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Dyslipidemia in South Asian patients

Abstract

South Asians around the globe have the highest rates of coronary artery disease (CAD). These rates are 50% to 300% higher than other populations, with a higher risk at younger ages. These high rates of CAD are accompanied by low or similar rates of major traditional risk factors. The prevalence of diabetes is three to six times higher among South Asians than Europeans, Americans, and other Asians but does not explain the “South Asian Paradox.” A genetic predisposition to CAD, mediated by high levels of lipoprotein(a), markedly magnifies the adverse effects of traditional risk factors related to lifestyle and best explains the South Asian Paradox. Although the major modifiable risk factors do not fully explain the excess burden of CAD, they are doubly important and remain the foundation of preventive and therapeutic strategies in this population. A more aggressive approach to preventive therapy, especially dyslipidemia, at an earlier age and at a lower threshold is clearly warranted.

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References and Recommended Reading

  1. 1.

    Enas EA, Mehta J: Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and treatment. Clin Cardiol 1995, 18:131–135.

    PubMed  CAS  Google Scholar 

  2. 2.

    Enas EA: Coronary artery disease epidemic in Indians: a cause for alarm and call for action. J Indian Med Assoc 2000, 98:694–695, 697–702.

    PubMed  CAS  Google Scholar 

  3. 3.

    Enas EA: How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic; 2005.

    Google Scholar 

  4. 4.

    Enas EA, Senthilkumar A, Chacko V, Puthumana N: Dyslipidemia among Indo-Asians: strategies for identification and management. Brit J Diabetes Vasc Dis 2005, 5:81–90.

    Article  Google Scholar 

  5. 5.

    Enas EA, Garg A, Davidson MA, et al.: Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996, 48:343–353.

    PubMed  CAS  Google Scholar 

  6. 6.

    Enas EA, Senthilkumar A, Juturu V, Gupta R: Coronary artery disease in women. Indian Heart J 2001, 53:282–292.

    PubMed  CAS  Google Scholar 

  7. 7.

    Jafar TH, Jafary FH, Jessani S, Chaturvedi N: Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J 2005, 150:221–226.

    PubMed  Article  Google Scholar 

  8. 8.

    Jafar TH: Women in Pakistan have a greater burden of clinical cardiovascular risk factors than men. Int J Cardiol 2006, 106:348–354.

    PubMed  Article  Google Scholar 

  9. 9.

    Klatsky AL, Tekawa I, Armstrong MA, Sidney S: The risk of hospitalization for ischemic heart disease among Asian Americans in northern California. Am J Public Health 1994, 84:1672–1675.

    PubMed  CAS  Google Scholar 

  10. 10.

    Palaniappan L, Wang Y, Fortmann SP: Coronary heart disease mortality for six ethnic groups in California, 1990–2000. Ann Epidemiol 2004, 14:499–506.

    PubMed  Article  Google Scholar 

  11. 11.

    Indrayan A: Forecasting vascular disease cases and assocaitd mortalty in India. http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_Bg_P2_Forecasting_vascular_disease_cases_and_associated_mortality_in_India.pdf. Acessed April 1, 2007.

  12. 12.

    Enas EA, Senthilkumar A, Chennikkara H, Bjurlin MA: Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations. Indian Heart J 2003, 55:310–338.

    PubMed  Google Scholar 

  13. 13.

    Watanabe H, Soderlund S, Soro-Paavonen A, et al.: Decreased high-density lipoprotein (HDL) particle size, pre-beta-, and large HDL subspecies concentration in Finnish low-HDL families. Relationship with intima-media thickness. Arterioscler Thromb Vasc Biol 2006, 26:897–902

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Cromwell WC: High-density lipoprotein asociations with coronary heart disease: Does measurement of cholesterol content give the best result? J Clin Lipidol 2007, 1:57–64.

    Article  Google Scholar 

  15. 15.

    Bhalodkar NC, Blum S, Rana T, et al.: Comparison of levels of large and small high-density lipoprotein cholesterol in Asian Indian men compared with Caucasian men in the Framingham Offspring Study. Am J Cardiol 2004, 94:1561–1563.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Superko HR, Enas EA, Kotha P, et al.: High-density lipoprotein subclass distribution in individuals of asian Indian descent: the National Asian Indian Heart Disease Project. Prev Cardiol 2005, 8:81–86.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Asztalos BF, Le Maulf F, Dallal GE, et al.: Comparison of the effects of high doses of rosuvastatin versus atorvastatin on the subpopulations of high-density lipoproteins. Am J Cardiol 2007, 99:681–685.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Grundy SM, Cleeman JI, Merz CN, et al.: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004, 110:227–239.

    PubMed  Article  Google Scholar 

  19. 19.

    Joseph A, Kutty VR, Soman CR: High risk for coronary heart disease in Thiruvananthapuram City: a study of serum lipids and other risk factors. Indian Heart J 2000, 52:29–35.

    PubMed  CAS  Google Scholar 

  20. 20.

    Mora S, Szklo M, Otvos JD, et al.: LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007, 192:211–217.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Bhalodkar NC, Blum S, Enas EA: Accuracy of the ratio of triglycerides to high-density lipoprotein cholesterol for predicting low-density lipoprotein cholesterol particle sizes, phenotype B, and particle concentrations among asian indians. Am J Cardiol 2006, 97:1007–1009.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Tewari S, Kumar S, Kapoor A, et al.: Premature coronary artery disease in North India: an angiography study of 1971 patients. Indian Heart J 2005, 57:311–318.

    PubMed  Google Scholar 

  23. 23.

    Smith J, Cianflone K, Al-Amri M, Sniderman A: Body composition and the apoB/apoA-I ratio in migrant Asian Indians and white Caucasians in Canada. Clin Sci (Lond) 2006, 111:201–207.

    CAS  Article  Google Scholar 

  24. 24.

    Ridker PM, Rifai N, Cook NR, et al.: Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA 2005, 294:326–333.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Joshi P, Islam S, Pais P, et al.: Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007, 297:286–294.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Alberti KG, Zimmet P, Shaw J: The metabolic syndrome-a new worldwide definition. Lancet 2005, 366:1059–1062.

    PubMed  Article  Google Scholar 

  27. 27.

    Reddy KS, Prabhakaran D, Chaturvedi V, et al.: Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ 2006, 84:461–469.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Lip GY, Barnett AH, Bradbury A, et al.: Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007, 21:183–211.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Miller GJ, Beckles GL, Maude GH, et al.: Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St James Survey, Trinidad. Int J Epidemiol 1989, 18:808–817.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Forouhi NG, Sattar N, Tillin T, et al.: Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia 2006, 49:2580–2588.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Enas EA, Chacko V, Senthilkumar A, et al.: Elevated lipoprotein(a)-a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon 2006, 52:5–50.

    PubMed  Article  Google Scholar 

  32. 32.

    Gambhir JK, Kaur H, Gambhir DS, Prabhu KM: Lipoprotein(a) as an independent risk factor for coronary artery disease in patients below 40 years of age. Indian Heart J 2000, 52:411–415.

    PubMed  CAS  Google Scholar 

  33. 33.

    Bhopal R, Fischbacher C, Vartiainen E, et al.: Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data. J Public Health (Oxf) 2005, 27:93–100.

    Article  Google Scholar 

  34. 34.

    Ballantyne CM, Weiss R, Moccetti T, et al.: Efficacy and safety of rosuvastatin 40 mg alone or in combination with ezetimibe in patients at high risk of cardiovascular disease (results from the EXPLORER study). Am J Cardiol 2007, 99:673–680.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Nakamura H, Arakawa K, Itakura H, et al.: Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet 2006, 368:1155–1163.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Matsuzaki M, Kita T, Mabuchi H, et al.: Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia. Circ J 2002, 66:1087–1095.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Deedwania P, Haffner S, Ycas J, Stein M: Comparison of statin treatment of hypercholesterolemic patients in ethenically diverse populations with and without diabetes J Am Coll Cardiol 2007, 49(Suppl):327A.

    Google Scholar 

  38. 38.

    Patel JV, Gupta S, Lie F, Hughes EA: Efficacy and safety of atorvastatin in South Asian patients with dyslipidemia: an open label noncomparative pilot study. Vasc Health and Risk Manage 2005, 1:351–356.

    Article  CAS  Google Scholar 

  39. 39.

    Jayaram S, Jain MM, Naikawadi AA, et al.: Comparative evaluation of the efficacy, safety, and tolerability of rosuvastatin 10 mg with atorvastatin 10 mg in adult patients with hypercholesterolaemia: the first Indian study. J Indian Med Assoc 2004, 102:48–50, 52.

    PubMed  CAS  Google Scholar 

  40. 40.

    Lee E, Ryan S, Birmingham B, et al.: Rosuvastatin pharmacokinetics and pharmacogenetics in white and Asian subjects residing in the same environment. Clin Pharmacol Ther 2005, 78:330–341.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Berg K, Dahlen G, Christophersen B, et al.: Lp(a) lipoprotein level predicts survival and major coronary events in the Scandinavian Simvastatin Survival Study. Clin Genet 1997, 52:254–261.

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Carlson LA, Hamsten A, Asplund A: Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid. J Intern Med 1989, 226:271–276.

    PubMed  CAS  Google Scholar 

  43. 43.

    Morgan JM, Capuzzi DM, Baksh RI, et al.: Effects of extended-release niacin on lipoprotein subclass distribution. Am J Cardiol 2003, 91:1432–1436.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Sharma M, Sharma DR, Singh V, et al.: Evaluation of efficacy and safety of fixed dose lovastatin and niacin(ER) combination in asian Indian dyslipidemic patients: a multicentric study. Vasc Health Risk Manage 2006, 2:87–93.

    Article  CAS  Google Scholar 

  45. 45.

    Kashyap ML, McGovern ME, Berra K, et al.: Long-term safety and efficacy of a once-daily niacin/lovastatin formulation for patients with dyslipidemia. Am J Cardiol 2002, 89:672–678.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Aarabi M, Jackson PR: Predicting coronary risk in UK South Asians: an adjustment method for Framingham-based tools. Eur J Cardiovasc Prev Rehabil 2005, 12:46–51.

    PubMed  Article  Google Scholar 

  47. 47.

    JBS: Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998, 80(Suppl 2):S1–S29.

  48. 48.

    American Association of Physicians of Indian Origin (AAPI) Concensus Statement on Management of Dyslipidemia among Asian Indians. http://www.AAPIUSA.org/aapicare/ aapihealth and nutrition. Accessed April 1, 2007.

  49. 49.

    Boden WE, O’Rourke RA, Teo KK, et al.: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007, 357:1503–1516.

    Article  Google Scholar 

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Correspondence to Enas A. Enas MD.

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Enas, E.A., Chacko, V., Pazhoor, S.G. et al. Dyslipidemia in South Asian patients. Curr Atheroscler Rep 9, 367–374 (2007). https://doi.org/10.1007/s11883-007-0047-y

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Keywords

  • Coronary Artery Disease
  • Rosuvastatin
  • Ezetimibe
  • Coronary Artery Disease Risk
  • Premature Coronary Artery Disease