Dyslipidaemia among Indo-Asians strategies for identification and management

Abstract

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.