New risk factors for coronary heart disease in Asia

Area of Science:

• Cardiovascular Research
• Epidemiology of Atherosclerosis
• Genetics of Heart Disease

Background:

• Traditional atherosclerotic risk factors show increasing prevalence in Asia, but their impact on coronary heart disease (CHD) remains unclear.
• Established risk factors like smoking, hypertension, hypercholesterolemia, diabetes, and obesity are present in only 50% of CHD cases in Asia.
• Studies suggest aging, smoking, and hypercholesterolemia have a lesser impact on endothelial function in Chinese populations compared to Caucasians.

Purpose of the Study:

• To investigate the role of newer risk factors for coronary heart disease (CHD) in Asian populations undergoing modernization.
• To identify factors beyond traditional risk markers that contribute to endothelial dysfunction and premature CHD in Asia.

Main Methods:

• Literature review and analysis of community studies in Hong Kong and southern mainland China.
• Examination of the association between heterozygous hyperhomocysteinemia (with or without folate deficiency) and arterial endothelial dysfunction.
• Investigation of hyperhomocysteinemia in conjunction with smoking as a risk factor for premature CHD in Hong Kong Chinese.

Main Results:

• Heterozygous hyperhomocysteinemia is identified as an independent risk factor for arterial endothelial dysfunction.
• Hyperhomocysteinemia combined with smoking significantly increases the risk of premature coronary heart disease in Hong Kong Chinese.
• Emerging risk factors include folate deficiency, low HDL-cholesterol, insulin resistance, abdominal obesity, and specific gene polymorphisms (MTHFR, ACE).

Conclusions:

• Endothelial dysfunction, an early stage of atherogenesis, necessitates the search for novel CHD risk factors in Asia.
• Heterozygous hyperhomocysteinemia and associated factors are critical emerging risks for CHD in Asian populations.
• Further research into genetic predispositions and metabolic factors is essential for understanding and preventing CHD in modernizing Asian countries.