Title:Dyslipidemia and Cardiovascular Disease Prevention in South Asians: A Review and Discussion of Causes, Challenges and Management Strategies
Volume: 17
Issue: 9
Author(s): Anum Saeed*, Salim S. Virani, Suresh Mulukutla and Clara K. Chow
Affiliation:
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,United States
Keywords:
Cardiovascular diseases, south asian, hyperlipidemia, dyslipidemia, CV prevention, atherosclerotic cardiovascular
disease (ASCVD).
Abstract:
Background: South Asians are at a significantly increased risk of atherosclerotic cardiovascular
disease (ASCVD). For a major portion of the South Asian population, the cardiovascular
disease events occur at a relatively younger age, are associated with worse outcomes, and have potentially
more severe socioeconomic implications compared to their western counterparts.
Methods: The term “South Asian” typically constitutes individuals from India, Pakistan, Nepal,
Bhutan, Bangladesh, Sri Lanka, and Maldives, including expatriates as well as their families from
these countries. Based on this, South Asians form approximately 25% of the world’s population,
with a high ASCVD burden in this group. In this review, we discuss the pathophysiological factors
underlying ASCVD in South Asians, the dyslipidemia types and management, and discuss approaches
to improve the overall ASCVD prevention efforts in this large subset population of the
world. Although the pathophysiological mechanisms underlying the excess risk of cardiovascular
disease in South Asians are multifactorial, dyslipidemia is a primary risk factor for the incidence
and prevalence of this disease. The traditional “South Asian” dyslipidemia pattern includes levels
of low-density lipoprotein cholesterol (LDL-C) in the normal range with a high concentration of
LDL particles, elevated triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C)
with dysfunctional HDL particles, and high levels of lipoprotein(a).
Conclusion: While combined efforts to study the expatriate South Asians in western countries
have been able to identify South Asian specific dyslipidemias, causal associations and optimal management
remain relatively less explored. Larger scale studies are needed to better quantify the relationship
of each lipid parameter with ASCVD risk among South Asians as well as optimal lipid targets
and management strategies to reduce morbidity and mortality in this high-risk group.