Lipids in South Asians: Epidemiology and Management

Overview

Journal Curr Cardiovasc Risk Rep

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2021 Apr 9

PMID 33833849

Citations 10

Authors

Minhal Makshood

Wendy S Post

Alka M Kanaya

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: This review focuses on lipoprotein abnormalities in South Asians (SA) and addresses risk stratification and management strategies to lower atherosclerotic cardiovascular disease (ASCVD) in this high-risk population.

Recent Findings: South Asians (SAs) are the fastest growing ethnic group in the United States (U.S) and have an increased risk of premature coronary artery disease (CAD). While the etiology may be multifactorial, lipoprotein abnormalities play a key role. SAs have lower low-density lipoprotein cholesterol (LDL-C) compared with Whites and at any given LDL-C level, SA ethnicity poses a higher risk of myocardial infarction (MI) and coronary artery disease (CAD) compared with other non-Asian groups. SAs have lower high-density lipoprotein cholesterol (HDL-C) with smaller particle sizes of HDL-C compared with Whites. SAs also have higher triglycerides than Whites which is strongly related to the high prevalence of metabolic syndrome in SAs. Lipoprotein a (Lp(a)) levels are also higher in SAs compared with many other ethnic groups. This unique lipoprotein profile plays a vital role in the elevated ASCVD risk in SAs. Studies evaluating dietary patterns of SAs in the U.S show high consumption of carbohydrates and saturated fats.

Summary: SAs have a high-risk lipoprotein profile compared with other ethnicities. Lipid abnormalities play a central role in the pathogenesis of CAD in SAs. More studies are needed to understand the true impact of the various lipoproteins and their contribution to increasing ASCVD in SAs. Aggressive lowering of LDL-C in high-risk groups using medications, such as statins, and lifestyle modification including dietary changes is essential in overall CAD risk reduction.

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References

Olson J, Bild D, Kronmal R, Burke G . Legacy of MESA. Glob Heart. 2016; 11(3):269-274. PMC: 5134741. DOI: 10.1016/j.gheart.2016.08.004. View

Anand S, Enas E, Pogue J, Haffner S, Pearson T, Yusuf S . Elevated lipoprotein(a) levels in South Asians in North America. Metabolism. 1998; 47(2):182-4. DOI: 10.1016/s0026-0495(98)90217-7. View

Gadgil M, Anderson C, Kandula N, Kanaya A . Dietary patterns are associated with metabolic risk factors in South Asians living in the United States. J Nutr. 2015; 145(6):1211-7. PMC: 4442115. DOI: 10.3945/jn.114.207753. View

Mukherjea A, Underwood K, Stewart A, Ivey S, Kanaya A . Asian Indian views on diet and health in the United States: importance of understanding cultural and social factors to address disparities. Fam Community Health. 2013; 36(4):311-23. PMC: 3987985. DOI: 10.1097/FCH.0b013e31829d2549. View

Anand S, Yusuf S, Vuksan V, Devanesen S, Montague P, Kelemen L . The Study of Health Assessment and Risk in Ethnic groups (SHARE): rationale and design. The SHARE Investigators. Can J Cardiol. 1998; 14(11):1349-57. View

Hastings K, Jose P, Kapphahn K, Frank A, Goldstein B, Thompson C . Leading Causes of Death among Asian American Subgroups (2003-2011). PLoS One. 2015; 10(4):e0124341. PMC: 4411112. DOI: 10.1371/journal.pone.0124341. View

Karthikeyan G, Teo K, Islam S, McQueen M, Pais P, Wang X . Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians: an analysis from the INTERHEART Study. J Am Coll Cardiol. 2009; 53(3):244-53. DOI: 10.1016/j.jacc.2008.09.041. View

Huffman M, Kandula N, Baldridge A, Tsai M, Prabhakaran D, Kanaya A . Evaluating the Potential Association Between Lipoprotein(a) and Atherosclerosis (from the Mediators of Atherosclerosis Among South Asians Living in America Cohort). Am J Cardiol. 2019; 123(6):919-921. PMC: 6397053. DOI: 10.1016/j.amjcard.2018.12.013. View

Thomas I, Gupta S, Sempos C, Cooper R . Serum lipids of Indian physicians living in the U.S. compared to U.S.-born physicians. Atherosclerosis. 1986; 61(2):99-106. DOI: 10.1016/0021-9150(86)90068-7. View

10.

Lee E, Ryan S, Birmingham B, Zalikowski J, March R, Ambrose H . Rosuvastatin pharmacokinetics and pharmacogenetics in white and Asian subjects residing in the same environment. Clin Pharmacol Ther. 2005; 78(4):330-41. DOI: 10.1016/j.clpt.2005.06.013. View

11.

Kandula N, Kanaya A, Liu K, Lee J, Herrington D, Hulley S . Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. J Am Heart Assoc. 2014; 3(5):e001117. PMC: 4323809. DOI: 10.1161/JAHA.114.001117. View

12.

Kanaya A, Vittinghoff E, Lin F, Kandula N, Herrington D, Liu K . Incidence and Progression of Coronary Artery Calcium in South Asians Compared With 4 Race/Ethnic Groups. J Am Heart Assoc. 2019; 8(2):e011053. PMC: 6497354. DOI: 10.1161/JAHA.118.011053. View

13.

Chow C, McQuillan B, Raju P, Iyengar S, Raju R, Harmer J . Greater adverse effects of cholesterol and diabetes on carotid intima-media thickness in South Asian Indians: comparison of risk factor-IMT associations in two population-based surveys. Atherosclerosis. 2007; 199(1):116-22. DOI: 10.1016/j.atherosclerosis.2007.10.008. View

14.

Bhupathiraju S, Guasch-Ferre M, Gadgil M, Newgard C, Bain J, Muehlbauer M . Dietary Patterns among Asian Indians Living in the United States Have Distinct Metabolomic Profiles That Are Associated with Cardiometabolic Risk. J Nutr. 2018; 148(7):1150-1159. PMC: 6251517. DOI: 10.1093/jn/nxy074. View

15.

Saleheen D, Zaidi M, Rasheed A, Ahmad U, Hakeem A, Murtaza M . The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia. Eur J Epidemiol. 2009; 24(6):329-38. PMC: 2697028. DOI: 10.1007/s10654-009-9334-y. View

16.

Bhalodkar N, Blum S, Rana T, Bhalodkar A, Kitchappa R, Kim K . 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(12):1561-3. DOI: 10.1016/j.amjcard.2004.08.040. View

17.

Isser H, Puri V, Narain V, Saran R, Dwivedi S, Singh S . Lipoprotein (a) and lipid levels in young patients with myocardial infarction and their first-degree relatives. Indian Heart J. 2002; 53(4):463-6. View

18.

Giugliano R, Cannon C, Blazing M, Nicolau J, Corbalan R, Spinar J . Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus: Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial). Circulation. 2017; 137(15):1571-1582. DOI: 10.1161/CIRCULATIONAHA.117.030950. View

19.

Wilson P, Polonsky T, Miedema M, Khera A, Kosinski A, Kuvin J . Systematic Review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice.... J Am Coll Cardiol. 2018; 73(24):3210-3227. DOI: 10.1016/j.jacc.2018.11.004. View

20.

Palaniappan L, Anthony M, Mahesh C, Elliott M, Killeen A, Giacherio D . Cardiovascular risk factors in ethnic minority women aged < or =30 years. Am J Cardiol. 2002; 89(5):524-9. DOI: 10.1016/s0002-9149(01)02291-3. View