Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Department of Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
Curr Diabetes Rev. 2021;17(9):e011221190238. doi: 10.2174/1573399817999210112192419.
South Asians are at a significantly increased risk of atherosclerotic cardiovascular disease (ASCVD). For a major portion of the South Asian population, the cardiovascular disease events occur at a relatively younger age, are associated with worse outcomes, and have potentially more severe socioeconomic implications compared to their western counterparts.
The term "South Asian" typically constitutes individuals from India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and Maldives, including expatriates as well as their families from these countries. Based on this, South Asians form approximately 25% of the world's population, with a high ASCVD burden in this group. In this review, we discuss the pathophysiological factors underlying ASCVD in South Asians, the dyslipidemia types and management, and discuss approaches to improve the overall ASCVD prevention efforts in this large subset population of the world. Although the pathophysiological mechanisms underlying the excess risk of cardiovascular disease in South Asians are multifactorial, dyslipidemia is a primary risk factor for the incidence and prevalence of this disease. The traditional "South Asian" dyslipidemia pattern includes levels of low-density lipoprotein cholesterol (LDL-C) in the normal range with a high concentration of LDL particles, elevated triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C) with dysfunctional HDL particles, and high levels of lipoprotein(a).
While combined efforts to study the expatriate South Asians in western countries have been able to identify South Asian specific dyslipidemias, causal associations and optimal management remain relatively less explored. Larger scale studies are needed to better quantify the relationship of each lipid parameter with ASCVD risk among South Asians as well as optimal lipid targets and management strategies to reduce morbidity and mortality in this high-risk group.
南亚人患动脉粥样硬化性心血管疾病（ASCVD）的风险显著增加。对于南亚人口的很大一部分人来说，心血管疾病事件发生在相对较年轻的年龄，与更差的结局相关，并且与西方同龄人相比，可能具有更严重的社会经济影响。
“南亚人”一词通常包括来自印度、巴基斯坦、尼泊尔、不丹、孟加拉国、斯里兰卡和马尔代夫的个人，以及来自这些国家的侨民及其家人。基于此，南亚人约占世界人口的 25%，在该人群中 ASCVD 的负担很高。在这篇综述中，我们讨论了南亚人 ASCVD 的病理生理因素、血脂异常类型和管理，并讨论了改善这一大世界人群 ASCVD 整体预防工作的方法。尽管南亚人患心血管疾病风险增加的病理生理机制是多因素的，但血脂异常是这种疾病发生和流行的主要危险因素。传统的“南亚”血脂异常模式包括 LDL-C 水平在正常范围内，LDL 颗粒浓度高，甘油三酯升高，HDL-C 水平低，HDL 颗粒功能障碍，脂蛋白（a）水平高。
虽然研究西方国家侨民南亚人的联合努力能够确定南亚特有的血脂异常，但因果关系和最佳管理仍相对较少探索。需要更大规模的研究来更好地量化每个血脂参数与南亚人 ASCVD 风险的关系，以及降低该高风险人群发病率和死亡率的最佳血脂目标和管理策略。
