Research Article| Volume 27, ISSUE 11, P1214-1221, November 2021

Distribution and Correlates of Incident Heart Failure Risk in South Asian Americans: The MASALA Study


      • The majority of South Asians in MASALA are at intermediate or high 10-year heart failure risk.
      • Diabetes is an important heart failure risk factor in South Asian Americans.
      • Heart failure risk is associated with income, education, and birthplace in South Asian Americans.



      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 (<1%), intermediate (1%–5%), and high (≥5%) HF risk, identified overall and by demographic and clinical characteristics, were compared. We evaluated age- and sex-adjusted associations of demographic characteristics and coronary artery calcium with predicted HF risk category using ordinal logistic regression. In 1159 participants (48% women), with a mean age of 57 ± 9 years, 40% had a low, 37% had an intermediate, and 24% had a high HF risk. Significant differences in HF risk distribution existed across demographic (income, education, birthplace) and clinical (diabetes, hypertension, body mass index, coronary artery calcium) groups (P < .01). Significant associations with high predicted HF risk were observed for a family of income 75,000/year or more (adjusted odds ratio 0.5 [95% confidence interval (CI) 0.4–0.7]), college education (0.6 [95% CI 0.4–0.9]), birthplace in another South Asian country (1.9 [95% CI 1.2–3.2], vs. born in India), and prevalent coronary artery calcium (2.6 [95% CI 1.9–3.6]).


      Almost two-thirds of South Asian Americans in the MASALA cohort are at intermediate or high predicted 10-year HF risk, with varying risk across demographic and clinical characteristics.

      Key Words

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