Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2016; 8(3): 247-257
Published online Mar 26, 2016. doi: 10.4330/wjc.v8.i3.247
Lipoprotein abnormalities in South Asians and its association with cardiovascular disease: Current state and future directions
Ozlem Bilen, Ayeesha Kamal, Salim S Virani
Ozlem Bilen, Salim S Virani, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Ayeesha Kamal, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi 3500, Pakistan
Author contributions: Bilen O, Kamal A and Virani SS conceptualized and designed the review together; Bilen O and Virani SS conducted the review and drafted the initial manuscript; all authors reviewed and approved the final manuscript as submitted.
Supported by The American Heart Association Beginning Grant-in-Aid, No. 14BGIA20460366; the American Diabetes Association Clinical Science and Epidemiology award, No. 1-14-CE-44; and the Baylor College of Medicine Center for Globalization Award.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim S Virani, MD, PhD, Department of Medicine, Baylor College of Medicine, Health Services Research and Development (152) Michael E, DeBakey Veterans Affairs Medical Center 2002 Holcombe Blvd., Houston, TX 77030, United States. virani@bcm.edu
Telephone: +1-713-4404410 Fax: +1-713-7487359
Received: August 5, 2015
Peer-review started: August 6, 2015
First decision: September 21, 2015
Revised: October 16, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: March 26, 2016
Processing time: 230 Days and 12.6 Hours
Abstract

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.

Keywords: Dyslipidemia; South Asians; Asian Indians; Cardiovascular disease

Core tip: South Asians have a high prevalence of coronary heart disease (CHD) and suffer from early-onset CHD. Indeed, an important contributor is their unique lipid profile which is characterized by elevated levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, elevated lipoprotein(a) levels, 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. Despite the rapid expansion of the current literature with better understanding of the specific lipid abnormalities in this patient 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.