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The British Journal of Diabetes & Vascular Disease
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Dyslipidaemia among Indo-Asians strategies for identification and management

Enas A Enas

Coronary Artery Disease in Indians (CADI) Research Foundation 1935 Green Trails Dr, Lisle, IL 60532, USA, cadiusa{at}msn.com

Annamalai Senthilkumar

Chacko Vinod

Neal Puthumana

ndo-Asians have the highest rates of coronary artery disease (CAD) despite the fact that nearly half are lifelong vegetarians. The incidence, prevalence, and mortality from CAD among overseas Indo-Asians have been 50% to 300% higher than the Europeans, Americans, and other Asians with a higher risk at younger ages. Approximately 10% of the adults in urban India have CAD, a rate similar to overseas Indians. Traditional risk factors do not fully explain the excess burden of CAD in Indo-Asians. Therefore, conventional approaches to testing and treatment of risk factors are not sufficient in this population. Indo-Asians have a higher prevalence of glucose intolerance, metabolic syndrome, diabetes, elevated concentrations of lipoprotein(a) (LP[a]), and homocysteine, and low concentrations of high density lipoprotein (HDL). HDL particles are also smaller in Indo-Asians than Whites. A more aggressive approach to all risk factors, including HDL, LP(a), triglycerides and homocysteine is warranted. The current evidence of established safety and broad spectrum lipoprotein benefits of niacin and statins would make these invaluable agents in the armamentarium against dyslipidaemia, especially in Indo-Asians. This is particularly true for those with metabolic syndrome, diabetic dyslipidaemia and Lp(a) excess.

Key Words: Indo-Asians • coronary artery disease • metabolic syndrome • dyslipidaemia • lipoprotein(a) • statin • niacin • combination therapy.

References

  • Enas EA Coronary artery disease epidemic in Indians: A cause for alarm and call for action. J Indian Med Assoc 2000;98:694-5, 697-702.
  • Enas EA, Dhawan J., Petkar S. Coronary artery disease in Asian Indians: Lessons learned so far and the role of Lp(a). Indian Heart J 1997;49:25-34.[Medline] [Order article via Infotrieve]
  • Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ 1991;302:560-4.[Abstract/Free Full Text]
  • Enas EA, Garg A., Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996;48:343-53.[Medline] [Order article via Infotrieve]
  • Mohan V., Deepa R., Shanthi Rani S., Premalatha G. Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India. The Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol 2001;38:682-7.[Abstract/Free Full Text]
  • Enas EA, Senthilkumar A., Juturu V., Gupta R. Coronary artery disease in women. Indian Heart J 2001;53:282-92.[Medline] [Order article via Infotrieve]
  • Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: Thoughts on pathogenesis, prevention, and treatment. Clin Cardiol 1995;18:131-5.[Web of Science][Medline] [Order article via Infotrieve]
  • Ncep Iii. Third Report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. National Institute of Health, 2002.
  • Gupta R., Gupta VP, Sarna M. et al. Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J 2002;54:59-66.[Medline] [Order article via Infotrieve]
  • Superko HR, Enas EA, Kotha P., Bhat N. Impaired cholesterol transport in Asian Indians. Preventive Cardiology 2004:(in press).
  • Bhalodker N., Blum S., Rana T., Enas E. Impaired reverse cholesterol transport in Asian Indian males compared to Framingham Of spring Study population. J Am Coll Cardiol 2004;94:1561-3.
  • Forouhi N., McKeigue P. How far can risk factors account for excess coronary mortality in South Asians? Can J Cardiol 1997;13(suppl B):47B (abstract).
  • www.diabetes.com Redefining obesity and its treatment: The Asia-Pacific perspective 2000. International Diabetes Institute in Australia and WHO www.diabetes.com.au/research/report_obesity.htm Accessed August 25, 2004, 2004.
  • Tan CE, Ma S., Wai D., Chew SK, Tai ES Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care 2004;27:1182-6.[Abstract/Free Full Text]
  • Malik S., Wong ND, Franklin SS et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004;110:1245-50.[Abstract/Free Full Text]
  • Pearson TA, Bulkley BH, Achuff SC, Kwiterovich PO, Gordis L. The association of low levels of HDL cholesterol and arteriographically defined coronary artery disease. Am J Epidemiol 1979;109:285-95.[Abstract/Free Full Text]
  • Foody JM, Ferdinand FD, Pearce GL, Lytle BW, Cosgrove DM, Sprecher DL HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery: 20-year experience from The Cleveland Clinic Foundation. Circulation 2000;102:11190-4.
  • Sharrett AR, Ballantyne CM, Coady SA et al. Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2001;104: 1108-13.[Abstract/Free Full Text]
  • Hughes LO, Wojciechowski AP, Raftery EB Relationship between plasma cholesterol and coronary artery disease in Asians. Atherosclerosis 1990;83:15-20.[Medline] [Order article via Infotrieve]
  • Stamler J., Daviglus ML, Garside DB, Dyer AR, Greenland P., Neaton JD Relationship of baseline serum cholesterol levels in three large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000;284:311-18.[Abstract/Free Full Text]
  • Menotti A., Lanti M., Puddu PE, Kromhout D. Coronary heart disease incidence in northern and southern European populations: A reanalysis of the Seven Countries Study for a European coronary risk chart. Heart 2000;84:238-44.[Abstract/Free Full Text]
  • Grundy SM, Cleeman JI, Merz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.[Abstract/Free Full Text]
  • McLaughlin T., Abbasi F., Cheal K., Chu J., Lamendola C., Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003;139:802-09.[Abstract/Free Full Text]
  • Enas EA, Senthilkumar A., Chennikkara H., Bjurlin MA Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations. Indian Heart J 2003;55:310-38.[Medline] [Order article via Infotrieve]
  • Lu W., Resnick HE, Jablonski KA et al. Non-HDL Cholesterol as a Predictor of Cardiovascular Disease in Type 2 Diabetes: The Strong Heart Study. Diabetes Care 2003;26:16-23.[Abstract/Free Full Text]
  • O'Callaghan P., Meleady R., Fitzgerald T., Graham I. Smoking and plasma homocysteine. Eur Heart J 2002;23:1580-6.[Abstract/Free Full Text]
  • Hopkins PN, Wu LL, Hunt SC, James BC, Vincent GM, Williams RR Lipoprotein(a) interactions with lipid and nonlipid risk factors in early familial coronary artery disease. Arterioscler Thromb Vasc Biol 1997;17: 2783-92.[Abstract/Free Full Text]
  • Refsum H., Yajnik CS, Gadkari M. et al. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr 2001;74:233-41.[Abstract/Free Full Text]
  • Gambhir JK, Kaur H., Gambhir DS, Prabhu KM Lipoprotein(a) as an independent risk factor for coronary artery disease in patients below 40 years of age. Indian Heart J 2000;52:411-15.[Medline] [Order article via Infotrieve]
  • Rifai N., Ma,Sacks FM et al. Apolipoprotein(a) size and lipoprotein(a) concentration and future risk of angina pectoris with evidence of severe coronary atherosclerosis in men: The Physicians' Health Study. Clin Chem 2004;50:1364-71.[Abstract/Free Full Text]
  • von Eckardstein A., Schulte H., Cullen P., Assmann G. Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk. J Am Coll Cardiol 2001;37:434-9.[Abstract/Free Full Text]
  • Christopher R., Kailasanatha KM, Nagaraja D., Tripathi M. Case-control study of serum lipoprotein(a) and apolipoproteins A-I and B in stroke in the young. Acta Neurol Scand 1996;94:127-30.[Web of Science][Medline] [Order article via Infotrieve]
  • Bostom AG, Cupples LA, Jenner JL et al. Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger. A prospective study. JAMA 1996;276:544-8.[Abstract/Free Full Text]
  • Rifai N., Ma J., Sacks FM et al. Apolipoprotein(a) Size and Lipoprotein(a) Concentration and Future Risk of Angina Pectoris with Evidence of Severe Coronary Atherosclerosis in Men: The Physicians' Health Study. Clin Chem 2004;50:1364-71.[Abstract/Free Full Text]
  • Howard BV, Le NA, Belcher JD et al. Concentrations of Lp(a) in black and white young adults: relations to risk factors for cardiovascular disease. Ann Epidemiol 1994;4:341-50.[Medline] [Order article via Infotrieve]
  • Anand S., Enas EA, Pogue J., Haffner S., Pearson T., Yusuf S. Elevated lipoprotein(a) levels in South Asians in North America. Metabolism 1998;47:182-4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Muthusamy V., Amuthan V., Kumaravel V. Lipoprotein(a) and premature coronary artery disease. Indian Heart J 2000;52:765 (abstract).
  • Mohan V., Deepa R., Haranath SP et al. Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India. Diabetes Care 1998;21:1819-23.[Abstract]
  • Enas EA http://www.Cadiresearch.com/illustrated.htm Accessed May 2004.
  • D'Agostino RB Sr, Grundy S., Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001;286:180-7.[Abstract/Free Full Text]
  • Liu JL, Hong Y., D'Agostino RB, Sr et al. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA 2004;291:2591-9.[Abstract/Free Full Text]
  • Enas EA, Senthilkumar A., Mathai A. Statins in the prevention and treatment of coronary artery disease: Closing the knowledge and treatment gap. Asian J Clin Card 2002;5:8-45. 43. Berg K., Dahlen G., Christophersen B., Cook T., Kjekshus J., Pedersen T. Lp(a) lipoprotein level predicts survival and major coronary events in the Scandinavian Simvastatin Survival Study. Clin Genet 1997;52:254-61. 44. Shlipak MG, Simon JA, Vittinghoff E. et al. Estrogen and progestin, lipoprotein(a), and the risk of recurrent coronary heart disease events after menopause. JAMA 2000;283:1845-52.[Abstract/Free Full Text]
  • Brown BG, Zhao XQ, Chait A. et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-92.[Abstract/Free Full Text]
  • Meyers CD, Carr MC, Park S., Brunzell JD Varying cost and free nicotinic acid content in over-the-counter niacin preparations for dyslipidemia. Ann Intern Med 2003;139:996-1002.[Abstract/Free Full Text]
  • Morgan JM, Capuzzi DM, Baksh RI et al. Effects of extended-release niacin on lipoprotein subclass distribution. Am J Cardiol 2003;91:1432-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Kashyap ML, McGovern ME, Berra K. et al. Long-term safety and efficacy of a once-daily niacin/lovastatin formulation for patients with dyslipidemia. Am J Cardiol 2002;89:672-8.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Elam MB, Hunninghake DB, Davis KB et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial. JAMA 2000;284:1263-70.[Abstract/Free Full Text]
  • Grundy SM, Vega GL, McGovern ME et al. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial. Arch Intern Med 2002;162:1568-76.[Abstract/Free Full Text]
  • Pan J., Van JT, Chan E., Kesala RL, Lin M., Charles MA Extended-release niacin treatment of the atherogenic lipid profile and lipoprotein(a) in diabetes. Metabolism 2002;51:1120-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Bays HE, Dujovne CA, McGovern ME et al. Comparison of once-daily, niacin extended-release/lovastatin with standard doses of atorvastatin and simvastatin (the ADvicor Versus Other Cholesterol-Modulating Agents Trial Evaluation [ADVOCATE]). Am J Cardiol 2003;91:667-72.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Wong ND, Pio JR, Franklin SS, L'Italien GJ, Kamath TV, Williams GR Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome. Am J Cardiol 2003;91: 1421-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 5, No. 2, 81-90 (2005)
DOI: 10.1177/14746514050050020601
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This Article
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