Coronary artery disease epidemic in Indians: a cause for alarm and call for action.

Coronary artery disease (CAD) rates in urban areas in India are now 4-fold higher than in the United States (US) although the rates were similar in 1968. Both overseas and resident Indians have the highest rates of CAD, although almost half of them are life-long vegetarians. When compared to Whites, Blacks, Hispanics and other Asians, CAD rates among Indians worldwide are two to four times higher at all ages and five to ten times higher in those < 40 years of age. Although CAD is a fatal disease with no known cure, it is also highly predictable, preventable, and treatable. During the past 30 years, CAD rates halved in the US, Australia, Canada, France, Japan, and Finland. These vast reductions in CAD mortality are attributed to nationwide changes in specific risk factors that were identified through epidemiological research and addressed through population-based interventions, rather than extensive use of expensive technology. Reduction in risk factors explains most of the decline with modest contributions from advances in treatment. Ironically, the CAD rates doubled in India during the same period, primarily due to dietary changes associated with epidemiological transition from a rural sustenance economy to an urban market oriented economy. The impact of such changes appears to be greater in Indians than in other populations due to a genetic predisposition. Significant decline of CAD is readily achievable in India, by adopting a combined population-wide and high-risk primary prevention strategy. This requires concerted action by the medical profession, govemment, media, and the public.

Lipoprotein(a) in coronary heart disease: a case-control study.

To determine the significance of lipoprotein(a) levels in coronary heart disease patients, a case-control study was performed with 48 newly diagnosed coronary heart disease patients and 23 controls who were evaluated using clinical history and biochemical examination. Lipoprotein(a) was measured by quantitative latex-enhanced immunoturbidimetric method. Geometric means of biochemical parameters were obtained. Comprehensive lipid tetrad index was calculated using a previously validated formula. There was no significant difference in prevalence of diabetes, hypertension and smoking in cases and controls. Dietary intake of calories, fats, fatty acids and antioxidant vitamins was also similar. The levels of fasting glucose, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were not significantly different in cases and controls (p > 0.05). Low-density lipoprotein/high-density lipoprotein ratio (4.33 +/- 1.5 vs 4.29 +/- 1.8) and total cholesterol/high-density lipoprotein ratio (6.59 + 1.7 vs 6.69 +/- 2.2) were similar. The mean lipoprotein(a) levels were significantly greater in cases (11.95 +/- 2.8 mg/dL, range 1-102 mg/dL) as compared to controls (6.68 +/- 3.4 mg/dL, range 1-73 mg/dL) (t = 2.08, p = 0.041). As compared to controls, in coronary heart disease cases, mean lipoprotein(a) levels in patients upto 50 years (10.27 +/- 2.8 vs 7.27 +/- 3.4 mg/dL) as well as those over 50 years (12.99 +/- 2.9 vs 4.91 +/- 3.5 mg/dL) were significantly more (p < 0.05). Coronary heart disease patients had a slightly greater prevalence of high lipoprotein(a) levels, 20 mg/dL or more (31.3 vs 13.0%; chi 2 = 2.83, l-tailed p < 0.05). Comprehensive lipid tetrad index (total cholesterol x triglycerides x lipoprotein(a) divided by high-density lipoprotein cholesterol) was also slightly higher in cases (14688.2 +/- 3.6) than in controls (8358.2 +/- 4.3) (t = 1.68, 1-tailed p < 0.05). This study shows that lipoprotein(a) levels are significantly more in both younger and older coronary heart disease patients as compared to controls.

Cooking oils, cholesterol and CAD: facts and myths.

Elevated blood cholesterol is the strongest risk factor for coronary artery disease, and dietary excess of saturated fats is its largest contributor. Contrary to common belief, the contribution of dietary cholesterol to blood cholesterol is small. As a matter of fact, one need not consume cholesterol to have high blood cholesterol. Most vegetable cooking oils are low in saturated fats and are "heart healthy" with the important exception of tropical oils, such as coconut and palm oil, which are very rich in saturated fats. Though these oils contain no cholesterol, their cholesterol-raising potential is similar to or higher than most animal fats. Liberal use of these oils should be discouraged.

Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.

The prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors.