Dyslipidemia in Indians and South Asians: How it is Different?
- A combination of hypertriglyceridemia, low levels of HDL-cholesterol and high levels of small dense lowdensity lipoprotein, termed as “atherogenic dyslipidemia’, is particularly seen in Asian Indians.
- Indians are prone to develop CHD at a younger age, often before the age of 40 years in men, more likely to have an anterior location of infarction, more likely to have significant left main, multi-vessel, and distal coronary artery disease, similar or lower prevalence of traditional risk factors than with other populations and prevalence of diabetes mellitus is uniformly higher.
- Increased abdominal visceral fat and greater insulin resistance at BMI levels that are traditionally considered “ideal” -“thin-fat phenotype”
- Although LDL cholesterol comparable to other populations, LDL particle size tends to be smaller.
- The serum triglyceride levels are highest in urban Asian Indians residing in India and migrant Asian Indians. Even the average serum triglyceride level of rural-based Asian Indians is higher than Caucasians
- Indians not only have lower HDL levels but also have a higher concentration of small, less-protective HDL particles. Indian males have a higher prevalence of low HDL2b , which suggests impaired reverse cholesterol transport
- Lipoprotein(a), homocysteine, and plasminogen activator inhibitor-1 levels tend to be higher in South Asians than in white populations
- Microalbuminuria is recognized as an independent cardiovascular disease risk factor. Numerous studies have suggested that altered adipokine production or action may play a role in the heightened vascular risk observed in South Asian patients. Altered adipokines may explain why lean nondiabetic Asian Indians have decreased insulin sensitivity compared with others
- Fibrates and ω-3 polyunsatalso have antiinflammatory and anti atherogenic properties, and may be additionally useful in Indians who have high prevalence of subclinical inflammation although there is no hard evidence supporting their use
