Angiographic comparison of coronary artery disease between Asians and Caucasians

Abstract

Summary:Asians in the United Kingdom surpass the already high mortality from coronary artery disease seen in Caucasians. In the present study, the angiographic features of consecutive series of 87 Caucasians, 83 British Asian and 30 Asian patients in India with coronary artery disease were assessed. Blood samples at fasting and after ingestion of75 g ofdextrose were taken to assess the extent ofdiabetes. Fasting blood samples were also taken for measurement of cholesterol, high-density lipoprotein cholesterol and triglyceride. Coronary angiograms were scored by two independent observers who were blinded to the patients' ethnic origin.The Asians were younger than the Caucasians, but did not differ in their body mass index, systolic or diastolic blood pressure or in cigarette consumption. Lipids were similar apart from Indian Asians having lower cholesterol than British Asians, and Caucasians having lower triglyceride than Asians. There were more diabetics in Asians than in Caucasians. Asians in Britain wait longer than Caucasians and Asians in India from onset of angina to undergoing coronary angiography.The presence oftriple vessel disease was not significantly different (P = 0.19) in the three groups, that is, 38%, 43% and 27% in Caucasians, British Asians and Indian Asians, respectively. The geometric mean coronary score was 26.3 (C.I. 22.6-30.6), 25.3 (C.I. 21.8-29.4), and 25.2 (C.I. 19.6-32.5) in Caucasians, British Asians and Indian Asians, respectively. This difference was not significant (P = 0.92). Total number of lesions more than three were similar, that is, in 25% Caucasian, 41% British Asian and 40% Indian Asian patients (P <0.10). British Asians had less proximal disease (P = 0.0002), and Indian Asians less distal disease (P = 0.003) compared to Caucasians. Non-discrete (long) lesions were more prevalent in Asians than Caucasians (P = 0.0005).The total number of lesions more than three in diabetic Asians was significantly more than in the non-diabetic, 71% versus 31% in British Asians (P = 0.002) and 90% versus 15% in Indian Asians (P= 0.0001). The relationship between diabetes and long lesions in both British and Indian Asians was highly significant (P < 0.00001 and P < 0.001, respectively).Thus severity and extent of coronary disease is no different in Asians as compared to Caucasians. Diabetes is perhaps responsible for the more diffuse disease seen in Asians.

Coronary Artery Diameter is Inversely Associated with the Severity of Coronary Lesions in Patients Undergoing Coronary Angiography

“…Following the study published by MacAlpin et al [18] in 1972, which demonstrated that the human coronary artery lumen diameter can be accurately measured by using the catheter tip as a calibrating object, we measured the coronary artery diameter in the present study using the catheter tip as a calibrating object. Our results were consistent with those of previous studies, which showed that the diameters of coronary arteries are highly variable [19-22], considering that genetic and environmental factors including age, sex, ethnicity, and race have all been correlated with the coronary artery diameter. Previous reports have also indicated a gender-related difference in coronary artery diameters [23], although the potential differences in coronary artery diameters between males and females remain controversial.…”

Differences between South Asians and White Europeans in five year outcome following percutaneous coronary intervention

“…A differential access to coronary angiography and revascularisation procedures has previously been reported among SA patients (10)(11)(12), although no difference was observed between British SAs and WEs in the time from onset of symptoms to referral for coronary angiography (13). It is not known whether there is a difference in outcomes between SA and WE in those offered PCI.…”

South Asian men have different patterns of coronary artery disease when compared with European men

“…These observations are unexplained but may be due to adverse local patterns of atherosclerosis itself, or vessel responses to atheroma. In support of this hypothesis, South Asians in the UK have been reported to have a more proximal distribution of angiographic CAD in association with longer lesions than Caucasians [11]. In addition, a number of studies suggest that South Asians have smaller coronary arteries than Europeans, although some, but not all, report that the difference is explained by smaller body size [12][13][14][15][16].…”