Lipoprotein abnormalities in South Asians and its association with cardiovascular disease: Current state and future directions

Abstract

South Asians have a high prevalence of coronary heart disease (CHD) and suffer from early-onset CHD compared to other ethnic groups. Conventional risk factors may not fully explain this increased CHD risk in this population. Indeed, South Asians have a unique lipid profile which may predispose them to premature CHD. Dyslipidemia in this patient population seems to be an important contributor to the high incidence of coronary atherosclerosis. The dyslipidemia in South Asians is characterized by elevated levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, elevated lipoprotein(a) levels, and a higher atherogenic particle burden despite comparable low-density lipoprotein cholesterol levels compared with other ethnic subgroups. HDL particles also appear to be smaller, dysfunctional, and proatherogenic in South Asians. Despite the rapid expansion of the current literature with better understanding of the specific lipid abnormalities in this patient population, studies with adequate sample sizes are needed to assess the significance and contribution of a given lipid parameter on overall cardiovascular risk in this population. Specific management goals and treatment thresholds do not exist for South Asians because of paucity of data. Current treatment recommendations are mostly extrapolated from Western guidelines. Lastly, large, prospective studies with outcomes data are needed to assess cardiovascular benefit associated with various lipid-lowering therapies (including combination therapy) in this patient population.

The role of Lp-PLA2 and biochemistry parameters as potential biomarkers of coronary artery disease in Asian South-Indians: a case-control study

“…South Asians make up 1/5 th of the world population and Asian Indians are a majority in this group (6). India has an estimated 31.8 million people with CAD, and the incidence of CAD in this population is expected to grow.…”

Serum lipid profile as a predictor of dengue severity: A systematic review and meta‐analysis

“…The association demonstrated in the present review is significantly stronger among Asians ( P ‐value <.0001) compared with Latin Americans ( P ‐value = .01). South Asians, which refer to people who have ancestral origins in the Indian subcontinent (eg, India, Pakistan, Bangladesh, Sri Lanka, and Nepal), are genetically predisposed to hypercholesterolemia, thus presenting marked difficulty in reducing serum cholesterol levels . Thus, it is suggested that for an acute decrease in the levels of this lipid, as those associated with severe dengue conditions, it is necessary that the responsible event of this phenomenon presents itself a sufficient intensity to overcome this genetic predisposition.…”

“…South Asians, which refer to people who have ancestral origins in the Indian subcontinent (eg, India, Pakistan, Bangladesh, Sri Lanka, and Nepal), are genetically predisposed to hypercholesterolemia, thus presenting marked difficulty in reducing serum cholesterol levels. 43 Thus, it is suggested that for an acute decrease in the levels of this lipid, as those associated with severe dengue conditions, it is necessary that the responsible event of this phenomenon presents itself a sufficient intensity to overcome this genetic predisposition. Latin Americans population, in turn, present serum cholesterol levels more sensitive to environmental variations, which make this association in the population less robust.…”

Cardiovascular disease and diabetes in patients with African or Asian background

“…The HDL cholesterol particles also tend to be smaller and are more often dysfunctional. Moreover, there is an increased prevalence of highly atherogenic, small dense LDL particles, even though the total LDL level is on a par with that of other population groups (8,9,16). It also appears that hyperglycaemia has a greater impact on left ventricular function in South Asians than in Caucasians, which often manifests itself as fatigue and reduced capacity for work (17,18).…”