Coronary heart disease and risk factors in Asian Indians

10-Year Trends in Serum Lipid Levels and Dyslipidemia Among Children and Adolescents From Several Schools in Beijing, China

Background

Serum lipid trends in children and adolescents are predictors of the future prevalence of cardiovascular disease in adults.

Methods

Data were obtained from cross-sectional studies conducted in 2004 and 2014. A total of 3249 children aged 6–18 years were included in the present study; serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were measured.

Results

Overall, upward trends in mean TC, non-HDL-C, and LDL-C levels, and in geometric mean TG levels, were observed (all P < 0.001). Mean HDL-C levels significantly decreased between 2004 and 2014 (from 1.54 mmol/L to 1.47 mmol/L; P < 0.001). The prevalence of abnormal levels of serum lipids, with the exception of the prevalence of low HDL-C (P = 0.503), significantly increased over the study period (all P < 0.05). The prevalence of hyperlipidemia (from 13.3%; 95% confidence interval [CI], 11.6%–15.0% to 24.5%; 95% CI, 22.4%–26.6%; P < 0.001) and dyslipidemia (from 18.8%; 95% CI, 16.9%–20.7% to 28.9%; 95% CI, 26.7%–31.3%; P < 0.001) also increased from 2004 to 2014. The prevalence of abnormal serum lipids increased, and mean serum lipid levels, with the exception of TC levels, worsened in subjects with obesity compared with non-overweight subjects, as well as in subjects with mixed obesity compared with non-obese subjects (P < 0.05 for all).

Conclusions

Adverse trends in serum lipid concentrations over the past 10 years were observed among children aged 6–9 years, with the exception of specific lipids, and among adolescents aged 10–18 years, from several schools in Beijing, China.

Preventing coronary heart disease risk of slum dwelling residents in India

Coronary heart disease (CHD) is the top cause of mortality and morbidity in India. People in slums are generally at a higher risk for CHD than Indians living in more affluent areas mostly because of the higher prevalence of major CHD risk factors such as uncontrolled hypertension and tobacco use amongst them. Knowing their CHD risk perceptions and bringing them into line with the actual CHD risk is a prerequisite for effective CHD risk management. Consequently, there is need to develop tailored interventions focusing medication management and tobacco cessation to reduce growing CHD epidemic among slum dwellers and long-term CHD burden in India.

Intravascular ultrasound-guided management of large thrombus burden in an aneurysmal coronary artery in a young male

Management of acute thrombotic occlusion of coronary artery aneurysms is challenging with a lack of randomized trial evidence. We report an unusual case of a 30-year-old Indian Australian male who presented with an extensive anterior STEMI because of very large thrombus burden in a dilated proximal left anterior descending artery. A relatively conservative treatment approach comprising emergency aspiration thrombectomy and ongoing infusion of glycoprotein IIb/IIIa inhibitor, guided by surveillant inpatient angiography and intravascular ultrasound, helped achieve a satisfactory outcome in a complex setting in which percutaneous coronary angioplasty and stenting were not desirable. © 2014 Wiley Periodicals, Inc.

Obesity and dyslipidemia in South Asians

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m² for overweight and ≥25 kg/m² for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.

Metabolic complications of obesity: inflated or inflamed?

Adipose tissue dysfunction rather than excess adipose tissue mass (defined as obesity) is mechanistically related to development of metabolic diseases traditionally linked to obesity: metabolic syndrome, type 2 diabetes and cardiovascular disease. Inflammation of adipose tissue seems to be an important manifestation of adipose tissue dysfunction and closely relates to insulin resistance, the mediator of obesity-related morbidity. However, it is not completely clear whether inflammation in adipose tissue leads to first, local, and then systemic insulin resistance or insulin resistance leads to adipose tissue inflammation, which, in turn, increases insulin resistance. These questions can only be answered by studying models of insulin resistance, independent of obesity. The conceptual shift from adipose tissue mass to adipose tissue function will have significant diagnostic and therapeutic implications. Our efforts in establishing markers to identify "at risk" population and finding newer therapeutic agents must focus on adipose tissue dysfunction and not on obesity alone.

Ethnicity and diabetic heart disease

Ethnicity is a complex yet important construct and an independent risk factor for diabetic heart disease (DHD) with paramount clinical significance. Clinicians should try to better understand the role of ethnicity through more questions. The risk of DHD is modified by ethnicity through more questions. The risk of DHD is modified by ethnicity, and its management may require a culturally sensitive individualized approach. Findings from Caucasian populations cannot be fully extrapolated to other ethnic groups, thereby emphasizing the importance of future research with ethnicity-based threshold for obesity. Available limited data support the interaction between genetic predisposition, environmental risk, and lifestyle choices and disparities based on ethnicity as the likely cause for ethnic variations in DHD.

Dyslipidemia in special populations: Asian Indians, African Americans, and Hispanics

Cardiovascular disease (CVD) is the leading cause of death in the United States, and certain population groups, such as South Asians, African Americans, and Hispanics, carry a disproportionately larger burden of CVD manifested as coronary artery disease, cerebrovascular disease, and hypertension. Persons of these special populations experience approximately two- to threefold greater morbidity and mortality. Prevalence of risk factors, including dyslipidemia, overweight, and diabetes, is not only higher in these groups, but is also rising. The reasons for such disparity appear to be multifactorial and influenced by such factors as lifestyle, diet, culture, genetics, and suboptimal healthcare. Furthermore, because these minority populations are not significantly represented in major clinical trials, evidence-based management strategies for treatment and prevention of CVD are seriously lacking. Lately, however, several randomized trials of therapy for dyslipidemia to reduce cardiovascular events among these ethnic groups have been undertaken. Preliminary data suggest the need for stricter goals and increasingly aggressive therapy for these special populations, including administrative and educational interventions.

Coronary artery diameter as a risk factor for acute coronary syndromes in Asian-Indians

Asian-Indians have high rates of coronary artery disease (CAD), which also occurs at an earlier age, with 50% of all heart attacks occurring in patients <55 years old and 25% in those <40 years old. Previous studies have cited structural factors in Asian-Indians, specifically smaller coronary arteries, as the cause of increased CAD in this population. We found that Asian-Indian patients have smaller coronary arteries, with a statistically significant difference in the mean diameter even after correction for body surface area.