Kalra Dinesh K, Sikand Geeta, Vijayaraghavan Krishnaswami, Guyton John R
Lipid Clinic, Division of Cardiology, Rush Medical College, Chicago, IL, USA.
Preventive Cardiology & Cholesterol Management Program, University of California Irvine School of Medicine, Irvine, CA, USA.
J Clin Lipidol. 2020 Mar-Apr;14(2):161-169. doi: 10.1016/j.jacl.2020.03.005.
South Asian risk for atherosclerotic cardiovascular disease (ASCVD) has received special emphasis in the 2018 US AHA/ACC/Multisociety Cholesterol Guidelines. The term "South Asian" refers specifically to the countries of India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and Maldives and to the worldwide diaspora of families from these countries. With this definition, approximately 25% of the world's population is South Asian, but about 50% of ASCVD occurs in this group. In this JCL Roundtable, we discuss the roles of visceral adiposity, diabetes, and features of the metabolic syndrome; lipoprotein(a); and diet and lifestyle, including the transition of both diet and lifestyle over the past 40 to 50 years. Genetic and/or hidden risk is an area of ongoing research. Individual patient assessment and intervention should recognize the earlier onset of ASCVD and the value of screening for traditional risk factors as well as waist circumference, coronary artery calcium scoring, and lipoprotein(a) assay. Culturally acceptable dietary strategies are available, although not widely implemented or evaluated as yet. In very-high-risk cases of secondary prevention, one should consider combining medications to drive low-density lipoprotein cholesterol much lower than 70 mg/dL. Our discussion concludes by insisting that the signal of alarm must be accompanied by decisive action.
2018年美国心脏协会（AHA）/美国心脏病学会（ACC）/多学会胆固醇指南特别强调了南亚人群患动脉粥样硬化性心血管疾病（ASCVD）的风险。“南亚”一词具体指印度、巴基斯坦、尼泊尔、不丹、孟加拉国、斯里兰卡和马尔代夫等国家，以及这些国家在世界各地的侨民家庭。根据这一定义，全球约25%的人口为南亚人，但约50%的ASCVD病例发生在这一群体中。在本次《临床化学杂志》圆桌会议中，我们讨论了内脏肥胖、糖尿病和代谢综合征特征；脂蛋白（a）；以及饮食和生活方式，包括过去40至50年饮食和生活方式的转变。遗传和/或隐性风险是一个正在进行研究的领域。对个体患者的评估和干预应认识到ASCVD发病更早的情况，以及筛查传统风险因素以及腰围、冠状动脉钙化评分和脂蛋白（a）检测的价值。虽然目前尚未广泛实施或评估，但已有文化上可接受的饮食策略。在二级预防的极高风险病例中，应考虑联合用药，使低密度脂蛋白胆固醇降至远低于70mg/dL。我们的讨论最后强调，发出警报信号的同时必须采取果断行动。
