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Excess coronary artery disease risk in South Asian immigrants: can dysfunctional high-density lipoprotein explain
1Medical College of Georgia, Augusta, GA 30912, USA. sdodani@mcg.edu
Insights
South Asian immigrants have a higher risk of coronary artery disease (CAD). Dysfunctional high-density lipoprotein (HDL) may play a role in CAD development, warranting further investigation in this population.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Immigrant Health
Background:
- Coronary artery disease (CAD) is a leading cause of death in the US.
- South Asian immigrants (SAIs) exhibit a disproportionately higher risk for CAD compared to Caucasians.
- Traditional CAD risk factors do not fully account for the elevated risk observed in SAIs.
Purpose of the Study:
- To review the existing literature on the potential role of dysfunctional high-density lipoprotein (HDL) in the pathogenesis of CAD.
- To explore novel risk factors, such as dysfunctional HDL and genetic polymorphisms, contributing to CAD in SAIs.
Main Methods:
- Literature review of studies investigating HDL function and its association with CAD.
- Analysis of potential mechanisms contributing to HDL dysfunction, including Apo lipoprotein A-I (Apo A-I) polymorphisms.
Main Results:
- Dysfunctional HDL, which paradoxically exhibits pro-oxidant properties, is associated with CAD in Caucasian populations.
- Conventional risk factors, insulin resistance, and metabolic syndrome may not adequately predict CAD risk in SAIs.
Conclusions:
- Dysfunctional HDL and genetic factors like Apo A-I polymorphisms are potential novel risk markers for CAD.
- Further research is crucial in SAIs to understand CAD associations and improve early detection and prevention strategies for this high-risk group.
Background:
Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the United States (US), and South Asian immigrants (SAIs) have a higher risk of CAD compared to Caucasians. Traditional risk factors may not completely explain high risk, and some of the unknown risk factors need to be explored. This short review is mainly focused on the possible role of dysfunctional high-density lipoprotein (HDL) in causing CAD and presents an overview of available literature on dysfunctional HDL.
Discussion:
The conventional risk factors, insulin resistance parameters, and metabolic syndrome, although important in predicting CAD risk, may not sufficiently predict risk in SAIs. HDL has antioxidant, antiinflammatory, and antithrombotic properties that contribute to its function as an antiatherogenic agent. Recent Caucasian studies have shown HDL is not only ineffective as an antioxidant but, paradoxically, appears to be prooxidant, and has been found to be associated with CAD. Several causes have been hypothesized for HDL to become dysfunctional, including Apo lipoprotein A-I (Apo A-I) polymorphisms. New risk factors and markers like dysfunctional HDL and genetic polymorphisms may be associated with CAD.
Conclusions:
More research is required in SAIs to explore associations with CAD and to enhance early detection and prevention of CAD in this high risk group.
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