TY - JOUR
T1 - Lipoprotein(a)
T2 - An underrecognized genetic risk factor for malignant coronary artery disease in young Indians
AU - Enas, Enas A.
AU - Varkey, Basil
AU - Dharmarajan, T. S.
AU - Pare, Guillaume
AU - Bahl, Vinay K.
N1 - Funding Information:
The authors thank Dr. Sotirios Tsimikas for his valuable suggestions. The research is funded by CADI Research Foundation (a non-profit organization ), Lisle, IL USA.
Publisher Copyright:
© 2019 Cardiological Society of India
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD—a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
AB - Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD—a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
KW - ASCVD risk enhancing factor
KW - Acute coronary syndrome
KW - Acute myocardial infarction
KW - Cardiovascular disease
KW - Coronary artery disease
KW - Indians
KW - Lipoprotein(a)
KW - Lp(a)-years
KW - Malignant coronary artery disease
KW - Mendelian randomization
KW - Standardized mortality ratio
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U2 - 10.1016/j.ihj.2019.04.007
DO - 10.1016/j.ihj.2019.04.007
M3 - Review article
C2 - 31543191
AN - SCOPUS:85066156465
SN - 0019-4832
VL - 71
SP - 184
EP - 198
JO - Indian Heart Journal
JF - Indian Heart Journal
IS - 3
ER -
