Coronary artery disease in South Asian immigrants living in New York City: angiographic findings and risk factor burdens.

BACKGROUND: The prevalence of coronary artery disease (CAD) among South Asians (SAs) significantly exceeds that of Caucasians. South Asians also suffer from more premature, clinically aggressive and angiographically extensive (3-vessel) disease. The role of conventional CAD risk factors (CCRFs) remains controversial. OBJECTIVES: We sought to determine if the CCRF burdens of SA immigrants differed from Caucasians. We also sought to determine whether angiographic CAD was more extensive among SAs and whether SA ethnicity was an independent predictor of 3-vessel disease. METHODS: We reviewed the CCRFs and angiograms of 520 SAs and 219 Caucasians consecutively referred with stable angina pectoris or acute coronary syndrome. RESULTS: Three-vessel CAD was significantly more common among SAs than Caucasians (32.5% vs 22.4%; P = .006). Diabetes mellitus (DM), age and male sex independently predicted 3-vessel disease. South Asian ethnicity showed a trend toward predicting 3-vessel disease (P = .06). The frequency of DM (55% vs 31.1%; P < .001), hypertension (77.5% vs 68.5%; P = .01), obesity (63.1% vs 44.3%; P < .001) and dyslipidemia (75.6% vs 61.6%; P < .001) were significantly greater among SAs; however, smoking was significantly more common among Caucasians (44.3% vs 21.3%; P < .001). Compared to Caucasians, SAs were significantly younger at the time of presentation for coronary angiography (58.5 vs 61.1 yrs; P = .001). CONCLUSIONS: SAs referred for coronary angiography with stable angina and acute coronary syndromes are younger, have significantly higher rates of 3-vessel disease, as well as higher rates of DM, hypertension, obesity and dyslipidemia than Caucasians. Aggressive screening, prevention and treatment may be warranted in this population.

Evidence for aggressive blood pressure-lowering goals in patients with coronary artery disease.

Lowering blood pressure (BP) reduces the risk of major cardiovascular mortality and morbidity. Current consensus targets for BP reduction are less than 140/90 mm Hg in uncomplicated hypertension and less than 130/80 mm Hg in those patients with diabetes, chronic kidney disease, and coronary artery disease or in those who are at high risk for developing coronary artery disease (defined as a Framingham risk score of > or = 10%). There is solid epidemiologic evidence for lower BP targets, supported by some clinical studies with surrogate end points. On the other hand, there are meager data from clinical trials using hard end points, and there is a concern that overly aggressive BP lowering, especially of diastolic BP, may impair coronary perfusion, particularly in patients with left ventricular hypertrophy and/or coronary artery disease. This review evaluates the evidence for the benefit of lower BP targets in hypertension management.