Sarah T Ahmed1,2, Hasan Rehman3, Julia M Akeroyd1,2, Mahboob Alam4, Tina Shah4,5, Ankur Kalra6,7, Salim S Virani8,9,10,11. 1. Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, 2002 Holcombe Blvd, Houston, TX, 77030, USA. 2. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 3. Department of Medicine, Houston Methodist Hospital, Houston, TX, USA. 4. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 5. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. 6. Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 7. Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA. 8. Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, 2002 Holcombe Blvd, Houston, TX, 77030, USA. virani@bcm.edu. 9. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 10. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. virani@bcm.edu. 11. Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA. virani@bcm.edu.
Abstract
PURPOSE OF REVIEW: While the burden of cardiovascular disease (CVD) is on the decline globally, it is on the rise among South Asians. South Asians are also believed to present early with coronary artery disease (CAD) compared with other ethnicities. RECENT FINDINGS: South Asians have demonstrated a higher burden of premature CAD (PCAD) compared with other ethnicities. These findings are not limited to non-immigrant South Asians but have also been found in immigrant South Asians settled around the world. In this article, we first discuss studies evaluating PCAD among South Asians residing in South Asia and among South Asian immigrants in other countries. We then discuss several traditional risk factors that could explain PCAD in South Asians (diabetes, hypertension, dietary factors, obesity) and lipoprotein-associated risk (low HDL-C levels, higher triglycerides, and elevated apolipoprotein B levels). We then discuss several emerging areas of research among South Asians including the role of dysfunctional HDL, elevated lipoprotein(a), genetics, and epigenetics. Although various risk markers and risk factors of CAD have been identified in South Asians, how they impact therapy is not well-known. PCAD is prevalent in the South Asian population. Large-scale studies are needed to identify how this information can be rationally utilized for early identification of risk among South Asians, and how currently available therapies can mitigate this increased risk.
PURPOSE OF REVIEW: While the burden of cardiovascular disease (CVD) is on the decline globally, it is on the rise among South Asians. South Asians are also believed to present early with coronary artery disease (CAD) compared with other ethnicities. RECENT FINDINGS: South Asians have demonstrated a higher burden of premature CAD (PCAD) compared with other ethnicities. These findings are not limited to non-immigrant South Asians but have also been found in immigrant South Asians settled around the world. In this article, we first discuss studies evaluating PCAD among South Asians residing in South Asia and among South Asian immigrants in other countries. We then discuss several traditional risk factors that could explain PCAD in South Asians (diabetes, hypertension, dietary factors, obesity) and lipoprotein-associated risk (low HDL-C levels, higher triglycerides, and elevated apolipoprotein B levels). We then discuss several emerging areas of research among South Asians including the role of dysfunctional HDL, elevated lipoprotein(a), genetics, and epigenetics. Although various risk markers and risk factors of CAD have been identified in South Asians, how they impact therapy is not well-known. PCAD is prevalent in the South Asian population. Large-scale studies are needed to identify how this information can be rationally utilized for early identification of risk among South Asians, and how currently available therapies can mitigate this increased risk.
Entities:
Keywords:
India; Pakistan; Premature CAD; Premature CHD; South Asia
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