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Cardinal features
of Coronary Heart Disease in Indians
| A report of WHO says that by the end of this century, India
would account for more than half of the total heart patients
in the world. |
| Incidence of CAD in US is 1 %, whereas it was as high
as 3 % among Indians and about 7 % among north Indians. |
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Higher
Rate - 2-4 fold higher prevalence of CAD and
mortality. Higher rates of clinical events - double than the
Whites, 4 fold higher than Chinese. |
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Greater
pre maturity - 5-10 yrs. earlier onset of first myocardial
infarction. 5--10 fold higher risk of myocardial infarction and
death in the younger age < 40 yrs. |
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Greater
severity - Three vessel disease common even in younger pre
menopausal women. Large infarction and greater muscle damage in
younger age. |
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Lower
prevalence of conventional risk factors like hypertension,
obesity, cigarette smoking. Cholesterol levels similar to Whites
but higher than other Asians. |
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Higher
prevalence of thrombogenic risk factors like - high
levels of lipoprotein (a), homocysteine, ApoB, high levels of
Triglycerides, fibrinogen, plasminogen activator inhibitor - 1,
low levels of HDL.
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The increased incidence of the CAD in the Indians is
due to a combination of Nature (genetic predisposition) and Nurture
(environmental factors). Because of the genetic predisposition the
harmful effects of environmental factors are greatly magnified.
Adverse life style factors include those associated with affluence, urbanization
and mechanization. When people move from the rural to the urban
environment they tend to become sedentary. Decreased
physical activity and increases consumption of calories and saturated
fatty acids, insulin resistance and athrogenic dyslipidaemia all add
and have synergistic effect on the development of CAD. Because
Indians have higher prevalence of thrombotic risk factors the
conventional risk factors become doubly dangerous. Lipoprotein(a)
elevated levels render many Indians genetically susceptible to CAD as
early as childhood. It has been seen that Lp(a) level > 30 mg % is
associated with increases High rate of CAD in Indians are in
sharp contrast to very low rates in other Asians. Despite high
rates of smoking and hypertension, CAD rates among both Chinese and
Japanese are about 4 fold lower than in US. The
low rate of CAD in Chinese despite high rates of other risk factors is
attributed to their highly Anti-Atherogenic Lipid Profile. In
a study the typical levels in rural China were:
Others have reported cholesterol levels as low as 80
mg /dl in some Chinese communities, where CAD is virtually non
existent.
Following are some observations
of a Berkeley study: -
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Indians around the
globe have highest rate of heart disease, usually 2 to 3 times
higher than Americans, Europeans, Chinese and Japanese. |
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Indo Americans are
at a higher risk of heat disease in spite of the fact that half
of them are vegetarians and lack many of the traditional risk
factors related to the heart disease. |
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About 25 % of the
heart attacks among the Indian descent occur when they are
younger than 40, unheard of in other populations. |
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Among those younger
than 30 years of age, the coronary artery disease mortality is
three fold higher than Whites in UK and 10 fold higher than Chinese
in Singapore. |
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