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Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors
Prabhat Jha1, Enas Enas, Salim Yusuf
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Insights
Asian Indians experience high rates of coronary artery disease (CAD). Insulin resistance, abdominal obesity, and dyslipidemia contribute significantly, alongside conventional risk factors, suggesting a need for aggressive management.
Area of Science:
- Cardiovascular Epidemiology
- Internal Medicine
- Genetics
Background:
- Asian Indians exhibit disproportionately high rates of coronary artery disease (CAD) globally.
- Understanding the unique risk factor profile in this population is critical for targeted prevention strategies.
Purpose of the Study:
- To delineate the prevalence of CAD in Asian Indians.
- To comprehensively review established and emerging risk factors contributing to CAD in this demographic.
Main Methods:
- Extensive literature review of British, international, Indian, and US-based studies.
- Analysis of epidemiological data focusing on CAD prevalence and risk factors.
Main Results:
- Asian Indians have one of the highest CAD rates, not fully explained by conventional factors like hypertension, high cholesterol, smoking, or obesity.
- Insulin resistance, abdominal obesity, and specific dyslipidemic disorders (low HDL, high triglycerides, high LDL, high lipoprotein(a)) are strongly implicated.
- Significant differences in CAD rates are noted compared to other Asian and White populations.
Conclusions:
- A combination of increased susceptibility (insulin resistance, abdominal obesity, dyslipidemia) and conventional risk factors drives high CAD rates in Asian Indians.
- Genetic predisposition, indicated by high lipoprotein(a), may play a role.
- Aggressive risk factor management and further epidemiological research are essential for this population.
Abstract:
PURPOSE OF THE STUDY: The purpose of this study is to describe the prevalence of coronary artery disease (CAD) and provide a review of the risk factors associated with CAD in Asian Indians. SEARCH METHODS USED: The authors extensively reviewed numerous British and international studies and the more limited number of studies in India and the US. SUMMARY OF IMPORTANT FINDINGS: Asian Indians have one of the highest rates of CAD. Conventional risk factors such as high blood pressure, high serum total cholesterol level, cigarette smoking, high fat diet, and obesity consistently fail to fully explain these high rates. There appears to be a strong role of insulin resistance and abdominal obesity, both of which have a high prevalence in Asian Indians. Various dyslipidemic disorders in Asian Indians such as low levels of HDL cholesterol, elevation of triglyceride, elevation of LDL cholesterol and elevation of lipoprotein (a) may also have a role. CONCLUSIONS: We hypothesize that against a background of higher susceptibility to CAD among Asian Indians, as characterized by insulin resistance, abdominal obesity and dyslipidemic disorders, conventional risk factors for CAD are also important. A genetic predisposition to CAD is suggested by high levels of lipoprotein (a) in Asian Indians. This would suggest that more aggressive identification and modulation of all known risk factors are necessary among Asian Indians along with a compelling need for further epidemiological studies in this population. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: The marked differences in the rates of CAD among Asian Indians, compared with Chinese, Japanese, Filipino, other Asians and Whites are discussed. KEY WORDS: Asian Indians, coronary artery disease, epidemiology, disease prevalence, risk factors, insulin resistance, dyslipidemic disorders, triglycedide, high density lipoprotein; lipoprotein (a)