Inflammation and coronary artery calcification in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

Atherosclerosis. 2018 Mar;270:49-56. doi: 10.1016/j.atherosclerosis.2018.01.033. Epub 2018 Jan 31.


Background and aims: Inflammatory biomarkers and adipocytokines (IBA) may contribute to atherosclerosis by promoting vascular inflammation. The association between IBA and coronary artery calcium (CAC), a marker of subclinical atherosclerosis, is not well defined in South Asians (SA). We hypothesized that IBA (high sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TNF-α], adiponectin, and leptin) were independently associated with and improved discrimination of CAC among SA.

Methods: We analyzed IBA and CAC among participants in the prospective Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used logistic regression models to examine cross-sectional associations of IBA with CAC presence (CAC >0) and severity (CAC >100), and C-statistics to assess the incremental contribution of each IBA to traditional risk factors (TRF) from the AHA/ACC Pooled Cohort Equations (PCE) for discrimination of CAC.

Results: Among 906 participants in the MASALA study, women (n = 420) had significantly higher levels of hsCRP, adiponectin, and leptin but lower levels of TNF-α than men (p < .01 for all). There was no significant association between any of the four IBA and either CAC category in multivariable-adjusted models, respectively. Lastly, none of the four IBA improved discrimination of CAC presence or severity when added to elements of the PCE.

Conclusions: IBA were not associated with CAC presence or severity in the MASALA population. IBA did not help identify SA at risk of subclinical atherosclerosis, although associations with ASCVD events remain unclear. In SA, CAC may have a distinct pathophysiology independent of inflammation as measured by IBA.

Keywords: Biomarker; Coronary artery calcium; Inflammation; Prevention; South Asian.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipokines / blood*
  • Adiponectin / blood
  • Adult
  • Aged
  • Aged, 80 and over
  • Asian Continental Ancestry Group*
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Coronary Angiography
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / ethnology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Inflammation / blood*
  • Inflammation / diagnosis
  • Inflammation / ethnology
  • Inflammation Mediators / blood*
  • Leptin / blood
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Tumor Necrosis Factor-alpha / analysis
  • United States / epidemiology
  • Vascular Calcification / blood*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / ethnology


  • ADIPOQ protein, human
  • Adipokines
  • Adiponectin
  • Biomarkers
  • Inflammation Mediators
  • LEP protein, human
  • Leptin
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein