Severity of Heart Disease
- The earliest report on heart disease among Indians showed a 7-fold higher rate of coronary atherosclerosis in Asian Indians compared to Chinese in Singapore.1 This report was based on 9,568 autopsies undertaken between 1950 and 1954.1
- Several angiographic studies in the last 50 years have consistently demonstrated greater severity of CAD (coronary artery disease) among Asian Indians than other populations even when matched for conventional risk factors.2, 3
- A higher proportion of Asian Indians was found unsuitable for coronary artery bypass graft (CABG) surgery by virtue of severe extensive and diffuse disease in the United Kingdom as early as 1984.4
- Of those undergoing coronary angiogram, severe heart disease (three-vessel disease) is found in nearly half of all Asian Indians including premenopausal women.5-7
- Asian Indians presenting with acute coronary syndromes (ACS) have greater burden of atherosclerosis (coronary plaque) and larger heart attacks than Europids.8
- Asian Indians are perhaps the only population who have all the risk factors related to severity of heart disease ─ high levels lipoprotein(a), low levels of HDL-C, high TC/HDL-C ratio, and high rates of diabetes.9-12
- The combination of these 4 risk factors may explain the extreme severity of heart disease among Asian Indians worldwide (see malignant heart disease).13
Sources
1. Danarag TJ, Acker M, Danaraj W, Ong W, Yam T. Ethnic group differences in coronary heart disease in Singapore: an analysis of necropsy records. Am Heart J. 1959;58:516-526.
2. Enas EA, Yusuf S, Mehta J. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol. 1992;70:945 – 949.
3. Muir C S. Coronary heart disease in seven racial groups in Singapore. Br Heart J. Jan 1960;22:45-53.
4. Lowry PJ, Glover DR, Mace PJ, Littler WA. Coronary artery disease in Asians in Birmingham. Br Heart J. 1984;52(6):610-613.
5. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: Thoughts on pathogenesis, prevention, and treatment. Clinical cardiology. 1995;18:131-135.
6. Dave TH, Wasir HS, Prabhakaran D, et al. Profile of coronary artery disease in Indian women: Correlation of clinical, non invasive and coronary angiographic findings. Indian heart journal. 1991;43(1):25-29.
7. Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk factor? The Canadian journal of cardiology. Mar 1 2006;22(3):193-197.
8. Hughes LO, Raval U, Raftery E. First myocardial infarctions in Asian and White men. BMJ. 1989;298:1345-1350.
9. 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; 2010.
10. Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)–a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. Jan 2006;52(1):5-50.
11. Mohan V, Deepa R, Haranath SP, et al. Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India. Diabetes Care. Nov 1998;21(11):1819-1823.
12. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. Nov 2007;9(5):367-374.
13. 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.