Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide and was responsible for 7.2 million deaths in 2003. Various studies have pointed out that South Asians have a higher prevalence of CAD as compared with other ethnicities. South Asians may have a genetic predisposition to CAD; however, environmental, nutritional, and lifestyle factors may also be responsible. South Asians have a much higher prevalence of metabolic syndrome, diabetes, insulin resistance (and resultant hyperinsulinemia), central obesity, dyslipidemias (lower high-density lipoprotein, increased lipoprotein[a], higher triglyceride levels), increased thrombotic tendency (increased plasminogen activator inhibitor-1 and decreased tissue plasminogen activator levels), decreased levels of physical activity, and low birth weights ("fetal origins hypothesis"). In addition, the dietary indiscretions and sedentary lifestyle practiced by most South Asians puts them at a higher risk. A multidisciplinary approach involving the population at risk, healthcare personnel, and the government is required to diminish the incidence. Educational programs regarding the genetic predisposition as well as risk factors for CAD, physical activity, and dietary modifications need to be encouraged. There is a need for implementation of newer guidelines as well as a lower threshold for initiating therapeutic interventions in this population. Mass media should be involved to bring about behavioral changes, and these changes should be reinforced at the physician's level.

Statins therapy slows down the progression of carotid atherosclerosis as measured by CIMT, indicating benefits at subclinical stage of the disease process.

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Intravascular ultrasound (IVUS) is a novel technique that provides an accurate and reproducible method to measure atheroma burden. Statin drugs reduce both atherogenic lipoproteins and cardiovascular morbidity and mortality. Studies assessing the effect of statin treatment on atheroma burden have shown conflicting results. Hence, this meta-analysis was conducted to evaluate the impact of statin therapy on coronary atherosclerosis progression. A systematic search using PubMed, EMBASE, and Cochrane Library databases was performed. Heterogeneity of the studies was analyzed by Cochran's Q statistics. The significance of common treatment effect was assessed by computing common mean difference between the control and treatment groups. A two-sided a error of <0.05 was considered statistically significant (P<.05). Eight trials composed of 919 patients including a placebo group with 458 patients and a treatment group with 461 patients were used. Characteristics of both groups at baseline were similar without any significant difference between them. In the pooled analysis, the common mean difference of coronary atheroma volume between statin therapy and the placebo arm was )3.573 (confidence interval, )4.46 to )2.68; P<.01). This meta-analysis demonstrates that treatment with statins not only slows atherosclerotic plaque progression but may also lead to plaque regression. J Clin Hypertens (Greenwich). 2011;13:492-496. Ó2011 Wiley Periodicals, Inc.Therapy with high doses of 3-hydroxy 3-methylglutaryl coenzyme A reductase (HMG CoA) inhibitors (statins) reduces both atherogenic lipoproteins and cardiovascular morbidity and mortality.1,2 Studies have shown that intensive statin therapy is more effective than moderate therapy in reducing the progression of atherosclerosis as determined by measuring carotid intimal medial thickness or assessing atheroma burden using intravascular ultrasound (IVUS). 3-5Angiography plays a pivotal role in the selection of patients for revascularization and has been widely used to measure the efficacy of anti-atherosclerotic drug therapies.6-8 However, angiography depicts a silhouette of the coronary lumen and does not directly image the atheroma within the vessel wall, where anti-atherosclerotic therapies show their effects. The recent application of IVUS in progression-regression trials enabled systematic assessment of the effects of such therapies on various components of the vessel, including the atheroma itself. 4,9-11 IVUS provides an accurate and reproducible method to measure atheroma burden and can be used to evaluate progression of coronary atherosclerosis. IVUS is a particularly good method for assessing atherosclerosis because it allows measurement of atheroma burden, not just luminal narrowing.12 IVUS allows the earlier stage of eccentric growth and intramural atheroma formation to be quantified and followed. 13 Therefore, many recent studies have used this tool to measure the effects of various anti-atherosclerotic therapies on coronary atheroma burden.However, studies assessing the ...

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