Relationship between plasma cholesterol and coronary artery disease in Asians

Dyslipidaemia among Indo-Asians strategies for identification and management

ndo-Asians have the highest rates of coronary artery disease (CAD) despite the fact that nearly half are lifelong vegetarians. The incidence, prevalence, and mortality from CAD among overseas Indo-Asians have been 50% to 300% higher than the Europeans, Americans, and other Asians with a higher risk at younger ages. Approximately 10% of the adults in urban India have CAD, a rate similar to overseas Indians. Traditional risk factors do not fully explain the excess burden of CAD in Indo-Asians. Therefore, conventional approaches to testing and treatment of risk factors are not sufficient in this population. Indo-Asians have a higher prevalence of glucose intolerance, metabolic syndrome, diabetes, elevated concentrations of lipoprotein(a) (LP[a]), and homocysteine, and low concentrations of high density lipoprotein (HDL). HDL particles are also smaller in Indo-Asians than Whites. A more aggressive approach to all risk factors, including HDL, LP(a), triglycerides and homocysteine is warranted. The current evidence of established safety and broad spectrum lipoprotein benefits of niacin and statins would make these invaluable agents in the armamentarium against dyslipidaemia, especially in Indo-Asians. This is particularly true for those with metabolic syndrome, diabetic dyslipidaemia and Lp(a) excess.

Lipoprotein abnormalities in South Asians and its association with cardiovascular disease: Current state and future directions

South Asians have a high prevalence of coronary heart disease (CHD) and suffer from early-onset CHD compared to other ethnic groups. Conventional risk factors may not fully explain this increased CHD risk in this population. Indeed, South Asians have a unique lipid profile which may predispose them to premature CHD. Dyslipidemia in this patient population seems to be an important contributor to the high incidence of coronary atherosclerosis. The dyslipidemia in South Asians is characterized by elevated levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, elevated lipoprotein(a) levels, and a higher atherogenic particle burden despite comparable low-density lipoprotein cholesterol levels compared with other ethnic subgroups. HDL particles also appear to be smaller, dysfunctional, and proatherogenic in South Asians. Despite the rapid expansion of the current literature with better understanding of the specific lipid abnormalities in this patient population, studies with adequate sample sizes are needed to assess the significance and contribution of a given lipid parameter on overall cardiovascular risk in this population. Specific management goals and treatment thresholds do not exist for South Asians because of paucity of data. Current treatment recommendations are mostly extrapolated from Western guidelines. Lastly, large, prospective studies with outcomes data are needed to assess cardiovascular benefit associated with various lipid-lowering therapies (including combination therapy) in this patient population.

ESSENS dyslipidemia: A placebo-controlled, randomized study of a nutritional supplement containing red yeast rice in subjects with newly diagnosed dyslipidemia

OBJECTIVE

Evidence suggests prolonged exposure to lower levels of low-density lipoprotein cholesterol (LDL-C), starting at a younger age, substantially lowers cardiovascular (CV) risk. Accordingly, the CV pandemic affecting younger population in low- to low-middle-income countries, where statin usage is poor even in secondary prevention, may benefit from lipid-lowering nutritional products, as nutritional intervention is generally preferred in these cultures. However, the safety and efficacy of such preparations have not been systematically tested.

METHODS

In this multicenter, double-blind study, 191 statin-free subjects with newly-diagnosed hyperlipidemia (LDL-C >120 mg/dL, 3.11 mmol/L) and no evidence of CV disease were randomized to one capsule of a proprietary bioactive phytonutrient formulation containing red yeast rice, grape-seed, niacinamide, and folic acid (RYR-NS) or matched placebo twice daily, along with lifestyle modification, for 12 wk.

RESULTS

Mean baseline LDL-C levels were 148.5 ± 24.0 mg/dL (3.85 ± 0.62 mmol/L) and 148.6 ± 21.9 mg/dL (3.85 ± 0.57 mmol/L) in the RYR-NS and placebo groups respectively. Compared with placebo, RYR-NS resulted in a significant reduction in LDL-C (-29.4% versus -3.5%, P < 0.0001) and non-high-density lipoprotein cholesterol (non-HDL-C; -29.8% versus -10.3%, P < 0.0001) at 12 wk. With RYR-NS, 43.4% individuals attained desirable LDL-C levels and 55.4% desirable non-HDL-C levels by week 12, compared to only 0% and 1.1%, respectively, at baseline. No safety issues were observed.

CONCLUSION

This study demonstrates the efficacy and safety of RYR-NS in lowering LDL-C and non-HDL-C after 12 wk, with magnitude of LDL-C reduction being comparable to that seen with moderate-intensity statin therapy. Further long-term studies are required to determine the impact of RYR-NS on treatment adherence and clinical outcomes.

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India

AIMS

The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients.

METHODS

This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory.

RESULTS

Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG.

CONCLUSION

We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

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

BACKGROUND

Natives of South India have a very high incidence of coronary artery disease, despite low calorie and fat intake.

HYPOTHESIS

This study was undertaken to determine whether morphologic features of atheromatous plaque reflect the serum total cholesterol.

METHODS

Fifty-three endarterectomy specimens from patients (mean age 47 +/- 9 years, mean cholesterol 203 +/- 47 mg/dl) obtained from one cardiac surgeon working in a single institution in South India were evaluated. Morphologic findings were compared with 40 endoarterectomy specimens obtained from age-matched Caucasians from Ottawa, Canada, with a reported mean cholesterol of 262 +/- 47 mg/dl. Morphometric measurements of the vessel size, percent stenosis, and the various components of the atherosclerotic plaque were determined by computerized planimetry.

RESULTS

The vessel size was smaller in the Indian than in the Canadian population (4.6 +/- 2.9 vs. 5.6 +/- 3.0 mm2, p = 0.07), the plaque area was less (4.3 +/- 2.3 vs. 5.3 +/- 2.8 mm2, p = 0.055) and the calculated percent stenosis was significantly less (93 vs. 96%, p = 0.028). Of all the parameters evaluated, only necrotic core in the Indian population (7.1 +/- 10.9% vs. Canadian 16.7 +/- 19.7%, p < 0.001) and proteoglycan deposition (7.9 +/- 11.2% vs. Canadian 3.7 +/- 5.3%, p < 0.023) were significantly different. Despite the Indians having low total cholesterol, there was greater diffuse double and triple-vessel disease and at a younger age than in the Caucasians.

CONCLUSIONS

From our data, it appears that the mechanism of development of atherosclerotic disease in the Indians may be different because they have smaller vessels, smaller necrotic core, and greater proteoglycan deposition. Other etiologies, especially those related to a high carbohydrate diet (which is typical for South Indians), should be considered.

Type 2 diabetes and cardiovascular risk in the UK south Asian community

A popular hypothesis for the greater prevalence of type 2 diabetes and cardiovascular disease in UK south Asians is that they have an increased susceptibility of developing insulin resistance in response to certain environmental factors, including obesity and adoption of a sedentary lifestyle. Insulin resistance is postulated as a central feature of the metabolic syndrome, culminating in type 2 diabetes, atherosclerotic vascular disease and CHD; a pathway potentially accelerated by migration/urbanisation. We describe and compare the prevalence of type 2 diabetes, cardiovascular disease and their associated risk factors in UK south Asian and white Caucasian populations to determine possible reasons for the increased preponderance of these diseases in south Asians, and highlight key evidence for optimal risk factor management. Finally, we describe a UK community-based programme that attempts to reduce the morbidity and mortality from type 2 diabetes and cardiovascular disease in south Asians through a new approach to management.

High-density lipoprotein subclass distribution in individuals of Asian Indian descent: the National Asian Indian Heart Disease Project

Individuals of Asian Indian descent have significantly higher cardiovascular event rates as compared with other ethnic groups. The authors investigated the prevalence of metabolic disorders linked to coronary artery disease in an Asian Indian male population compared with non-Asian Indian males. Standard lipid measurements did not discriminate between groups, and the Asian Indian group exhibited less of the high coronary artery disease risk small low-density lipoprotein trait. Despite less of the small low-density lipoprotein trait in the Asian Indian group and no difference in high-density lipoprotein cholesterol, the Asian Indian group had a significantly higher prevalence (p < 0.0002) of low high-density lipoprotein 2b, implying impaired reverse cholesterol transport. This observation remained significant in the subgroup of patients with high-density lipoprotein cholesterol over 40 mg/dL, a region felt not to reflect impaired reverse cholesterol transport. Low high-density lipoprotein 2b combined with the higher lipoprotein(a) in the Asian Indian group may help explain the high prevalence of coronary artery disease in this ethnic population.

Apolipoprotein E polymorphism in Northern Indian patients with coronary heart disease: phenotype distribution and relation to serum lipids and lipoproteins

Apolipoprotein E (apo E), a genetic determinant of plasma lipid levels and coronary heart disease (CHD) needs to be investigated in Asian Indians since they have a propensity to develop dyslipidemia and accelerated atherosclerosis. We studied apo E phenotypes and plasma lipid levels in 52 Northern Indian male patients (aged 38-71 years) with angiographically proven CHD, and compared them to 50 healthy blood donors taken as the control group. High levels of Lp(a), (p < 0.05), and a definite trend towards lower levels of HDL-C (p < 0.05), was observed in the CHD patients as compared to the control subjects. The frequency of apo E allele epsilon3 was 0.86 and 0.862, and epsilon4 allele was 0.12 and 0.08 in the patients and controls, respectively. However, a lower frequency of the E2 allele was observed in the patient group (E2 = 0.02) as compared to the controls (epsilon2 = 0.06) (p = ns). In individuals with apo E3/E3 phenotype, significantly lower HDL-C levels was observed in the CHD patients as compared to the control subjects (p < 0.05). A positive correlation was observed between apo E phenotypes and Lp(a) levels in the CHD subjects as compared to the controls (p < 0.05), the level being significantly high in CHD subjects with at least one E4 allele. To conclude, in this sample of Northern Indian subjects with CHD, there is a significant correlation between apo E3/E3 phenotype and low levels of HDL-C as compared to the control subjects. Further, apo E phenotype is positively correlated with high Lp(a) levels in the CHD subjects having at least one E4 allele. However, these relationships need to be explored in a larger sample of subjects.

Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study

This study compares risk factors for cardiovascular disease in civil servants of three ethnic groups screened as part of the Whitehall II cohort study. Previously identified risk factors for cardiovascular disease in 360 Afro-Caribbean and 577 South Asian subjects are compared with the 8973 white Caucasian subjects. Controlling for socio-economic status is more precise than in most previous studies of cardiovascular differences between ethnic groups. After controlling for socio-economic confounding factors, age and sex, South Asian subjects were found to have increased prevalence of hypertension (defined as either having systolic pressure of > 160, diastolic pressure of > 95 or being on antihypertensives) OR 2.3 (95% CI 1.6-3.3), diabetes OR 4.2 (95%, CI 3.0-5.8) and a high risk lipid profile, although total cholesterol was lower than in the white population. Afro-Caribbean subjects had more hypertension OR 4.0 (95% CI 2.8-5.7) and diabetes OR 2.8 (95% CI 1.7-4.6), but this was accompanied by a favourable lipid profile with low cholesterol and high HDL. Afro-Caribbean alcohol and smoking habits were low-risk. Socio-economic status was found to be an important confounding factor for ethnic differences in biochemical risk factors for cardiovascular disease. However, adjusting for socioeconomic class only attenuates observed differences; it does not abolish them.

Serum cholesterol and coronary artery disease in populations with low cholesterol levels: the Indian paradox

OBJECTIVE

To examine the relation between serum cholesterol and coronary artery disease prevalence below the range of cholesterol values generally observed in developed countries.

DESIGN AND SETTING

Cross-sectional survey of two randomly selected villages from Moradabad district and 20 randomly selected streets in the city of Moradabad.

SUBJECTS AND METHODS

3575 Indians, aged 25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women) subjects. The survey methods were questionnaires, physical examination and electrocardiography.

RESULTS

The overall prevalences of coronary artery disease were 9.0% in urban and 3.3% in rural subjects and the prevalences were significantly (P<0.001) higher in men compared to women in both urban (11.0 vs. 6.9%) and rural subjects (3.9 vs. 2.6%). The average serum cholesterol concentrations were 4.91 mmol/l in urban and 4.22 mmol/l in rural subjects without any sex differences. The prevalences of coronary artery disease were significantly higher among subjects with low and high serum cholesterol concentration compared to subjects with very low cholesterol and showed a positive relation with serum cholesterol within the range of serum cholesterol level studied in both rural and urban in both sexes. Among subjects with low serum cholesterol, there was a higher prevalence of coronary risk factors, hypertension, diabetes, obesity and sedentary lifestyle. Serum cholesterol level showed a significant positive relation with low density lipoprotein cholesterol and triglycerides in all the four subgroups. Logistic regression analysis after pooling of data from both rural and urban, with adjustment of age showed that low serum cholesterol level (odds ratio: men 0.96, women 0.91) had a positive strong relation with coronary artery disease and there was no evidence of any threshold. Diabetes mellitus (men 0.73, women 0.74) and sedentary lifestyle (men 0.86, women 0.74) were significant risk factors of coronary disease in both sexes. Hypertension (men 0.82, women 0.64) and smoking (men 0.81, women 0.52) were weakly associated with coronary disease in men but not in women.

CONCLUSION

Serum cholesterol level was directly related to prevalence of coronary artery disease even in those with low cholesterol concentration (<5.18 mmol/l). It is possible that some Indian populations may benefit by increased physical activity and decline in serum cholesterol below the range of desired serum cholesterol in developed countries.

Geographic variation in vascular mortality in Eurasia: spatial autocorrelation analysis of mortality variables and risk factors

The geographic variation patterns of vascular mortality and their major risk factors from 68 samples in Eurasia are described in this work. The goodness-of-fit tests and analysis of variance indicate significant differences in incidence of mortality from the studied diseases, as well as in risk factors among the various geographic regions in four age groups. Correlation analysis points out the two general tendencies for the majority of studied traits: (a) significant positive association with latitude and (b) significant negative correlation with longitude. In turn, one-dimensional correlograms showed no specific geographic pattern at least up to 3000 km for all studied variables. However, at the large geographic scale a long-distance differentiation pattern was indicated for total serum cholesterol and body mass index; regional patches--for total death rate, mortality rate from cardiovascular and ischaemic heart diseases, systolic and diastolic blood pressure; and a local patches pattern was detected for mortality rate from stroke. Two-dimensional correlograms uncovered three distinct and significant patterns of variation: (a) a north-south trend for total mortality rate, for death rate from cardiovascular and ischaemic heart diseases, for diastolic and systolic blood pressure and for body mass index; (b) a northwest-southeast pattern for mortality rate from cerebrovascular disease; and (c) local patches for total serum cholesterol.

Like father like son? Sons of patients of European or Indian origin with coronary artery disease reflect their parents' risk factor patterns

OBJECTIVE

To investigate the extent to which risk factor patterns associated with coronary artery disease (CAD) in patients of Indian origin and in those of North European origin undergoing coronary angiography for suspected angina were reflected in their apparently healthy sons aged 15-30 years.

DESIGN

Prospective study in which risk markers were measured in patients of Indian origin and in matched European patients undergoing angiography and in their sons.

SETTING

Patients attending a regional cardiac centre and their families.

PATIENTS

102 consecutive male patients of Indian origin undergoing diagnostic coronary angiography for suspected angina and 89 of their sons aged between 15 and 30 years; 102 age matched male European patients and 82 sons.

MAIN OUTCOME MEASURES

Father son correlations for risk markers predicting the severity of parental CAD; differences in mean levels of these markers between young males of Indian origin and those of North European origin.

RESULTS

Lp(a) lipoprotein, total cholesterol, and serum insulin were independent predictors of the severity of CAD in patients of Indian origin and in those of North European origin. In both groups, there was strong correlation between paternal and filial serum insulin (r = 0.41 Indian origin, r = 0.49 North European, P < 0.001), Lp(a) lipoprotein (r = 0.44 Indian origin, r = 0.48 North European, P < 0.001), and total cholesterol (r = 0.39 Indian origin, r = 0.45 North European, P < 0.001) concentrations, and the risk factor profiles of the sons were predictive of CAD severity in their fathers. Sons of patients of Indian origin had significantly higher serum insulin (Indian origin 14.3 mU/l v North European 8.4 mU/l, P = 0.002) and Lp(a) lipoprotein (Indian origin 19.1 mmol/l v North European 10.5 mmol/l, P = 0.001) concentrations than sons of patients of North European origin.

CONCLUSIONS

Apparently healthy young men aged 15-30 years from either ethnic community already reflect risk marker patterns associated with coronary artery disease in their parents, both for genetically determined factors such as Lp(a) lipoprotein and environmentally influenced factors such as insulin and cholesterol. Health promotion measures aimed at reducing the prevalence of CAD should include the adolescent and young adult populations, particularly those with a family history of CAD, or who are from ethnic communities in which this diagnosis is prevalent.

Prevalence of hypercholesterolaemia and coronary heart disease risk factors among southeast Asian refugees in a primary care clinic

The National Cholesterol Education Program's guidelines for the detection, evaluation, and treatment of high serum cholesterol in adults were employed in screening 155 Southeast Asian refugees in a primary care clinic in Seattle, Washington. In order to determine the need for a therapeutic intervention, information also was collected on the presence of other coronary heart disease (CHD) risk factors. Male gender (39%), cigarette smoking (27%) and hypertension (26%) were the most common CHD risk factors; diabetes mellitus, obesity, a family or prior history of CHD or cerebral/peripheral vascular disease were each noted in less than 10%. The mean serum total cholesterol was 194 mg/dl. Thirty-seven (24%) patients required further lipoprotein analysis based on cholesterol level, history of CHD and risk factors for CHD. Twenty-one (66%) of 32 patients who underwent lipoprotein analysis (14% of all patients) were candidates for a therapeutic intervention for hypercholesterolaemia. Additionally, 14 (44%) patients undergoing lipoprotein analysis had depressed high-density lipoprotein levels (< 35 mg/dl). We conclude that CHD risk factors including hypercholesterolaemia are common in Southeast Asian refugee clinic patients and that in many, a therapeutic intervention may well be justified. Southeast Asian refugees should be routinely screened for hypercholesterolaemia and other CHD risk factors in accordance with the National Cholesterol Education Program's guidelines.

Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study

Asian Indians have the highest rates of coronary artery disease (CAD) of any ethnic group studied, despite the fact that nearly half of this group are life-long vegetarians. CAD occurs early in age and generally follows a malignant course. Although the incidence of classic risk factors is low, high triglyceride and low high-density lipoprotein cholesterol levels, high lipoprotein(a) levels, hyperinsulinemia, and apple-type obesity all show a substantial prevalence in this population. Aggressive modification of life style beginning before adolescence seems justified in view of the malignant nature of CAD in this population. Pharmacologic intervention similar to that of secondary prevention of CAD seems justified as primary prevention in high-risk Asian Indians.

Plasma levels of apolipoproteins A-1 and B in Indian patients with angiographically defined coronary artery disease

Apolipoproteins A-1 and B concentration were measured in 201 Indian patients (32 females; 169 males) undergoing elective diagnostic coronary arteriography in order to assess the predictive power of apolipoproteins as a 'marker' of coronary artery disease (CAD). This association was also compared to that of other traditional risk factors: age, hypertension, diabetes, family history, smoking and plasma levels of total cholesterol, triglycerides, low and high density lipoproteins. The apolipoprotein (Apo) A-1 levels averaged 82.9 +/- 18.9 mg/dl in the normal coronary group (n = 43) and 76.0 +/- 18.1 mg/dl in the group with coronary artery disease (n = 158). The average Apo B levels in the normal coronary group and coronary artery disease group were 67.8 +/- 17.7 mg/dl and 78.9 +/- 19.5 mg/dl, respectively. Overall Apo B and triglyceride levels (of all lipid measures) showed larger univariate difference between the normal group (no coronary artery disease) and the group with coronary artery disease. The variable with strongest predictive power for coronary artery disease was the ratio of Apo A-1 to Apo B. These findings were confirmed using multiple logistic regression analysis adjusting for age and other traditional risk factors. Our results indicate that the measurement of apolipoproteins A-1 and B provide a better marker for predicting the presence of coronary artery disease as compared to traditional lipid measures. Overall the levels of these apolipoproteins seem to be lower in Indian population as compared to those reported from the West.

Serum lipid profile and its association with some cardiovascular risk factors in an urban Chinese population

The lipid profile of a Chinese population, which has a lower prevalence of coronary heart disease compared with Caucasians, is studied to determine whether lipid-modifying disease prevention programs are necessary. The study population consisted of 910 men (mean age 36.7 +/- 9.2 yrs) and 603 women (mean age 38.6 +/- 9.1 yrs), who were employees of a public utility company and non-medical staff of a district hospital. Indices of obesity, fasting cholesterol (TC), and its various subfraction, triglycerides (TG), apolipoprotein A-I (Apo A-I), and apolipoprotein B (Apo B) concentrations were measured. Glucose tolerance was also estimated by measuring fasting and 2 h glucose after a 75 g oral glucose load. The lipid profile was similar to that of the North American population, with an overall prevalence of low density lipoprotein cholesterol (LDL-C) > or = 4.1 mmol/L of 21% and 11% in men and women respectively. Similar variations with age, sex, smoking and glucose tolerance compared with Caucasian populations were observed. The high prevalence of subjects with "undesirable" lipid values in this Chinese population, which at present has a coronary artery disease prevalence of one-eighth to one-quarter compared with that in Caucasians, suggests that the incidence of the disease may well rise in the future to pose a similar problem to that in Caucasian populations. Cut off values of lipids conferring increased cardiovascular risks need to be determined in this population, so that public health strategies may be formulated.

Coronary Artery Bypass in Asian Patients

Coronary artery disease in Asians deserves far more attention than it has received in the literature to date. Most of the available reports focus on immigrants from the Indian subcontinent. These immigrants have a significantly higher risk of coronary artery disease than either their compatriots who do not emigrate or the indigenous population of their adopted countries. This finding cannot be explained on the basis of standard coronary risk factors. There is a general clinical impression that Asians of all nationalities have smaller coronary arteries and more diffuse coronary disease than other ethnic groups; therefore, they are less suitable candidates for conventional bypass grafting. This impression remains a source of controversy. Our experience at the Texas Heart Institute indicates that, after coronary bypass surgery, early and long-term results in Asians are as satisfactory as in other ethnic groups. However, much more research is needed to explain the many paradoxical aspects of coronary disease in Asian patients.

Lipids, lipoproteins and other coronary risk factors in Chinese male survivors of myocardial infarction

OBJECTIVE

To assess the importance of an abnormal lipid profile as a risk factor in relation to non-biochemical risk factors, and to define the risk levels for lipid, lipoprotein and apolipoprotein in a Chinese population.

PATIENTS AND METHODS

Serum lipids, lipoproteins, apolipoproteins and other cardiovascular risk factors were studied in 89 Chinese men 3 months after acute myocardial infarction and 56 controls.

RESULTS

Cases had higher mean total cholesterol (TC), LDL- and VLDL-cholesterol, triglycerides and apolipoprotein B (Apo B), and lower mean HDL-cholesterol and apolipoprotein AI (Apo AI). Mean BMI was also higher, as was the prevalence of smokers and subjects with a history of hypertension. In univariate analysis, the odds ratios for TG > or = 1.6 mmol/l, LDL-cholesterol > or = 4.1 mmol/l, VLDL-cholesterol > or = 0.73 mmol/l, Apo B > or = 104 mg/dl were of the same order of magnitude as being a current smoker, having a BMI > or = 24.3 kg/m2, and a history of hypertension. High HDL-cholesterol (> or = 1.39 mmol/l) and Apo AI (> or = 139 mg/dl) were protective factors. The odds ratios for successively higher quartile values of cholesterol were not statistically significant. Multiple logistic regression identified smoking habit, history of hypertension, obesity, high Apo B and low Apo AI concentrations as independent risk factors for myocardial infarction.

CONCLUSIONS

In a Chinese population, low serum Apo AI and high Apo B are risk factors for myocardial infarction of a comparable magnitude to smoking, hypertension and obesity.

Coronary artery disease in Asians

From available studies, there appears to be a racial preponderance of coronary artery disease (CAD) among Indians when compared to other ethnic groups. We found that this racial difference exists even in a young Asian population with premature atherosclerosis. In this small series, these racial differences could not be explained by the commonly known risk factors for coronary artery disease--smoking, hypertension, diabetes and hypercholesterolaemia, findings similar to those found in older patients elsewhere. Only fasting triglyceride levels were significantly higher among young Indians compared to non Indians (p less than 0.02) although the importance of this finding as a risk factor for CAD remains controversial. The majority of these young patients were treated medically and their one year survival was good.