Multi-Ethnic Study of Atherosclerosis (MESA)

Principal Investigator: Kiang, Liu, PhD
Co-Investigators: Philip Greenland, MD and Martha Daviglus, MD

Prospective epidemiologic studies on cardiovascular disease (CVD) have traditionally tracked clinically overt events such as myocardial infarction, stroke and death to identify CVD risk factors. This approach has helped researchers establish CVD risk factors for the general population but has failed to identify indices for those with subclinical heart disease.

Study Design

Multi-Ethnic Study of Atherosclerosis (MESA) is a multi-center, prospective observational study designed to examine the early stages of atherosclerosis and other cardiovascular diseases. This ten-year study launched in 1999 will recruit 6,500 participants nationally (1,100 participants locally) between the ages of 45 and 84 with no history of clinical heart disease. Equal number of males and females will be recruited into this study. The ethnicity of the MESA population will comprised of 40% percent Caucasian, 30% African-American, 20% Hispanic and10% Asian. MESA is funded by the National Institutes of Health.

Primary Aims of the MESA Study:

1. Provide more accurate and quantifiable measures of cardiovascular disease.
2. Characterize cardiovascular disease before clinical diagnosis.
3. Optimize the study of progression of subclinical CVD in Caucasian, Asian, Hispanic and
African-American populations in the United States.
4. Compare subclinical with clinical indices of atherosclerosis among multiple ethnic groups to
elucidate the genetic differences in the pathogenesis of heart disease.

Data Collection

Baseline and four follow-up clinic visits will be conducted over the course of ten years. MESA examination procedures will include traditional cardiovascular assessments: blood pressure, anthropometry, electrocardiogram, and blood lipid tests. Examples of novel clinical tests are electron-beam CT, carotid ultrasound, cardiac magnetic resonance imaging and genetic blood tests.

Diet Assessment

Several dietary factors are considered to contribute to the development of atherosclerosis, either through promoting obesity or other metabolic pathways. In MESA study, target nutrients of interest are total caloric intake, saturated and unsaturated fats, nutrient antioxidants (i.e. Vitamins A, C and E), iron and other minerals and dietary fiber. Since dietary supplement use is pervasive in our country, vitamin and mineral pills as well as herbal or other non-traditional supplements will also be assessed among study participants.

All MESA participants will complete a food frequency questionnaire (FFQ). This tool is designed to facilitate analysis of specific nutrients, whole foods and nutritional supplements as they relate to CVD risk. The opportunity to analyze and contrast dietary intake in a cross-section of four ethnic groups is an unique and important aspect of MESA. This information may help researchers determine the ethnic differences in dietary intake as they relate to the development of subclinical and clinical heart disease.

Summary

MESA will provide important new information about the pathophysiology of subclinical CVD disease development and progression. This study has the potential to (1) identify noninvasive subclinical disease measures that best predict CVD risk, (2) prevent the conversion of subclinical to clinical heart disease and (3) establish more effective treatments both subclinical and clinical heart disease.

Sources:

Kuller LH, Shemanski L, Psaty BM, Borhani NO, Gardin J, Haan MN, O'Leeary, DH, Savage PJ, Tell GS, Tracy R. Subclinical disease as an independent risk factor for cardiovascular disease. Circulation. 1995;92:720-726.

Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP. Normal human right and left ventricular mass, systolic function and gender differences by cine magnetic resonance imaging. J Cardiovasc Mag Res 1999;1:7-21.

Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures: Are the differences real? Do they matter? N Engl J of Med. 1997;336:480-486.