CHAI (Cardiovascular Health in Asian Indians) Collaborative

The Cardiovascular Health of Asian Indians (CHAI) Collaborative will facilitate collaboration of experts —epidemiologists, statisticians, and geneticists to identify genetic markers of heightened atherosclerosis in South Asians. The fund will be established at the Cleveland Clinic, at the Department of Cardiovascular Medicine at Heart, Vascular and Thoracic Institute.


of heart attacks in people of South Asian descent occur under age 45

40 secs

Every 40 seconds, someone in the U.S. has a heart attack


People of South Asian descent have 4x the risk of atherosclerosis


South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world’s population, and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Further, given that South Asians form close to 80% of the minority races in the United States, it is essential to identify the basis for this elevated risk.

Published literature has thus far shown that this elevated risk is disproportionate to that which can be attributed to lifestyle and modifiable risk factors alone. Polygenic risk scores have been of interest in this regard, and broadly speaking, refer to how the genetic makeup of a population differs from that of another population, and in doing so, increases their risk of a particular outcome. There have been a few cohorts that have focused on assessing the risk of ASCVD in South Asians, such as the MASALA group. The rationale of the present collaborative is to utilize the data from two such large prospective South Asian study cohorts in the United States, and to device a polygenic risk score that can help evaluate the risk of South Asians for ASCVD, and in doing so, form the basis for potential therapeutic targets.

Study Design and Methods

The present study will use patient populations from large prospective study cohorts that have prospectively collected epidemiologic and cardiovascular data from South Asians living in the United States. Coronary artery calcium scoring will also be conducted using pre-specified 4D-CT protocols by trained radiographers and interpreted by two blinded radiologists. Subsequently, multi-collinear models will be made to device polygenic risk scores that correlate with severity of ASCVD risk as estimated from CAC scoring and compared with a non-South Asian population.

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