
- Published
- 2021
35. Proportional Mortality From Ischemic Heart Disease Among Asian American Subgroups, From 2018 to 2020
- Author
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Nilay S. Shah, Latha P. Palaniappan, and Sadiya S. Khan
- Subjects
Asian ,Asian People ,Myocardial Ischemia ,Internal Medicine ,Humans ,Minority Health ,White People - Abstract
This cross-sectional study examines the percentage of deaths attributed to ischemic heart disease by age and sex of Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese decedents.
- Published
- 2022
36. Age at Diagnosis of Hypertension by Race and Ethnicity in the US From 2011 to 2020
- Author
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Xiaoning Huang, Kristen Lee, Michael C. Wang, Nilay S. Shah, and Sadiya S. Khan
- Subjects
Hypertension ,Racial Groups ,Ethnicity ,Humans ,Cardiology and Cardiovascular Medicine - Published
- 2022
37. Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019
- Author
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William A. Grobman, Matthew J. O’Brien, Nilay S. Shah, Amanda M. Perak, Sadiya S. Khan, Erica P. Gunderson, Mercedes R. Carnethon, Priya M. Freaney, Namratha R. Kandula, Kai McKeever Bullard, and Michael C. Wang
- Subjects
Adult ,business.industry ,Offspring ,Vietnamese ,Ethnic group ,General Medicine ,medicine.disease ,Annual Percent Change ,language.human_language ,United States ,Gestational diabetes ,Race (biology) ,Diabetes, Gestational ,Parity ,Cross-Sectional Studies ,Pregnancy ,language ,Medicine ,Pacific islanders ,Humans ,Female ,business ,Live birth ,Live Birth ,Demography - Abstract
Importance Gestational diabetes is associated with adverse maternal and offspring outcomes. Objective To determine whether rates of gestational diabetes among individuals at first live birth changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US. Design, Setting, and Participants Serial cross-sectional analysis using National Center for Health Statistics data for 12 610 235 individuals aged 15 to 44 years with singleton first live births from 2011 to 2019 in the US. Exposures Gestational diabetes data stratified by the following race and ethnicity groups: Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican); non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese); non-Hispanic Black; and non-Hispanic White. Main Outcomes and Measures The primary outcomes were age-standardized rates of gestational diabetes (per 1000 live births) and respective mean annual percent change and rate ratios (RRs) of gestational diabetes in non-Hispanic Asian/Pacific Islander (overall and in subgroups), non-Hispanic Black, and Hispanic/Latina (overall and in subgroups) individuals relative to non-Hispanic White individuals (referent group). Results Among the 12 610 235 included individuals (mean [SD] age, 26.3 [5.8] years), the overall age-standardized gestational diabetes rate significantly increased from 47.6 (95% CI, 47.1-48.0) to 63.5 (95% CI, 63.1-64.0) per 1000 live births from 2011 to 2019, a mean annual percent change of 3.7% (95% CI, 2.8%-4.6%) per year. Of the 12 610 235 participants, 21% were Hispanic/Latina (2019 gestational diabetes rate, 66.6 [95% CI, 65.6-67.7]; RR, 1.15 [95% CI, 1.13-1.18]), 8% were non-Hispanic Asian/Pacific Islander (2019 gestational diabetes rate, 102.7 [95% CI, 100.7-104.7]; RR, 1.78 [95% CI, 1.74-1.82]), 14% were non-Hispanic Black (2019 gestational diabetes rate, 55.7 [95% CI, 54.5-57.0]; RR, 0.97 [95% CI, 0.94-0.99]), and 56% were non-Hispanic White (2019 gestational diabetes rate, 57.7 [95% CI, 57.2-58.3]; referent group). Gestational diabetes rates were highest in Asian Indian participants (2019 gestational diabetes rate, 129.1 [95% CI, 100.7-104.7]; RR, 2.24 [95% CI, 2.15-2.33]). Among Hispanic/Latina participants, gestational diabetes rates were highest among Puerto Rican individuals (2019 gestational diabetes rate, 75.8 [95% CI, 71.8-79.9]; RR, 1.31 [95% CI, 1.24-1.39]). Gestational diabetes rates increased among all race and ethnicity subgroups and across all age groups. Conclusions and Relevance Among individuals with a singleton first live birth in the US from 2011 to 2019, rates of gestational diabetes increased across all racial and ethnic subgroups. Differences in absolute gestational diabetes rates were observed across race and ethnicity subgroups.
- Published
- 2021
38. Gestational Diabetes and Hypertensive Disorders of Pregnancy by Maternal Birthplace
- Author
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Nilay S. Shah, Michael C. Wang, Namratha R. Kandula, Mercedes R. Carnethon, Erica P. Gunderson, William A. Grobman, and Sadiya S. Khan
- Subjects
Adult ,Diabetes, Gestational ,Young Adult ,Adolescent ,Epidemiology ,Pregnancy ,Public Health, Environmental and Occupational Health ,Ethnicity ,Pregnancy Outcome ,Humans ,Female ,Hypertension, Pregnancy-Induced ,Article - Abstract
Gestational diabetes mellitus and hypertensive disorders of pregnancy increase the risk for future adverse health outcomes in the pregnant woman and baby, and disparities exist in the rates of gestational diabetes mellitus and hypertensive disorders of pregnancy by race/ethnicity. The objective of this study is to identify the differences in gestational diabetes mellitus and hypertensive disorders of pregnancy rates by maternal place of birth within race/ethnicity groups.In women aged 15-44 years at first live singleton birth in U.S. surveillance data between 2014 and 2019, age-standardized rates of gestational diabetes mellitus and hypertensive disorders of pregnancy and the rate ratios of gestational diabetes mellitus and hypertensive disorders of pregnancy in women born outside versus those born in the U.S. were evaluated, stratified by race/ethnicity. Analyses were conducted in 2021.Of 8,574,264 included women, 6,827,198 were born in the U.S. (mean age=26.2 [SD 5.7] years), and 1,747,066 were born outside the U.S. (mean age=28.2 [SD=5.8] years). Overall, the gestational diabetes mellitus rate was higher in women born outside than in those born in the U.S. (70.3, 95% CI=69.9, 70.7 vs 53.2, 95% CI=53.0, 53.4 per 1,000 live births; rate ratio=1.32, 95% CI=1.31, 1.33), a pattern observed in most race/ethnic groups. By contrast, the overall hypertensive disorders of pregnancy rate was lower in those born outside than in those born in the U.S. (52.5, 95% CI=52.2, 52.9 vs 90.1, 95% CI=89.9, 90.3 per 1,000 live births; rate ratio=0.58, 95% CI=0.58, 0.59), a pattern observed in most race/ethnic groups.In the U.S., gestational diabetes mellitus rates were higher and hypertensive disorders of pregnancy rates were lower in women born outside the U.S. than in those born in the U.S. in most race/ethnicity groups.
- Published
- 2021
39. Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019
- Author
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Natalie A, Cameron, Lucia C, Petito, Nilay S, Shah, Amanda M, Perak, Janet M, Catov, Natalie A, Bello, Simon, Capewell, Martin, O'Flaherty, Donald M, Lloyd-Jones, Philip, Greenland, William A, Grobman, and Sadiya S, Khan
- Subjects
Adult ,Cross-Sectional Studies ,Pregnancy ,Racial Groups ,Ethnicity ,Infant, Newborn ,Humans ,Female ,Hispanic or Latino ,Hypertension, Pregnancy-Induced ,General Medicine ,United States - Abstract
Hypertensive disorders of pregnancy are leading causes of morbidity and mortality among pregnant individuals as well as newborns, with increasing incidence during the past decade. Understanding the individual associations of advancing age of pregnant individuals at delivery, more recent delivery year (period), and more recent birth year of pregnant individuals (cohort) with adverse trends in hypertensive disorders of pregnancy could help guide public health efforts to improve the health of pregnant individuals.To clarify the independent associations of delivery year and birth year of pregnant individuals, independent of age of pregnant individuals, with incident rates of hypertensive disorders of pregnancy.This serial cross-sectional study of 38 141 561 nulliparous individuals aged 15 to 44 years with a singleton, live birth used 1995-2019 natality data from the National Vital Statistics System.Year of delivery (period) and birth year (cohort) of pregnant individuals.Rates of incident hypertensive disorders of pregnancy, defined as gestational hypertension, preeclampsia, or eclampsia, recorded on birth certificates. Generalized linear mixed models were used to calculate adjusted rate ratios (aRRs) comparing the incidence of hypertensive disorders of pregnancy in each delivery period (adjusted for age and cohort) and birth cohort (adjusted for age and period) with the baseline group as the reference for each. Analyses were additionally stratified by the self-reported racial and ethnic group of pregnant individuals.Of 38 141 561 individuals, 20.2% were Hispanic, 0.8% were non-Hispanic American Indian or Alaska Native, 6.5% were non-Hispanic Asian or Pacific Islander, 13.9% were non-Hispanic Black, and 57.8% were non-Hispanic White. Among pregnant individuals who delivered in 2015 to 2019 compared with 1995 to 1999, the aRR for the incidence of hypertensive disorders of pregnancy was 1.59 (95% CI, 1.57-1.62), adjusted for age and cohort. Among pregnant individuals born in 1996 to 2004 compared with 1951 to 1959, the aRR for the incidence of hypertensive disorders of pregnancy was 2.61 (95% CI, 2.41-2.84), adjusted for age and period. The incidence was higher among self-identified non-Hispanic Black individuals in each birth cohort, with similar relative changes for period (aRR, 1.76 [95% CI, 1.70-1.81]) and cohort (aRR, 3.26 [95% CI, 2.72-3.91]) compared with non-Hispanic White individuals (period: aRR, 1.60 [95% CI, 1.57-1.63]; cohort: aRR, 2.53 [95% CI, 2.26-2.83]).This cross-sectional study suggests that more recent birth cohorts of pregnant individuals have experienced a doubling of rates of hypertensive disorders of pregnancy, even after adjustment for age and delivery period. Substantial racial and ethnic disparities persisted across generations.
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- 2022
40. Geographic Variation in Trends and Disparities in Heart Failure Mortality in the United States, 1999 to 2017
- Author
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Lucia C. Petito, Katharine Harrington, Nilay S. Shah, Sadiya S. Khan, Clyde W. Yancy, Peter Glynn, Donald M. Lloyd-Jones, Rebecca Molsberry, and Mercedes R. Carnethon
- Subjects
Adult ,Male ,Race and Ethnicity ,Epidemiology ,Health Status ,Geographic variation ,030204 cardiovascular system & hematology ,geographic variation ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Medicine ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,Original Research ,health disparities ,Aged ,Retrospective Studies ,Heart Failure ,Aged, 80 and over ,business.industry ,Disease mortality ,Middle Aged ,medicine.disease ,Health equity ,United States ,Survival Rate ,Cross-Sectional Studies ,Heart failure ,Female ,Mortality/Survival ,Cardiology and Cardiovascular Medicine ,business ,Demography ,Follow-Up Studies ,Forecasting - Abstract
Background Cardiovascular disease mortality related to heart failure (HF) is rising in the United States. It is unknown whether trends in HF mortality are consistent across geographic areas and are associated with state‐level variation in cardiovascular health (CVH). The goal of the present study was to assess regional and state‐level trends in cardiovascular disease mortality related to HF and their association with variation in state‐level CVH. Methods and Results Age‐adjusted mortality rates (AAMR) per 100 000 attributable to HF were ascertained using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research from 1999 to 2017. CVH at the state‐level was quantified using the Behavioral Risk Factor Surveillance System. Linear regression was used to assess temporal trends in HF AAMR were examined by census region and state and to examine the association between state‐level CVH and HF AAMR. AAMR attributable to HF declined from 1999 to 2011 and increased between 2011 and 2017 across all census regions. Annual increases after 2011 were greatest in the Midwest (β=1.14 [95% CI, 0.75, 1.53]) and South (β=0.96 [0.66, 1.26]). States in the South and Midwest consistently had the highest HF AAMR in all time periods, with Mississippi having the highest AAMR (109.6 [104.5, 114.6] in 2017). Within race‒sex groups, consistent geographic patterns were observed. The variability in HF AAMR was associated with state‐level CVH ( P Conclusions Wide geographic variation exists in HF mortality, with the highest rates and greatest recent increases observed in the South and Midwest. Higher levels of poor CVH in these states suggest the potential for interventions to promote CVH and reduce the burden of HF.
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- 2021
41. Leading causes of death in Asian Indians in the United States (2005-2017)
- Author
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Claudia Fernandez Perez, Kevin Xi, Aditya Simha, Nilay S. Shah, Robert J. Huang, Latha Palaniappan, Sukyung Chung, Tim Au, Nora Sharp, Nathaniel Islas, and Malathi Srinivasan
- Subjects
Male ,Multidisciplinary ,Asian ,Heart Diseases ,Cause of Death ,Neoplasms ,Humans ,Female ,United States ,White People - Abstract
Objective Asian Indians are among the fastest growing United States (US) ethnic subgroups. We characterized mortality trends for leading causes of death among foreign-born and US-born Asian Indians in the US between 2005–2017. Study design and setting Using US standardized death certificate data, we examined leading causes of death in 73,470 Asian Indians and 20,496,189 non-Hispanic whites (NHWs) across age, gender, and nativity. For each cause, we report age-standardized mortality rates (AMR), longitudinal trends, and absolute percent change (APC). Results We found that Asian Indians’ leading causes of death were heart disease (28% mortality males; 24% females) and cancer (18% males; 22% females). Foreign-born Asian Indians had higher all-cause AMR compared to US-born (AMR 271 foreign-born, CI 263–280; 175.8 US-born, CI 140–221; p Conclusions Foreign-born Asian Indians were 2.2 times more likely to die of heart disease and 1.6 times more likely to die of cancer. Asian Indian male AMR was 49% greater than female on average, although AMR was consistently lower for Asian Indians when compared to NHWs.
- Published
- 2021
42. Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asian Adults in the United States: The MASALA Cohort Study
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Juned Siddique, Sadiya S. Khan, John A. Schneider, Namratha R. Kandula, Mark D. Huffman, Nilay S. Shah, and Alka M. Kanaya
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Adult ,Male ,social networks ,Race and Ethnicity ,South asia ,Epidemiology ,Cardiovascular health ,Health Status ,Ethnic group ,030204 cardiovascular system & hematology ,Risk Assessment ,Social Networking ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Risk Factors ,Medicine ,South Asian ,Humans ,030212 general & internal medicine ,Social determinants of health ,Original Research ,Aged ,Aged, 80 and over ,Social network ,Asian ,business.industry ,Incidence ,Social environment ,cardiovascular health ,Middle Aged ,Atherosclerosis ,Coronary Vessels ,United States ,Primary Prevention ,Coronary artery calcium ,Cross-Sectional Studies ,Cardiovascular Diseases ,social determinants of health ,Calcium ,Female ,Cardiology and Cardiovascular Medicine ,business ,Demography ,Cohort study - Abstract
Background South Asian adults have worse cardiovascular health (CVH) and more coronary artery calcium compared with other race/ethnicities. The impact of the social environment has not been examined as a potential driver of CVH or coronary artery calcium in this population. We evaluated associations of social network characteristics with CVH and coronary artery calcium in South Asian American adults to inform strategies for CVH promotion in this at‐risk population. Methods and Results Using data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) cohort study, multinomial and multivariable logistic regression were used to evaluate associations of participant social network size and density, proportion of network who are kin or South Asian ethnicity and reported health of participant's identified social network members (“alters”), with participant CVH and presence of coronary artery calcium. The 699 MASALA participants included were mean age 59.2 (SD, 9.2) years and 42.9% women. After adjustment, a 1‐person larger social network size was associated with 13% higher odds of ideal CVH (odds ratio [OR], 1.13; 95% CI, 1.01–1.27). Reporting an alter with high blood pressure was associated with lower odds of ideal CVH (OR, 0.51; 95% CI, 0.29–0.88), and reporting an alter with high cholesterol was associated with lower odds of ideal CVH (OR, 0.54; 95% CI, 0.30–0.94). Conclusions Social network characteristics are associated with CVH in South Asian American adults. Engaging social networks may help promote CVH in this population.
- Published
- 2021
43. Gestational Diabetes and Overweight/Obesity: Analysis of Nulliparous Women in the U.S., 2011-2019
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Sadiya S. Khan, Lucia C. Petito, Nilay S. Shah, William A. Grobman, Erica P. Gunderson, Michael C. Wang, and Matthew J. O’Brien
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Adult ,medicine.medical_specialty ,Epidemiology ,Population ,Overweight ,Logistic regression ,Article ,Body Mass Index ,Pregnancy ,Risk Factors ,medicine ,Humans ,Obesity ,Risk factor ,education ,education.field_of_study ,business.industry ,Obstetrics ,Overweight obesity ,Public Health, Environmental and Occupational Health ,nutritional and metabolic diseases ,medicine.disease ,Gestational diabetes ,Diabetes, Gestational ,Cross-Sectional Studies ,Female ,medicine.symptom ,business - Abstract
INTRODUCTION: Rates of gestational diabetes mellitus (GDM) are increasing in parallel with rates of overweight and obesity. This analysis examines nationwide trends in the population-attributable fraction for GDM associated with prepregnancy overweight and obesity. METHODS: A serial, cross-sectional study was performed using U.S. population-based Birth Data Files maintained by the National Center for Health Statistics between 2011 and 2019. Live singleton births to nulliparous women aged 15–44 years were included, and all analyses were stratified by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian). Prevalences of prepregnancy overweight (25.0–29.9 kg/m(2), 23.0–27.4 kg/m(2)) and obesity (≥30.0 kg/m(2), ≥27.5 kg/m(2)) based on standard and Asian-specific BMI categories, respectively, were quantified. Logistic regression estimated adjusted associations between prepregnancy overweight and obesity and GDM with normal weight (18.0–24.9 kg/m(2), 18.0–22.9 kg/m(2)) as the ref. Annual population-attributable fractions for GDM associated with prepregnancy overweight and obesity were calculated, which account for both prevalence of the risk factor and the associated risk of GDM. RESULTS: Among 11,950,881 included women, mean maternal age was 26.3 years. Population-attributable fractions for GDM associated with overweight were stable (Hispanic: 12.0% to 11.3%, non-Hispanic Asian: 12.1% to 11.6%, p≥0.20) or decreased (non-Hispanic White: 10.8% to 9.4%, non-Hispanic Black: 12.3% to 9.2%, p
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- 2021
44. Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011-2018: A cross-sectional study
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Lucia C. Petito, Joe Feinglass, Sadiya S. Khan, Jacob B. Pierce, Nilay S. Shah, Lindsay R. Pool, and Donald M. Lloyd-Jones
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Male ,Rural Population ,Urban Population ,Epidemiology ,Cross-sectional study ,Health Care Providers ,Psychological intervention ,Disease ,Cardiovascular Medicine ,Medical Conditions ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,Medical Personnel ,Cause of death ,Aged, 80 and over ,Multidisciplinary ,Mortality rate ,Middle Aged ,Socioeconomic Aspects of Health ,Professions ,Research Design ,Cardiovascular Diseases ,Female ,Research Article ,Adult ,Census ,medicine.medical_specialty ,Death Rates ,Science ,Cardiology ,Research and Analysis Methods ,Population Metrics ,Physicians ,Humans ,Mortality ,Risk factor ,Socioeconomic status ,Aged ,Heart Failure ,Survey Research ,Population Biology ,business.industry ,Public health ,Biology and Life Sciences ,Health Status Disparities ,United States ,Health Care ,Cross-Sectional Studies ,Medical Risk Factors ,People and Places ,Population Groupings ,business ,Demography - Abstract
Background Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. Methods and findings We queried CDC WONDER to identify HF deaths between 2011–2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35–64 and 65–84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011–2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011–2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2–74.2] vs. 57.2 [56.8–57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3–138.9] in 2018) with greatest increases in HF-related mortality in those 35–64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04–1.16]) and older adults (1.04 [1.02–1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates ( Conclusions Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
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- 2021
45. Adverse Trends in Premature Cardiometabolic Mortality in the United States, 1999 to 2018
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Simon Capewell, Nilay S. Shah, Donald M. Lloyd-Jones, Martin O'Flaherty, Namratha R. Kandula, Kiarri N. Kershaw, Sadiya S. Khan, Mark D. Huffman, and Mercedes R. Carnethon
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Adult ,Male ,Race and Ethnicity ,Heart disease ,Heart Diseases ,Epidemiology ,heart disease ,030204 cardiovascular system & hematology ,White People ,premature ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Environmental health ,Cardiovascular Disease ,Cause of Death ,medicine ,Humans ,030212 general & internal medicine ,National trends ,Original Research ,Retrospective Studies ,business.industry ,Mortality, Premature ,Middle Aged ,medicine.disease ,mortality ,United States ,cerebrovascular disease ,Black or African American ,Cerebrovascular Disorders ,diabetes mellitus ,Life expectancy ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
BackgroundLife expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race‐sex groups.Methods and ResultsUsing death certificates from the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research, we quantified premature deaths (ConclusionsOver one‐fifth of cardiometabolic deaths occurred at
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- 2020
46. AHA LIFE’S SIMPLE 7 METRICS ARE NOT SIGNIFICANTLY ASSOCIATED WITH SUBCLINICAL CORONARY ATHEROSCLEROSIS INCIDENCE OR PROGRESSION AMONG SOUTH ASIANS OR OTHER RACIAL/ETHNIC GROUPS: FINDINGS FROM THE MASALA AND MESA STUDIES
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Vardhmaan Jain, mahmoud AlRifai, Alka Kanaya, Nilay S. Shah, Sameera Talegawkar, Kevin Shah, Salim S. Virani, Erin D. Michos, Roger S. Blumenthal, and Jaideep Patel
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
47. Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018
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Norrina B. Allen, Sadiya S. Khan, Hongyan Ning, John T. Wilkins, Nilay S. Shah, Donald M. Lloyd-Jones, and Amanda M. Perak
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medicine.medical_specialty ,Atherosclerotic cardiovascular disease ,business.industry ,Physiology (medical) ,Population Distributions ,Environmental health ,Cardiovascular health ,Epidemiology ,Distribution (pharmacology) ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Disease rates - Abstract
Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (PFigure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.
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- 2020
48. Abstract 15422: Distribution of 10- and 30-year Predicted Risks for Heart Failure in the United States: NHANES 2015 to 2018
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Sanjiv J. Shah, Clyde W. Yancy, Hongyan Ning, Sadiya S. Khan, Donald M. Lloyd-Jones, Nilay S. Shah, and John T. Wilkins
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Environmental health ,Heart failure ,Epidemiology ,medicine ,Distribution (economics) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Introduction: Heart failure (HF) poses a significant health burden with prevalence projected to increase by 46% by 2030 in the United States. Targeted implementation and dissemination of clinical and public health preventive measures across the life course will be informed by describing population distributions of short- and long-term predicted HF risk. Methods: Among nonpregnant middle-aged (30-59 years) adults without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10-year (10Y) and 30-year (30Y) HF risk estimates were calculated using short- and long-term risk equations derived in the Cardiovascular Lifetime Risk Pooling Project. High estimated 10Y risk was classified as ≥5%, and high 30Y risk as ≥20%. Participants were categorized by combined 10Y and 30Y estimated risk categories overall and stratified by sex, race, age, and body mass index. Distributions were compared using chi-square tests. Results: In 1495 NHANES participants (representing 53,022,413 Americans) with mean age 45 years (SE 0.3), median 10Y risk was 0.8% and 30Y risk was 11%. Approximately 4% of individuals were estimated to have high 10Y predicted risk of HF. Of those who were classified as low 10Y risk, 23% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, and BMI (PFigure ). Black males more frequently were classified as high 10Y or 30Y risk compared to other race-sex groups. Older individuals and those with BMI ≥30 kg/m 2 had a higher frequency of low 10Y but high 30Y risk. Conclusions: More than one-fourth of middle-aged U.S. adults have elevated short- or long-term predicted risk for HF. While the majority of middle-aged US adults are at low 10Y risk for HF, a large proportion among this subgroup are at high 30Y HF risk. Application of both short- and long-term HF risk prediction may mitigate the growing morbidity and mortality related to HF and identify strategies to target those at-risk earlier in the life course.
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- 2020
49. Trends in Hypertension-Related Cardiovascular Mortality in the United States, 2000 to 2018
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Leah Rethy, Donald M. Lloyd-Jones, James Paparello, Sadiya S. Khan, and Nilay S. Shah
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Male ,medicine.medical_specialty ,Underlying cause of death ,MEDLINE ,Disease ,Article ,Cause of Death ,Internal Medicine ,Humans ,Medicine ,cardiovascular diseases ,Mortality ,Cardiovascular mortality ,business.industry ,Mortality rate ,Public health ,Middle Aged ,medicine.disease ,United States ,Causality ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Heart failure ,Hypertension ,Emergency medicine ,Female ,Public Health ,Cardiology and Cardiovascular Medicine ,Ischemic heart ,business ,Triphasic Pattern ,Demography - Abstract
Background Despite targeted public health efforts, rates of hypertension (HTN) remain persistently high, and HTN control low with significant race-sex disparities. HTN infrequently causes death directly, but more commonly causes death through cardiovascular diseases (CVD), such as ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease. To comprehensively estimate the burden of HTN and inform prevention strategies, we determined trends in HTN-related CVD deaths overall and stratified by CVD subtypes in the United States. Methods Age-adjusted mortality rates (AAMR) were calculated based on death certificates of US residents ≥25 years (y) with any mention of HTN and CVD listed as the underlying cause of death between 2000-2018 (CDC WONDER). Joinpoint software identified inflection points in AAMR for HTN-related CVD. Trends in AAMR (average annual percentage change [AAPC, 95% CI]) of HTN-related CVD deaths as well as stratified by CVD subtype: IHD, HF, and cerebrovascular disease were calculated. All analyses were performed in all decedents and stratified by race-sex subgroups. AAMR rate-ratios (95% CI) of HTN-related CVD deaths in black compared with white men and women were calculated for 2018. Results Between 2000-2018, the AAMR of HTN-related CVD deaths increased by +0.5%/y (0.1, 0.8). A triphasic pattern in overall HTN-related CVD AAMR was identified (FIGURE): between 2000-2003, AAMR increased (+2.2%/y [0.4, 4.0]), between 2003-2012 AAMR decreased (-0.9%/y [-1.3, -0.5]), and between 2012-2018 AAMR increased again (+1.7%/y [1.1, 2.3]). Trends differed by CVD-subtype. The AAMR for HTN-related- IHD deaths declined -1.5 % /y (-1.8, -1.1), HF deaths increased 1.8%/y (1.4, 2.3), and cerebrovascular deaths remained stable -0.1%/year (-0.4, 0.2) between 2000-2018. For all CVD-subtypes AAMR increased in the most recent period (2012-2018) with significant disparities by race-sex. In 2018, AAMR of HTN-related CVD was 1.76 (1.73, 1.80) and 1.63 (1.60, 1.66) times higher in black compared with white men and women, respectively. Conclusions Since 2000, the AAMR for HTN-related CVD deaths has increased, particularly for HTN-related HF deaths. Trends consistently worsened between 2012-2018, with persistent racial disparities. Resources aimed at preventing and managing HTN are urgently needed to equitably reduce preventable CVD deaths.
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- 2020
50. Addressing Asian American Misrepresentation and Underrepresentation in Research
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Nilay S. Shah and Namratha R. Kandula
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030505 public health ,Minority group ,Biomedical Research ,Asian ,Health Equity ,Epidemiology ,Patient Selection ,Ethnic group ,General Medicine ,Health Status Disparities ,Masking (Electronic Health Record) ,Health equity ,United States ,Representation (politics) ,03 medical and health sciences ,Race (biology) ,Misrepresentation ,Research Design ,Political science ,Commentary ,Humans ,Minority Health ,0305 other medical science ,Inclusion (education) ,Demography - Abstract
Asian Americans are the fastest growing racial/ethnic minority group in the United States and have unique, heterogenous health status and outcomes across a range of conditions between disaggregated Asian subgroups. Despite the rapid growth of this group, clinical and epidemiologic research lags considerably in adequately and appropriately representing Asian Americans. Too often, Asian American participants and populations are inappropriately aggregated into a single race category in research, masking important differences between ethnic subgroups. In this commentary, actionable recommendations are provided to investigators in order to enhance inclusion and representation of Asian Americans in a broad scope of research programs. Incorporating these recommendations in research planning and conduct will support health and promote health equity for these populations. Ethn Dis. 2020;30(3):513-516; doi:10.18865/ed.30.3.513
- Published
- 2020
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