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Medical News & Perspectives
July 13, 2022

MASALA Study Probes Why People With South Asian Ancestry Have Increased Cardiovascular Disease Risks

JAMA. 2022;328(6):511-514. doi:10.1001/jama.2022.11417

Studies dating back to the late 1950s have shown that people with South Asian ancestry have higher cardiovascular disease risk than people of other racial and ethnic groups, and the heightened risks have been observed in the US over the past 2 decades. To better understand why, in 2010 two Indian American internists, Alka Kanaya, MD, and Namratha Kandula, MD, MPH, launched the Mediators of Atherosclerosis in South Asians Living in America, or MASALA, prospective cohort study.

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    5 Comments for this article
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    MASALA Study
    Yameen Mazumder, MBBS, DTM&H | James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
    Very interesting and timely study for the prevention of CVD among the South Asian population, especially for the young and for adolescents.

    Having read the interview, I did not see any mention about prevalence of tobacco smoking which, I think, does play a major role in CVD.
    CONFLICT OF INTEREST: None Reported
    Tobacco
    Namratha Kandula, MD, MPH | Northwestern University
    Thank you for the comment on smoking and tobacco as a contributor to CVD in people of South Asian origin. In the MASALA study, which is majority Indian American, the prevalence of smoking was < 3%. As we enrich the cohort with Bangladeshi and Pakistani participants, we will continue to assess smoking which may vary by county of origin, education, and immigrant generation. We are only asking about cigarettes, but there are other forms of tobacco that should be assessed in patients and immigrant communities.
    CONFLICT OF INTEREST: PI of the MASALA study
    Prevalence of Low Birth Weight and Intrauterine Growth Restriction among South Asian Populations
    Tonse Raju, MD, DCH | National Institutes of Health
    This is a very interesting study that can positively impact the cardiovascular health of South Asian populations living in the US. An additional risk factor not discussed in the interview is the high prevalence of intrauterine growth restriction and low birth weight. These variables contribute to the developmental origins of health and disease (DOHAD). I trust that investigators of the MASALA study are collecting birth weight and gestational age information for the cohort they are studying.

    Tonse N. K. Raju, MD
    Environmental influences on Child Health Outcome Program
    National Institutes of Health
    Bethesda, MD, USA
    />
    CONFLICT OF INTEREST: None Reported
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    Multifactorial Causation
    Angel Sanchez-Figueras, DDS | Payer
    Thank you for such an enlightening and stimulating research article. I found it thoroughly interesting and it did trigger some thoughts that I have had throughout my many years of dental practice.

    It has been my anecdotal observation throughout 35 years of dental practice that patients of South Asian ancestry (primarily those from India) present with moderate to severe periodontal disease at a higher rate than people from other parts of Asia as well as from other regions of the world. The association between the generalized inflammatory repercussions of chronic periodontitis and systemic disease has
    been documented. I have also observed an apparent correlation between South Asian ancestry and presence of cardiovascular disease (type II diabetes as well) in medical history disclosures. My thoughts are always on the preventive end of the scale. More is required here and your article points this out quite clearly. I just can't help but think that periodontitis is one more contributing factor in cardiovascular disease, one that for one reason or another is being overlooked.

    I have always had a particular interest in periodontitis-systemic disease association research. I believe a future evaluation of the incidence of periodontitis in the South Asian population and its correlation to cardiovascular disease presence would be a valuable test that could further disclose another factor influencing the increased incidence of cardiovascular disease in this population. Obtaining further data and clarity in this matter could catalyze a different direction and emphasis of future research.

    Thank you so very much,

    Angel Sanchez-Figueras, Jr., D.D.S.
    Los Angeles, CA
    CONFLICT OF INTEREST: None Reported
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    Crossing the Diversity Chasm
    Esha Ray Chaudhuri, PhD | Independent Equity Analyst
    As an equity analyst of South Asian origin I would like to congratulate Drs Alka Kanaya and Namratha Kandula for perhaps inadvertently developing an important Kanaya-Kandula model for transforming the trending lens of the diversity, equity, and inclusion into a sustainable foundation of person-centered medical research in contemporary global societies.

    I also thank the JAMA interviewer for recognizing the paradox of common assumptions about homogeneity in diverse communities.

    I appreciate the resiliency of the MASALA Study to question the global reliability of culture-specific measurement metrics particularly for prognostication.

    I
    commend the dynamism of the evolving phases of the project insights for its recognition of the role of social determinants of health/illness and also acknowledging their intersecting impact.

    Finally, I applaud the creativity of Drs Kanaya and Kandula for coming up with the amazing acronyms of MASALA , SAHELI and SATH!
    CONFLICT OF INTEREST: None Reported
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