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INTERHEART: More than 80% of South Asians had low HDL cholesterol
A report from the INTERHEART study highlights the high prevalence of low plasma levels of high density lipoprotein (HDL) cholesterol in South Asians compared with other Asians. Over 80% of subjects, with or without previous heart attack, had a low level of HDL cholesterol (<40 mg/dl in men and <50 mg/dL in women). These data emphasise the need for targeted intervention amongst this group.
Karthikeyan G, Teo KK, Islam S et al. Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians. J Am Coll Cardiol 2009;53:244-53.
The INTERHEART study was a global case-control study that included 15,152 cases of first acute myocardial infarction (AMI) and 14,820 age- and sex-matched controls from 262 centres in 52 countries. In this latest report, the authors analysed data from 5,731 cases of AMI and 6,459 control subjects recruited by 65 centres in
HDL cholesterol levels in the South Asian population were substantially lower than in the other subgroups; 82% of AMI cases and 81% of controls had low HDL cholesterol. In contrast, the percentage of people with low HDL cholesterol in the other subgroups was generally similar with that observed in non-Asians (fig 2).
As in non-Asians, elevations in HDL cholesterol were associated with a decreased risk of AMI, although the protective effect of higher HDL cholesterol appeared to be weaker for South Asians than for other Asians (odds ratio for 1 SD increase in HDL cholesterol 0.87, 95% CI 0.72 to 1.06 in South Asians vs. 0.77, 95% CI 0.70 to 0.85 in other Asians. In other words, a 1 SD increase in HDL cholesterol was associated with a 13% decrease in AMI risk in South Asians but a 23% decrease in AMI risk in other Asians. However, increases in apolipoprotein AI (ApoAI) were similarly protective against AMI across the Asian subgroups.
In respect of low density lipoprotein (LDL) cholesterol, levels were about 10 mg/dL lower in Asians than non-Asians (127 vs. 136 mg/dL for cases and 119 vs. 127 mg/dL for controls). This may be related to lower body mass, although even after adjustment for waist-hip ratio or body mass index, LDL cholesterol were lower among Asians than non-Asians. Despite this, the risk of AMI was higher with lower LDL cholesterol levels.
Across the LDL cholesterol categories, subjects with normal or high HDL cholesterol had a lower risk of AMI than those with low HDL cholesterol.
Consistent with the overall INTERHEART report,1 the ratio of ApoB/ApoAI was the strongest predictor of AMI risk in Asians. For a 1 SD increase in this ratio, the odds ratio for AMI was 1.38 (95% CI 1.31 to 1.46) compared with 1.06 (95% CI 1.01 to 1.11) for every SD increase in the LDL-C/HDL-C ratio.
The lower levels of HDL cholesterol in South Asians observed in the INTERHEART study reinforce the relevance of interventions aimed at raising HDL cholesterol in this population. The authors concluded: ‘The low level of HDL cholesterol among South Asians requires further study and targeted intervention.’
1. Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-52.
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