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Dyslipidemia in Racial/Ethnic Groups

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Cardiovascular Disease in Racial and Ethnic Minorities

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Some population groups in the United States have excess burdens of major risk factors for cardiovascular disease (CVD) and are more likely to have more risk factors than their white counterparts. Although the reasons for the excess CVD mortality among African-Americans remain controversial, it is evident that the high prevalence and suboptimal control of coronary risk factors and a greater degree of clustering of certain coronary risk factors contribute importantly. The predictive value of most conventional CVD risk factors appears to be similar for African-Americans and whites. Most population-based studies report that African-Americans have lower total serum cholesterol levels and a lower prevalence of hypercholesterolemia, but low-density lipoprotein cholesterol (LDL-C) levels were similar. Although African-Americans achieve a similar lowering of LDL-C with statin therapy, they are less likely to have increased cholesterol treated. Although low HDL as a CHD risk factor has been known for decades, only recently has clinical trial evidence addressed the benefits of raising high-density lipoprotein (HDL)-C.

On an average, higher levels of HDL-C are observed in African-American adults compared to white adults. Low hepatic lipase activity leads to increased plasma HDL-C concentrations in African-American men. Triglyceride levels in African-American men and women are generally lower than in white men and women, either with or without CHD. When African-Americans have elevated lipoprotein(a) levels in conjunction with small apolipoprotein(a) isoforms, a significant association with CHD has been found. Hispanics have lower mortality rates than non-Hispanic whites and blacks, referred to as the “Hispanic Paradox,” although a recent study provided evidence against the Hispanic Paradox in a population of diabetic individuals. Like African-Americans and other ethnic minorities, Hispanics have been under-represented in lipid clinical trials. South Asian Indians have a two- to three-fold higher prevalence of diabetes and a higher prevalence of metabolic syndrome than in whites. Premature atherosclerosis in young Asian Indians also appears to be related in part to the commonly observed dyslipidemia tetrad of elevated triglycerides, low HDL, small dense LDL-C, and elevated lipoprotein(a). High prevalence of modifiable risk factors provides great opportunity for prevention, risk reduction, reducing and ultimately eliminating disparities in cardiovascular care and outcomes.

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  1. State University of New York Downstate Medical Center, Brooklyn, New York, USA

    L. T. Clark MD & S. Shaheen MD

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  1. Cardiology Division, Emory University, 5355 Hunter Road, Atlanta, GA, 30349, USA

    Keith C. Ferdinand MD

  2. Department of Internal Medicine, New Hanover Regional Medical Center, 212 Walnut Street, Wilmington, NC, 28401 #101, USA

    Annemarie Armani MD

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Clark, L.T., Shaheen, S. (2009). Dyslipidemia in Racial/Ethnic Groups. In: Ferdinand, K.C., Armani, A. (eds) Cardiovascular Disease in Racial and Ethnic Minorities. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-410-0_7

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