Skip to main content

Advertisement

SpringerLink
Log in

Psychosocial Factors Associated with Subclinical Atherosclerosis in South Asians: The MASALA Study

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

South Asians have the highest rates of premature atherosclerotic cardiovascular disease amongst all ethnic groups in the world; however this risk cannot be fully explained by traditional risk factors. Participants from the Mediators of Atherosclerosis in South Asians Living in America Study were included in this cross-sectional analysis. The purpose of this study was to investigate the association of psychosocial factors (including anger, anxiety, depressive symptoms, current and chronic stress, and everyday hassles) with carotid intima-media thickness (CIMT). Three multivariate models were examined to evaluate the association between the psychosocial factors and CIMT. Findings suggest that the impact of psychosocial factors on subclinical atherosclerosis is differential for South Asian men and women. For men, anxiety and depression were associated; while for women, stress was associated with common carotid intima media thickness, independent of traditional CVD risk factors, diet and physical activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Austria)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee JW, Brancati FL, Yeh HC. Trends in the prevalence of type 2 diabetes in Asians versus whites: results from the United States National Health Interview Survey, 1997–2008. Diabetes Care. 2011;34(2):353–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr Fall. 2007;2(4):267–75.

    Article  Google Scholar 

  3. Enas EA, Yusuf S, Mehta J. Meeting of the international working group on coronary artery disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J. 1996;48(6):727–32.

    CAS  PubMed  Google Scholar 

  4. Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J Diabetes Complications. 2010;24(3):145–53.

    Article  PubMed  Google Scholar 

  5. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. 2007;9(5):367–74.

    Article  CAS  PubMed  Google Scholar 

  6. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364(9438):937–52.

    Article  PubMed  Google Scholar 

  7. Bainey KR, Jugdutt BI. Increased burden of coronary artery disease in South-Asians living in North America. Need for an aggressive management algorithm. Atherosclerosis. 2009;204(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  8. Low CA, Thurston RC, Matthews KA. Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med. 2010;72(9):842–54.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469–500.

    Article  PubMed  Google Scholar 

  10. Ohira T, Diez Roux AV, Polak JF, Homma S, Iso H, Wasserman BA. Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis. Psychosom Med. 2012;74(5):517–25.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diez Roux AV, Ranjit N, Powell L, et al. Psychosocial factors and coronary calcium in adults without clinical cardiovascular disease. Ann Intern Med. 2006;144(11):822–31.

    Article  PubMed  Google Scholar 

  12. Mainous AG 3rd, Everett CJ, Diaz VA, Player MS, Gebregziabher M, Smith DW. Life stress and atherosclerosis: a pathway through unhealthy lifestyle. Int J Psychiatry Med. 2010;40(2):147–61.

    Article  PubMed  Google Scholar 

  13. Ruijter HM, Haitjema S, Asselbergs FW, Pasterkamp G. Sex matters to the heart: a special issue dedicated to the impact of sex related differences of cardiovascular diseases. Atherosclerosis. 2015;241(1):205–7.

    Article  Google Scholar 

  14. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):2192–217.

    Article  CAS  PubMed  Google Scholar 

  15. Appelman Y, van Rijn BB, Ten Haaf ME, Boersma E, Peters SA. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015;241(1):211–8.

    Article  CAS  PubMed  Google Scholar 

  16. Kanaya AM, Kandula N, Herrington D, et al. Mediators of atherosclerosis in South Asians Living in America (MASALA) study: objectives, methods, and cohort description. Clin Cardiol. 2013;36(12):713–20.

    Article  PubMed  PubMed Central  Google Scholar 

  17. The ENRICHD investigators. Enhancing recovery in coronary heart disease patients (ENRICHD): study design and methods. Am Heart J. 2000;139(1 Pt 1):1–9.

    Google Scholar 

  18. Jensen RA, Shea S, Ranjit N, et al. Psychosocial risk factors and retinal microvascular signs: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2010;171(5):522–31.

    Article  PubMed  Google Scholar 

  19. Williams DR, Yan Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status—stress and discrimination. J Health Psychol. 1997;2(3):335–51.

    Article  CAS  PubMed  Google Scholar 

  20. Williams JE, Paton CC, Siegler IC, Eigenbrodt ML, Nieto FJ, Tyroler HA. Anger proneness predicts coronary heart disease risk: prospective analysis from the atherosclerosis risk in communities (ARIC) study. Circulation. 2000;101(17):2034–9.

    Article  CAS  PubMed  Google Scholar 

  21. Ainsworth BE, Irwin ML, Addy CL, Whitt MC, Stolarczyk LM. Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study. J Women’s Health Gender Based Med. 1999;8(6):805–13.

    Article  CAS  Google Scholar 

  22. Kelemen LE, Anand SS, Vuksan V, et al. Development and evaluation of cultural food frequency questionnaires for South Asians, Chinese, and Europeans in North America. J Am Diet Assoc. 2003;103(9):1178–84.

    Article  PubMed  Google Scholar 

  23. Gadgil MD, Anderson CA, Kandula NR, Kanaya AM. Dietary patterns are associated with metabolic risk factors in South asians living in the United States. J Nutr. 2015;145(6):1211–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8738):382–6.

    Article  CAS  PubMed  Google Scholar 

  25. Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel keys lecture. Circulation. 1997;95(1):252–64.

    Article  CAS  PubMed  Google Scholar 

  26. Kardys I, Vliegenthart R, Oudkerk M, Hofman A, Witteman JC. The female advantage in cardiovascular disease: Do vascular beds contribute equally? Am J Epidemiol. 2007;166(4):403–12.

    Article  PubMed  Google Scholar 

  27. Williams JE, Couper DJ, Din-Dzietham R, Nieto FJ, Folsom AR. Race-gender differences in the association of trait anger with subclinical carotid artery atherosclerosis: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2007;165(11):1296–304.

    Article  PubMed  Google Scholar 

  28. Santos IS, Goulart AC, Brunoni AR, Kemp AH, Lotufo PA, Bensenor IM. Anxiety and depressive symptoms are associated with higher carotid intima-media thickness. Cross-sectional analysis from ELSA-Brasil baseline data. Atherosclerosis. 2015;240(2):529–34.

    Article  CAS  PubMed  Google Scholar 

  29. Stewart JC, Janicki DL, Muldoon MF, Sutton-Tyrrell K, Kamarck TW. Negative emotions and 3-year progression of subclinical atherosclerosis. Arch Gen Psychiatry. 2007;64(2):225–33.

    Article  PubMed  Google Scholar 

  30. Pizzi C, Costa GM, Santarella L, et al. Depression symptoms and the progression of carotid intima-media thickness: a 5-year follow-up study. Atherosclerosis. 2014;233(2):530–6.

    Article  CAS  PubMed  Google Scholar 

  31. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis. 2005;178(2):339–44.

    Article  CAS  PubMed  Google Scholar 

  32. Berkman LF, Leo-Summers L, Horwitz RI. Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann Intern Med. 1992;117(12):1003–9.

    Article  CAS  PubMed  Google Scholar 

  33. Williams RB, Barefoot JC, Califf RM, et al. Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. JAMA. 1992;267(4):520–4.

    Article  CAS  PubMed  Google Scholar 

  34. Rosengren A, Wilhelmsen L, Orth-Gomer K. Coronary disease in relation to social support and social class in Swedish men. A 15 year follow-up in the study of men born in 1933. Eur Heart J. 2004;25(1):56–63.

    Article  PubMed  Google Scholar 

  35. Pedersen SS, van Domburg RT, Larsen ML. The effect of low social support on short-term prognosis in patients following a first myocardial infarction. Scand J Psychol. 2004;45(4):313–8.

    Article  PubMed  Google Scholar 

Download references

Funding

The MASALA study was supported by the NIH grant #1R01 HL093009. Data collection at UCSF was also supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. The sponsors did not play a significant role in the analysis, interpretation, and presentation of these results.

Author information

Authors and Affiliations

  1. Department of Social, Behavioral and Administrative Sciences, College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94594, USA

    Bijal M. Shah

  2. College of Pharmacy, Touro University California, Vallejo, CA, USA

    Shriraj Shah

  3. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA

    Namratha R. Kandula

  4. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Meghana D. Gadgil

  5. Division of General Internal Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Alka M. Kanaya

Authors
  1. Bijal M. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shriraj Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Namratha R. Kandula
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meghana D. Gadgil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alka M. Kanaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bijal M. Shah.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, B.M., Shah, S., Kandula, N.R. et al. Psychosocial Factors Associated with Subclinical Atherosclerosis in South Asians: The MASALA Study. J Immigrant Minority Health 18, 1317–1327 (2016). https://doi.org/10.1007/s10903-016-0367-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-016-0367-5

Keywords

Search

Navigation