Key result
Low HDL-C is ~25 percentage points more prevalent in South Asians despite similar AMI lipid risk across Asians.
Why the study?
Patterns of lipid abnormalities among Asians and their relative impact on the risk of a first AMI had not been well characterized.
Do plasma lipid and apolipoprotein abnormalities predict the risk of a first acute myocardial infarction among different Asian subgroups compared with non-Asians?
Case-Control (n=12,190)
Yes
Do plasma lipid and apolipoprotein abnormalities predict the risk of a first acute myocardial infarction among different Asian subgroups compared with non-Asians?
Despite lower baseline LDL-C levels in Asians, the preserved association of LDL-C and strong association of ApoB/ApoA1 with first AMI risk suggest a need to re-evaluate lipid treatment thresholds in Asian populations and target low HDL-C/ApoA1 in South Asians.
Answers are grounded in this paper and cite their sources.
Low HDL-C prevalence in first AMI supports risk assessment; extends non-Asian lipid associations to South Asians but leaves open therapeutic implications.
Objectives This study sought to determine the prevalence of lipid and lipoprotein abnormalities and their association with the risk of a first acute myocardial infarction (AMI) among Asians. Background Patterns of lipid abnormalities among Asians and their relative impact on cardiovascular risk have not been well characterized. Methods In a case-control study, 65 centers in Asia recruited 5,731 cases of a first AMI and 6,459 control subjects. Plasma levels of lipids and apolipoproteins in the different Asian subgroups (South Asians, Chinese, Southeast Asians, and Japanese) were determined and correlated with the risk of AMI. Results Among both cases and controls, mean low-density lipoprotein cholesterol (LDL-C) levels were about 10 mg/dl lower in Asians compared with non-Asians. A greater proportion of Asian cases and controls had LDL-C </=100 mg/dl (25.5% and 32.3% in Asians vs. 19.4% and 25.3% in non-Asians, respectively). High-density lipoprotein cholesterol (HDL-C) levels were slightly lower among Asians compared with non-Asians. There was a preponderance of people with low HDL-C among South Asians (South Asia vs. rest of Asia: cases 82.3% vs. 57.4%; controls 81% vs. 51.6%; p < 0.0001 for both comparisons). However, despite these differences in absolute levels, the risk of AMI associated with increases in LDL-C and decreases in HDL-C was similar for Asians and non-Asians. Among South Asians, changes in apolipoprotein (Apo)A1 predicted risk better than HDL-C. ApoB/ApoA1 showed the strongest association with the risk of AMI. Conclusions The preserved association of LDL-C with risk of AMI among Asians, despite the lower baseline levels, suggests the need to rethink treatment thresholds and targets in this population. The low HDL-C level among South Asians requires further study and targeted intervention.
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Karthikeyan et al. (2009) conducted a case-control in First acute myocardial infarction (n=12,190). Plasma lipid and apolipoprotein abnormalities (LDL-C, HDL-C, ApoB, ApoA1) vs. Control subjects without acute myocardial infarction / non-Asians was evaluated on First acute myocardial infarction and prevalence of lipid abnormalities (e.g., low HDL-C in South Asians vs. rest of Asia) (p=<0.0001). Plasma lipid and apolipoprotein levels were similarly associated with first AMI risk in Asians and non-Asians despite lower LDL-C, with high rates of low HDL-C in South Asians (82.3% vs 57.4%, p<0.0001).
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