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Lipids in South Asians: Epidemiology and Management

  • Lipids (E. Michos, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review focuses on lipoprotein abnormalities in South Asians (SA) and addresses risk stratification and management strategies to lower atherosclerotic cardiovascular disease (ASCVD) in this high-risk population.

Recent Findings

South Asians (SAs) are the fastest growing ethnic group in the United States (U.S) and have an increased risk of premature coronary artery disease (CAD). While the etiology may be multifactorial, lipoprotein abnormalities play a key role. SAs have lower low-density lipoprotein cholesterol (LDL-C) compared with Whites and at any given LDL-C level, SA ethnicity poses a higher risk of myocardial infarction (MI) and coronary artery disease (CAD) compared with other non-Asian groups. SAs have lower high-density lipoprotein cholesterol (HDL-C) with smaller particle sizes of HDL-C compared with Whites. SAs also have higher triglycerides than Whites which is strongly related to the high prevalence of metabolic syndrome in SAs. Lipoprotein a (Lp(a)) levels are also higher in SAs compared with many other ethnic groups. This unique lipoprotein profile plays a vital role in the elevated ASCVD risk in SAs. Studies evaluating dietary patterns of SAs in the U.S show high consumption of carbohydrates and saturated fats.

Summary

SAs have a high-risk lipoprotein profile compared with other ethnicities. Lipid abnormalities play a central role in the pathogenesis of CAD in SAs. More studies are needed to understand the true impact of the various lipoproteins and their contribution to increasing ASCVD in SAs. Aggressive lowering of LDL-C in high-risk groups using medications, such as statins, and lifestyle modification including dietary changes is essential in overall CAD risk reduction.

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Abbreviations

ACC/AHA:

American College of Cardiology/American Heart Association

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

AMI:

Acute myocardial infarction

ASCVD:

Atherosclerotic cardiovascular disease

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CCA-IMT:

Carotid artery–intima media thickness

CETP:

Cholesteryl ester transfer protein

CVD:

Coronary vascular disease

FIELD:

Fenofibrate Intervention and Event Lowering in Diabetes

FOURIER:

Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk

HDL-C:

High-density lipoprotein cholesterol

ICA-IMT:

Internal carotid artery intima-media thickness

IMPROVE-IT:

Improved Reduction of Outcomes: Vytorin Efficacy International Trial

LDL-C:

Low-density lipoprotein cholesterol

Lp(a):

Lipoprotein a

MASALA:

The Mediators of Atherosclerosis in South Asians Living in America

MESA:

Multi-Ethnic Study of Atherosclerosis

MS:

Metabolic syndrome

PCE:

Pooled cohort equation

PCSK-9:

Proprotein convertase subtilisin/kexin type 9

SAs:

South Asians

VLDL-C:

Very low-density lipoprotein cholesterol

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Authors and Affiliations

  1. Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA

    Minhal Makshood

  2. Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Wendy S. Post

  3. University of California. San Francisco, 1545 Divisadero St, Suite 311, San Francisco, CA, 94115, USA

    Alka M. Kanaya

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Makshood, M., Post, W.S. & Kanaya, A.M. Lipids in South Asians: Epidemiology and Management. Curr Cardiovasc Risk Rep 13, 24 (2019). https://doi.org/10.1007/s12170-019-0618-9

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