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The Pandemic of Coronary Heart Disease in South Asia: What Clinicians Need to Know

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Abstract

Purpose of Review

South Asia has around 1/6th of the current global population. Epidemiological studies suggest that South Asians living in South Asia and diaspora are at an increased risk of premature atherosclerotic cardiovascular diseases (ASCVDs). This is due to an interplay of genetic, acquired, and environmental risk factors. Due to its increasing share of the global population, clinicians need to know the reasons for this early predisposition, and strategies for early identification and mitigation.

Recent Findings

South Asians have earlier onset of cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity. This increased risk is seen in both native South Asians and the diaspora.

Summary

South Asians have earlier onset of ASCVD due to an earlier onset of cardiometabolic risk factors. Health promotion and early identification of these risk factors are essential to mitigate this ongoing crisis.

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Abbreviations

apoA:

Apolipoprotein A

apoB:

Apolipoprotein B

ASCVD:

Atherosclerotic cardiovascular disease

BMI:

Body mass index

BRAVE:

Bangladesh Risk of Acute Vascular Event

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CARRS:

Centre for Cardiometabolic Risk Reduction in South-Asia study

CI:

Confidence interval

CKD:

Chronic kidney disease

CRP:

C-reactive protein

CVD:

Cardiovascular disease

DM:

Diabetes mellitus

eGFR:

Estimated glomerular filtration rate

GBD:

Global Burden of Diseases

HDL-C:

High-density lipoprotein cholesterol

HOMA:

Homeostasis model assessment of insulin resistance

HR:

Hazard ratio

IHD:

Ischemic heart disease

INTERHEART:

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries

LDL-C:

Low-density lipoprotein cholesterol

Lp(a):

Lipoprotein(a)

MASALA:

Mediators of Atherosclerosis in South Asians Living in America

MESA:

Multi-Ethnic Study of Atherosclerosis

MI:

Myocardial infarction

NCD:

Non-communicable disease

NHANES:

National Health and Nutrition Examination Survey

PA:

Physical activity

RCT:

Randomized control trials

SHARE:

Study of Health Assessment and Risk in Ethnic Groups

TG:

Triglyceride

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Funding

Dr. Virani is supported by the Department of Veterans Affairs, NIH, and Tahir, and Jooma Family Foundation. Farhala Baloch is a Fogarty fellow of NIH Award number D43TW011625.

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Authors and Affiliations

  1. Department of Medicine, Henry Ford Hospital, Detroit, MI, USA

    Kartik Gupta

  2. Section of Cardiology, Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan

    Farhala Baloch

  3. Division of Hospital Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA

    Tanya S. Kakar

  4. All India Institute of Medical Sciences, New Delhi, India

    Harsh Agarwal

  5. Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA

    Bharat Rawlley

  6. Department of Family Medicine, Aga Khan University Medical College, Karachi, Pakistan

    Unab I. Khan

  7. Department of Community Health Sciences, Aga Khan University Medical College, Karachi, Pakistan

    Romaina Iqbal

  8. School of Nursing & Midwifery, Aga Khan University Medical College, Karachi, Pakistan

    Rubina Barolia

  9. Office of the Vice Provost (Research), Aga Khan University Medical College, Karachi, Pakistan

    Salim S. Virani

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  1. Kartik Gupta
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  9. Salim S. Virani
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Dr. Virani is a Section Editor for the Springer journals Current Atherosclerosis Reports and Current Cardiology Reports. The other authors declare that they have no conflict of interest.

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Gupta, K., Baloch, F., Kakar, T.S. et al. The Pandemic of Coronary Heart Disease in South Asia: What Clinicians Need to Know. Curr Atheroscler Rep 25, 359–372 (2023). https://doi.org/10.1007/s11883-023-01110-5

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