South Asian Cardiovascular Disease &amp; Cancer Risk: Genetics &amp; Pathophysiology

Palaniappan, Latha; Garg, Arun; Enas, Enas; Lewis, Henrietta; Bari, Sehrish; Gulati, Martha; Flores, Cristina; Mathur, Ashish; Molina, César; Narula, Jagat; Rahman, Shahid; Leng, Jennifer; Gany, Francesca

doi:10.1007/s10900-018-0527-8

Cited by 26 publications

(23 citation statements)

References 184 publications

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“…SACs have one of the highest rates of atherosclerosis and coronary artery disease (CAD) in Canada ( 12 – 15 ). Previous epidemiological work has also shown elevated incidence, prevalence and mortality from CAD in this cohort, which is characterized by two basic features: lower age of onset and elevated severity ( 14 , 16 ). The INTERHEART study demonstrated that more than 90% of a population's attributable risk to myocardial infarctions (MIs), including that of South Asians, can be explained by 9 key risk factors including smoking, PA, intake of fruits and vegetables, alcohol, hypertension, abdominal adiposity, stress, elevated apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio, and diabetes mellitus ( 17 ).…”

Section: Cvd Risk Factor Profile In South Asian Canadianssupporting

confidence: 61%

“…This goal can only be achieved by identifying high risk groups within a population, determining barriers and facilitators to preventative behavior like PA, and implementing efficacious interventions to address these barriers and augment facilitators. Undoubtedly, the prevalence CVD in SACs is amongst the highest in Canada ( 12 , 13 , 15 , 16 ). They also suffer from a full spectrum of CVD risk factors, ranging from modifiable hypertension and diabetes ( 3 , 13 , 21 ) to non-modifiable adverse genetic profiles ( 125 , 126 ).…”

Section: Future Directionsmentioning

confidence: 99%

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The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians

Tharmaratnam

Iskandar

Doherty

et al. 2018

Front. Cardiovasc. Med.

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Unequivocal evidence suggests an increased prevalence of cardiovascular disease (CVD) amongst South Asian Canadians (SACs) compared to other ethnic cohorts, due to a combination of their unique cardiometabolic profile and environmental factors. This unfavorable CVD profile is characterized by an elevated risk of dyslipidemia, high apolipoprotein B/apolipoprotein A1 ratio, hypertension, glucose intolerance, type 2 diabetes mellitus, as well as increased BMI, body fat percentage, abdominal and visceral adiposity. Despite the overwhelming evidence for the effectiveness of physical activity (PA) in circumventing the onset of CVD and in the reduction of CVD risk factors, SACs are among the most physically inactive cohorts in Canada. This relates to a set of common and unique socio-cultural barriers, such as gender, beliefs and perceptions about illness, immigration, unfavorable PA environments, and their high prevalence of debilitating chronic diseases. Several strategies to improve PA participation rates in this high-risk population have been suggested, and include the implementation of culturally sensitive PA interventions, as well as clinician training in PA prescription through workshops that emphasize knowledge translation into clinical practice. Therefore, the purpose of this mini-review is to highlight and discuss: (1) the burden of heart disease in SACs (2) the cardiovascular benefits of PA for SACs; (3) factors affecting PA participation among SACs and how they can be addressed; (4) the impact of culturally sensitive PA prescription on CVD prevention; (5) barriers to culture-specific PA prescription by clinicians, and strategies to improve its use and impact.

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Section: Cvd Risk Factor Profile In South Asian Canadianssupporting

confidence: 61%

Section: Future Directionsmentioning

confidence: 99%

The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians

Tharmaratnam

Iskandar

Doherty

et al. 2018

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

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“…Only one-third of measured metabolic factors such as insulin resistance, dyslipidemia, and central obesity explain the excess CVD risk that SA face[ 51 ]. Novel biomarkers that may correlate with increased CVD include increased serum leptin and C-reactive protein, as well as adiponectin levels that are lower in SA compared to Caucasians despite similar BMI[ 99 ]. The correlation between decreased adiponectin and increased insulin resistance is particularly strong for SA[ 100 ].…”

Section: Individual Cardiovascular Risk Factorsmentioning

confidence: 99%

“…Lp(a) levels are largely genetically determined, varying over 1000-fold among individuals and 5-fold across populations. SA have a median Lp(a) concentration of 16 mg/dL compared to 6 mg/dL in Caucasians[ 99 ]. Elevated Lp(a) levels associate with vulnerable plaques and culprit lesions in acute coronary syndromes, including premature CAD, correlating with the extent and severity of both acute coronary syndrome, CAD, and coronary artery calcium score[ 17 ].…”

Section: Individual Cardiovascular Risk Factorsmentioning

confidence: 99%

Managing cardiovascular disease risk in South Asian kidney transplant recipients

Prasad¹,

Bhamidi²

2021

WJT

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South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.

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“…One-third of the population in South Asia develops CVD during their lifetime [ 5 ], making it a major public health and clinical problem. Although considerable diversity exists between countries in South Asia, all South Asians have markedly higher risk of CVD than other ethnicities [ 3 , 6 ]. The rise in CVD might reflect the intersectionality of poor health systems, behavioral factors, genetic factors, and gender factors in South Asia.…”

mentioning

confidence: 99%

Cardiovascular health through a sex and gender lens in six South Asian countries: Findings from the WHO STEPS surveillance

et al. 2022

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Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries. Methods We conducted a retrospective analysis of the World Health Organization’s “STEPwise approach to surveillance of risk factors for non-communicable disease” or “STEPS” from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed. Results The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (β male = -0.30, 95% CI = -0.37, -0.23 vs β female = -0.23, 95% CI = -0.29, -0.17; P < 0.001) and having a household size ≥5 (β male = -0.15, 95% CI = -0.24, -0.06 vs β female = -0.11, 95% CI = -0.16, -0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (OR male = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs OR female = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males. Conclusions Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.

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South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology

Cited by 26 publications

References 184 publications

The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians

The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians

Managing cardiovascular disease risk in South Asian kidney transplant recipients

Cardiovascular health through a sex and gender lens in six South Asian countries: Findings from the WHO STEPS surveillance

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