Conventional Cardiovascular Risk Factors

• All conventional risk factors are significantly associated with the risk of coronary artery disease (CAD)  in Asian Indians, as in all other populations.¹ However, compared with Whites, Asian Indians have a lower prevalence of hypertension, hypercholesterolemia, obesity, and smoking, but a higher prevalence of high triglycerides (TG), low high-density lipoprotein (HDL), glucose intolerance, and central obesity.²

• Total cholesterol levels among Asian Indians are similar or lower than in Europids.^{3, 4} But Asian Indians have significant abnormalities of virtually all lipoproteins, and these play a crucial role in CAD.

•  Smoking rates in Asian Indian men are lower than in Japan, China, and other Asian countries and are very low in Asian Indian women.⁵ Tobacco use (both cigarettes and beedis) is strongly related to CAD. Current smoking (of >10 cigarettes or beedi a day  is associated with a significant increase in the risk of heart attack.⁶

• In the United Kingdom, hypertension is more common and associated with greater morbidity and mortality in Asian Indians than Whites but less than in Blacks.^{7, 8}

• The risk factors are decreasing in the Indian Diasporas commensurate with the pattern seen in the dominant population in the respective countries. But the converse is true in India.²

• Although the conventional risk factors do not fully explain the excess burden of CAD, these risk factors appear to be doubly important in Asian Indians, and remain the principal targets for prevention and treatment.² Furthermore the threshold of intervention and the treatment targets are lower than that recommended for Europids.⁹

Sources

1. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. Sep 11 2004;364(9438):937-952.

2. 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.

3. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. Nov 2007;9(5):367-374.

4. Enas EA, Senthilkumar A, Chacko V, Puthumana N. Dyslipidemia among Indo-Asians: Strategies for identification and management. Brit J of Diabetes and Vascular Dis. 2005;5:81-90.

5. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J. 1996;48(4):343-353.

6. Pais P, Pogue J, Gerstein H, et al. Risk factors for acute myocardial infarction in Indians: A case-control study. Lancet. 1996;348(9024):358-363.

7. Lane DA, Lip GY. Ethnic differences in hypertension and blood pressure control in the U.K. QJM. 2001;94(7):391-396.

8. Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart (British Cardiac Society). 1997;78(6):555-563.

9. Enas  EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.