Hosseini Farshad, Malhi Navraj, Sellers Stephanie L, Khan Nadia, Li Chi Kien, Taylor Carolyn M, Gupta Milan, Verma Subodh, Ramanathan Krishnan
Division of Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2022 Oct;38(10):1570-1579. doi: 10.1016/j.cjca.2022.05.005. Epub 2022 May 11.
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes compared with White Caucasians (WCs) following invasive revascularisation procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and to discuss their potential impact on the development of coronary disease, acute coronary syndrome, and revascularisation outcomes. SAs have a more diffuse pattern with multivessel involvement compared with WCs. However, less is known about other morphologic characteristics, such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher noncalcified plaque composition, elevated thrombosis, and inflammatory markers likely contribute to the disease pattern. Although the current evidence on the role of coronary vessel size remains inconsistent, smaller diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularisation outcomes. In conclusion, SAs have a unique CAD risk profile composed of traditional and novel risk factors. Our findings highlight the need for additional awareness of health professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
与白种人（WCs）相比，南亚人（SAs）患冠状动脉疾病的患病率更高、发病更早，并且在进行侵入性血运重建手术后，其预后更差，而侵入性血运重建手术是冠状动脉疾病（CAD）治疗的主要手段。我们试图回顾南亚和白种人患者在CAD模式和危险因素方面的差异，并讨论它们对冠心病、急性冠状动脉综合征和血运重建结果发展的潜在影响。与白种人相比，南亚人的病变模式更弥漫，多支血管受累。然而，关于南亚人群中动脉粥样硬化斑块钙化和冠状动脉直径等其他形态学特征的了解较少。尽管冠状动脉钙化负担相似，但较高的非钙化斑块成分、血栓形成增加和炎症标志物可能导致了这种疾病模式。尽管目前关于冠状动脉大小作用的证据仍然不一致，但南亚人较小的冠状动脉直径可能在较高的疾病患病率中发挥潜在作用。考虑到冠状动脉直径对血运重建结果的影响，这一点尤为重要。总之，南亚人具有由传统和新出现的危险因素组成的独特CAD风险特征。我们的研究结果强调，医疗专业人员需要进一步认识到这种特定的风险特征和潜在的治疗靶点，以及对这一弱势群体进行进一步研究的必要性。
