Advertisement

Dyslipidemia in South Asians living in a western community

Published:December 15, 2008DOI:https://doi.org/10.1016/j.jacl.2008.12.002

      Abstract

      An increased prevalence of coronary heart disease (CHD) has been well documented in the South Asian population living worldwide. The prevalence of certain traditional CHD risk factors, like diabetes mellitus and tobacco use, have been on the rise in this ethnic group and likely contribute to the increase in CHD prevalence. Still, a disproportionate excess of CHD exists, and this may be linked to novel CHD risk factors. We have reviewed the prevalence of CHD in South Asians and its association to both traditional and novel CHD risk factors. We present a literature review of traditional and novel CHD risk factors, and incorporate the results of a cross-sectional study investigating the prevalence of these factors in a South Asian population residing in the United States with no prior diagnosis of CHD. The total cholesterol (TC) (mean ± standard deviation) was 193.72 ± 33.76 mg/dL, high-density lipoprotein (HDL) was 42.20 ± 12.11 mg/dL, and low-density lipoprotein (LDL) was 124.88 ± 27.22 mg/dL. The mean triglyceride level was 166.60 mg/dL. The prevalence of elevated TC (>200 mg/dL) was 41.3% and elevated LDL (>130 mg/dL) 40.7%. There was a significant difference between men and women in the prevalence of reduced HDL (<40 mg/dL) (67.3% vs. 49.4%), elevated triglycerides (>130 mg/dL) (56.4 vs. 30.4%), and small-dense LDL particles (53.6% vs. 27.8%).
      Considerably higher prevalence of novel CHD risk factors has been noted in the South Asian population. The CHD risk may increase significantly when these novel factors co-exist with traditional CHD risk factors.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Lipidology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lee J.
        • Heng D.
        • Chia K.S.
        • Chew S.K.
        • Tan B.Y.
        • Hughes K.
        Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study.
        Int J Epidemiol. 2001; 30: 983-988
        • Mohan V.
        • Deepa R.
        • Rani S.S.
        • Premalatha G.
        Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5).
        J Am Coll Cardiol. 2001; 38: 682-687
        • Srinath Reddy K.
        • Shah B.
        • Varghese C.
        • Ramadoss A.
        Responding to the threat of chronic diseases in India.
        Lancet. 2005; 366: 1744-1749
        • 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
        • Dhawan J.
        • Bray C.L.
        • Warburton R.
        • Ghambhir D.S.
        • Morris J.
        Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect?.
        Br Heart J. 1994; 72: 413-421
        • Hughes L.O.
        • Wojciechowski A.P.
        • Raftery E.B.
        Relationship between plasma cholesterol and coronary artery disease in Asians.
        Atherosclerosis. 1990; 83: 15-20
        • McKeigue P.M.
        • Miller G.J.
        • Marmot M.G.
        Coronary heart disease in south Asians overseas: a review.
        J Clin Epidemiol. 1989; 42: 597-609
        • Control CfD
        Prevalence of cigarette use among 14 racial/ethnic populations—United States, 1999-2001.
        MMWR. 2004; 53: 49-52
        • WHO
        Tobacco or health: a global status report.
        World Health Organization, Geneva1997
        • Wild S.
        • Roglic G.
        • Green A.
        • Sicree R.
        • King H.
        Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Kooner J.S.
        • Baliga R.R.
        • Wilding J.
        • et al.
        Abdominal obesity, impaired nonesterified fatty acid suppression, and insulin-mediated glucose disposal are early metabolic abnormalities in families with premature myocardial infarction.
        Arterioscler Thromb Vasc Biol. 1998; 18: 1021-1026
        • McKeigue P.M.
        • Shah B.
        • Marmot M.G.
        Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.
        Lancet. 1991; 337: 382-386
        • Zoratti R.
        • Godsland I.F.
        • Chaturvedi N.
        • Crook D.
        • Stevenson J.C.
        • McKeigue P.M.
        Relation of plasma lipids to insulin resistance, nonesterified fatty acid levels, and body fat in men from three ethnic groups: relevance to variation in risk of diabetes and coronary disease.
        Metabolism. 2000; 49: 245-252
        • Lakka H.M.
        • Laaksonen D.E.
        • Lakka T.A.
        • et al.
        The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.
        JAMA. 2002; 288: 2709-2716
        • King H.
        • Aubert R.E.
        • Herman W.H.
        Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections.
        Diabetes Care. 1998; 21: 1414-1431
        • Hodge A.M.
        • Dowse G.K.
        • Collins V.R.
        • et al.
        Abdominal fat distribution and insulin levels only partially explain adverse cardiovascular risk profile in Asian Indians.
        J Cardiovasc Risk. 1996; 3: 263-270
        • Jeyarajah E.J.
        • Cromwell W.C.
        • Otvos J.D.
        Lipoprotein particle analysis by nuclear magnetic resonance spectroscopy.
        Clin Lab Med. 2006; 26: 847-870
        • Grewal K.S.
        • Kolluri R.
        • Patel A.
        Prevalence of Lipid triad, lipoprotein (a) and C-reactive protein in a screening population of South Asian women: implications for heart disease in Asian American women.
        Second International Conference on Women, Heart Disease and Stroke (American Heart Association), Orlando, HL2005
        • France M.W.
        • Kwok S.
        • McElduff P.
        • Seneviratne C.J.
        Ethnic trends in lipid tests in general practice.
        QJM. 2003; 96: 919-923
        • Gama R.
        • Elfatih A.B.
        • Anderson N.R.
        Ethnic differences in total and HDL cholesterol concentrations: Caucasians compared with predominantly Punjabi Sikh Indo-Asians.
        Ann Clin Biochem. 2002; 39: 609-611
        • McKeigue P.M.
        • Marmot M.G.
        • Adelstein A.M.
        • et al.
        Diet and risk factors for coronary heart disease in Asians in northwest London.
        Lancet. 1985; 2: 1086-1090
        • Bhalodkar N.C.
        • 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
        • Enas E.A.
        Coronary artery disease epidemic in Indians: a cause for alarm and call for action.
        J Indian Med Assoc. 2000; 98 (697–702): 694-695
        • Julius U.
        • Dittrich M.
        • Pietzsch J.
        Factors influencing the formation of small dense low-density lipoprotein particles in dependence on the presence of the metabolic syndrome and on the degree of glucose intolerance.
        Int J Clin Pract. 2007; 61: 1798-1804
        • Kulkarni K.R.
        • Markovitz J.H.
        • Nanda N.C.
        • Segrest J.P.
        Increased prevalence of smaller and denser LDL particles in Asian Indians.
        Arterioscler Thromb Vasc Biol. 1999; 19): 2749-2755
        • Danesh J.
        • Collins R.
        • Peto R.
        • Lowe G.D.
        Haematocrit, viscosity, erythrocyte sedimentation rate: meta-analyses of prospective studies of coronary heart disease.
        Eur Heart J. 2000; 21: 515-520
        • Gupta R.
        • Deedwania P.C.
        • Gupta A.
        • et al.
        Prevalence of metabolic syndrome in an Indian urban population.
        Int J Cardiol. 2004; 97: 257-261
        • Rajeshwari R.
        • Nicklas T.
        • Pownall H.
        • Berenson G.
        Cardiovascular diseaes: a major health risk in Asian Indians.
        Nutr Res. 2005; 25: 515-533
        • Barrett-Connor E.L.
        • Cohn B.A.
        • Wingard D.L.
        • Edelstein S.L.
        Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study.
        JAMA. 1991; 265: 627-631
      1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Schrott H.G.
        • Bittner V.
        • Vittinghoff E.
        • Herrington D.M.
        • Hulley S.
        Adherence to National Cholesterol Education Program treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replacement Study (HERS). The HERS Research Group.
        JAMA. 1997; 277: 1281-1286
        • Palaniappan L.
        • Wang Y.
        • Fortmann S.P.
        Coronary heart disease mortality for six ethnic groups in California, 1990-2000.
        Ann Epidemiol. 2004; 14: 499-506
        • Gambhir J.K.
        • Kaur H.
        • Gambhir D.S.
        • Prabhu K.M.
        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
        • Isser H.S.
        • Puri V.K.
        • Narain V.S.
        • Saran R.K.
        • Dwivedi S.K.
        • Singh S.
        Lipoprotein (a) and lipid levels in young patients with myocardial infarction and their first-degree relatives.
        Indian Heart J. 2001; 53: 463-466
        • Bhatnagar D.
        • Anand I.S.
        • Durrington P.N.
        • et al.
        Coronary risk factors in people from the Indian subcontinent living in west London and their siblings in India.
        Lancet. 1995; 345: 405-409
        • Hopkins P.N.
        • Wu L.L.
        • Hunt S.C.
        • James B.C.
        • Vincent G.M.
        • Williams R.R.
        Lipoprotein(a) interactions with lipid and nonlipid risk factors in early familial coronary artery disease.
        Arterioscler Thromb Vasc Biol. 1997; 17: 2783-2792
        • Pearson T.A.
        • Mensah G.A.
        • Alexander R.W.
        • et al.
        Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
        Circulation. 2003; 107: 499-511
        • Rutter M.K.
        • Meigs J.B.
        • Sullivan L.M.
        • D'Agostino Sr., R.B.
        • Wilson P.W.
        C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study.
        Circulation. 2004; 110: 380-385
        • Anand S.S.
        • Razak F.
        • Yi Q.
        • et al.
        C-reactive protein as a screening test for cardiovascular risk in a multiethnic population.
        Arterioscler Thromb Vasc Biol. 2004; 24: 1509-1515
        • O'Callaghan P.
        • Meleady R.
        • Fitzgerald T.
        • Graham I.
        Smoking and plasma homocysteine.
        Eur Heart J. 2002; 23: 1580-1586
        • Clarke R.
        • Collins R.
        • Lewington S.
        Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis.
        JAMA. 2002; 288: 2015-2022
        • Foody J.M.
        • Milberg J.A.
        • Robinson K.
        • et al.
        Homocysteine and lipoprotein(a) interact to increase CAD risk in young men and women.
        Arterioscler Thromb Vasc Biol. 2000; 20: 493-499
        • Refsum H.
        • Yajnik C.S.
        • Gadkari M.
        • et al.
        Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians.
        Am J Clin Nutr. 2001; 74: 233-241
        • Chambers J.C.
        • Obeid O.A.
        • Refsum H.
        • et al.
        Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men.
        Lancet. 2000; 355: 523-527
        • Obeid O.A.
        • Mannan N.
        • Perry G.
        • Iles R.A.
        • Boucher B.J.
        Homocysteine and folate in healthy east London Bangladeshis.
        Lancet. 1998; 352: 1829-1830
        • Bazzano L.A.
        • Reynolds K.
        • Holder K.N.
        • He J.
        Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis of randomized controlled trials.
        JAMA. 2006; 296: 2720-2726