Coronary Size
- Contrary to common belief, the size of the coronary arteries in Asian Indians is not different from Europids when adjusted for body surface area and body mass index (BMI).1-4
- Severe and extensive disease can mimic small coronary arteries (Figure 005). The first angiogram from the same individual (Figure 006) shows large arteries five years earlier. Extremely rapid plaque buildup during the five years between the angiograms had almost completely blocked all three major arteries, making them almost invisible on the angiogram conveying the false impression that Indians have tiny arteries.5
- Diffuse atherosclerosis of the entire artery rather than localized narrowing is another reason for the widespread misconception of small coronary arteries among Asian Indians.
- Body surface area and gender are both independent predictors of coronary artery size, although body size has a greater influence than gender.6
- Left main, left anterior descending and other coronary arteries are smaller in women independent of body size and left ventricular mass.7 This suggests an intrinsic sex effect on coronary dimensions.8
- Smaller individuals will have small coronary arteries irrespective of ethnicity, and Indians are no exception. However, intervention in small coronary arteries would be more challenging.1
- Patients who underwent coronary angioplasty of smaller vessels have a significantly increased risk of major adverse clinical events, particularly repeat procedures.9
- Also see Angioplasty and CABG
Sources
1. Dhawan J, Bray CL. Are Asian coronary arteries smaller than Caucasian? A study on angiographic coronary artery size estimation during life. Int J Cardiol. 1995;49(3):267-269.
2. Zindrou D, Taylor KM, Bagger JP. Coronary artery size and disease in UK South Asian and Caucasian men. Eur J Cardiothorac Surg. Apr 2006;29(4):492-495.
3. Enas EA. Atheromatous plaque reflects serum total cholesterol levels: a comparative morphologic study of endarterectomy coronary atherosclerotic plaques removed from patients from the southern part of India and Caucasians from Ottawa, Canada. Clinical cardiology. Sep 1998;21(9):699-700.
4. Lip GY, Rathore VS, Katira R, Watson RD, Singh SP. Do Indo-Asians have smaller coronary arteries? Postgraduate medical journal. Aug 1999;75(886):463-466.
5. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic USA; 2011.
6. Kim SG, Apple S, Mintz GS, et al. The importance of gender on coronary artery size: in-vivo assessment by intravascular ultrasound. Clin Cardiol. May 2004;27(5):291-294.
7. Kucher N, Lipp E, Schwerzmann M, Zimmerli M, Allemann Y, Seiler C. Gender differences in coronary artery size per 100 g of left ventricular mass in a population without cardiac disease. Swiss Med Wkly. Oct 20 2001;131(41-42):610-615.
8. Sheifer SE, Canos MR, Weinfurt KP, et al. Sex differences in coronary artery size assessed by intravascular ultrasound. Am Heart J. Apr 2000;139(4):649-653.
9. Saucedo J, Popma JJ, Kennard ED, et al. Relation of coronary artery size to one-year clinical events after new device angioplasty of native coronary arteries (a New Approach to Coronary Intervention [NACI] Registry Report). Am J Cardiol. Jan 15 2000;85(2):166-171.