CLINICAL RESEARCH: CORONARY DISEASE
Lipid Profile, Plasma Apolipoproteins, and Risk of a First Myocardial Infarction Among AsiansAn Analysis From the INTERHEART Study
Ganesan Karthikeyan, MD, DM*, ,
Koon K. Teo, MBBCh, PhD, FRCPC,
Shofiqul Islam, MSc,
Mathew J. McQueen, MD, FRCPC,
Prem Pais, MD ,
Xingyu Wang, PhD ,
Hiroshi Sato, MD||,
Chim Choy Lang, MD¶,
Chitr Sitthi-Amorn, MD#,
M.R. Pandey, MBBS**,
Khawar Kazmi, MBBS,
John E. Sanderson, MA, MD, FRCP, FACC and
Salim Yusuf, DPhil, FRCPC, FRSC,*
* Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
St. Johns Medical College, Bangalore, India
The Beijing Hypertension League Institute, Beijing, China
|| Osaka University Graduate School of Medicine, Osaka, Japan
¶ Ninewells Hospital and Medical School, Dundee, United Kingdom
# Chulalongkorn University, Bangkok, Thailand
** Nepal Hypertension Society, Kathmandu, Nepal
Liaquat National Hospital, Karachi, Pakistan
Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, United Kingdom
Manuscript received August 11, 2008;
revised manuscript received September 16, 2008,
accepted September 22, 2008.
* Reprint requests and correspondence: Dr. Salim Yusuf, Department of Medicine, McMaster University, 2nd Floor McMaster Clinic, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (Email: yusufs{at}mcmaster.ca).
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.
Key Words: lipids • lipoproteins • myocardial infarction
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | Apo = apolipoprotein | | CVD = cardiovascular disease | | HDL-C = high-density lipoprotein cholesterol | | LDL-C = low-density lipoprotein cholesterol | | TG = triglyceride |
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