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Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians

Enas A Enas1, Basil Varkey2, T S Dharmarajan3

  • 1Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL, USA.

Indian Heart Journal
|September 24, 2019
PubMed

Insights

Malignant coronary artery disease (CAD) is prevalent in young Indians due to high Lipoprotein(a) (Lp(a)) levels. Elevated Lp(a) significantly increases the risk of premature heart attacks in this population.

Area of Science:

  • Cardiology
  • Genetics
  • Epidemiology

Background:

  • Malignant coronary artery disease (CAD) affects young individuals (<45 years men, <50 years women) with few traditional risk factors.
  • Young Indians experience acute myocardial infarction (AMI) 10 years earlier, with 3-5 times higher rates than other populations.
  • Established CAD risk factors do not fully explain the high burden of disease in young Indians.

Purpose of the Study:

  • To highlight the significant role of Lipoprotein(a) (Lp(a)) as a potent genetic risk factor for premature CAD in Indians.
  • To emphasize the clinical relevance of Lp(a) measurement in the Indian population, given its high prevalence and associated risk.

Main Methods:

  • Review of existing literature on malignant CAD, acute myocardial infarction (AMI), and Lipoprotein(a) (Lp(a)) in the Indian population.
  • Analysis of epidemiological data concerning CAD risk factors and prevalence in South Asians compared to other ethnicities.

Main Results:

  • Lipoprotein(a) (Lp(a)) is identified as the strongest genetic risk factor for premature CAD, with high levels common in Indians with malignant CAD.
  • Elevated Lp(a) confers a 2-3 fold increased risk of CAD, comparable to established risk factors like diabetes.
  • South Asians exhibit the second highest Lp(a) levels globally, leading to the highest AMI risk from elevated Lp(a), exceeding that in Europeans.
  • Approximately 25% of Indians and South Asians have elevated Lp(a) levels (≥50 mg/dl).

Conclusions:

  • Lipoprotein(a) (Lp(a)) is a critical risk factor for premature coronary artery disease (CAD) in Indians, potentially surpassing diabetes in importance.
  • Lp(a) measurement is clinically ready and should be integral to all CAD research involving Indians.

Keywords:
ASCVD risk enhancing factorAcute coronary syndromeAcute myocardial infarctionCardiovascular diseaseCoronary artery diseaseIndiansLipoprotein(a)Lp(a)-yearsMalignant coronary artery diseaseMendelian randomizationStandardized mortality ratio

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