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Excess coronary artery disease risk in South Asian immigrants: Can dysfunctional high-density lipoprotein explain increased risk?  [cached]
Sunita Dodani
Vascular Health and Risk Management , 2008,
Abstract: Sunita DodaniMedical College of Georgia, Augusta, GA, USABackground: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the United States (US), and South Asian immigrants (SAIs) have a higher risk of CAD compared to Caucasians. Traditional risk factors may not completely explain high risk, and some of the unknown risk factors need to be explored. This short review is mainly focused on the possible role of dysfunctional high-density lipoprotein (HDL) in causing CAD and presents an overview of available literature on dysfunctional HDL.Discussion: The conventional risk factors, insulin resistance parameters, and metabolic syndrome, although important in predicting CAD risk, may not sufficiently predict risk in SAIs. HDL has antioxidant, antiinflammatory, and antithrombotic properties that contribute to its function as an antiatherogenic agent. Recent Caucasian studies have shown HDL is not only ineffective as an antioxidant but, paradoxically, appears to be prooxidant, and has been found to be associated with CAD. Several causes have been hypothesized for HDL to become dysfunctional, including Apo lipoprotein A-I (Apo A-I) polymorphisms. New risk factors and markers like dysfunctional HDL and genetic polymorphisms may be associated with CAD.Conclusions: More research is required in SAIs to explore associations with CAD and to enhance early detection and prevention of CAD in this high risk group.Keywords: South Asian immigrants, coronary heart disease, cardiovascular risk, high-density lipoprotein
Metabolic syndrome in South Asian immigrants: more than low HDL requiring aggressive management
Sunita Dodani, Rebecca Henkhaus, Jo Wick, James Vacek, Kamal Gupta, Lei Dong, Merlin G Butler
Lipids in Health and Disease , 2011, DOI: 10.1186/1476-511x-10-45
Abstract: Despite improvements in clinical outcomes and decrease in event rates by 50% over the past 30 years, coronary artery disease (CAD) continues to be a major cause of death in the US [1]. A disturbing trend toward high rates of CAD, insulin resistance or metabolic syndrome (MS) has been noted among South Asian immigrants (SAIs)- people from the Indian sub-continent (Bangladesh, Pakistan, India, Sri Lanka, Nepal and Bhutan) [2-6]. This is particularly alarming for several reasons; (i) South Asians represent one-fifth of the global population. In the US, 3.6 million, or 1.3% of the population, is made up of SAIs [7-10]. SAIs are the fastest growing Asian immigrant population in the US which has more than doubled since the 1980 s (growth rate of 108%), and of that growth, three-fourths is due to immigration [7] and (ii) prevalence of CAD in SAIs is twice as high as other immigrant populations [11] and three times higher than in the Framingham Heart Study (FHS), even after adjustment for all conventional risk factors [12-14].MS plays a causative role in the prevalence of type II diabetes (T2D) as well as premature atherosclerosis in SAIs, a pattern increasingly noted in parallel with migration and urbanization. Current guidelines for the criteria used to define MS including body mass index (BMI) and waist circumference (WC), were predominantly modeled after white Caucasians and are likely to underestimate MS and abdominal obesity in SAIs [13-16]. Evidence suggests that immigration from South Asia to the US, and the acculturation that occurs, exacerbates the consequences of MS and increases CAD risk. Moreover, low HDL is one of the components of MS and SAIs are known to have low HDL. However, assessment of HDL functionality and its correlation with MS is important and has not been studied in any population. In order to understand the type of MS and its association with dysfunctional HDL-Dys-HDL (if present), we conducted a National Institutes of Health (NIH) funded project
Genetic studies on the APOA1-C3-A5 gene cluster in Asian Indians with premature coronary artery disease
Jayashree Shanker, Ganapathy Perumal, Veena S Rao, Natesha B Khadrinarasimhiah, Shibu John, Sridhara Hebbagodi, Manjari Mukherjee, Vijay V Kakkar
Lipids in Health and Disease , 2008, DOI: 10.1186/1476-511x-7-33
Abstract: Genotyping and lipid assays were carried out using standard protocols. Plasma lipids showed a strong heritability (h2 48% – 70%; P < 0.0001). A subset of 77 ASPs with positive sign of Logarithm of Odds (LOD) score showed significant linkage to CAD trait by multi-point analysis (LOD score 7.42, P < 0.001) and to Sac1 (LOD score 4.49) and -75G>A (LOD score 2.77) SNPs by single-point analysis (P < 0.001). There was significant proportion of mean allele sharing (pi) for the Sac1 (pi 0.59), -75G>A (pi 0.56) and +83C>T (pi 0.52) (P < 0.001) SNPs, respectively. QTL analysis showed suggestive evidence of linkage of the Sac1 SNP to Total Cholesterol (TC), High Density Lipoprotein-cholesterol (HDL-C) and Apolipoprotein B (ApoB) with LOD scores of 1.42, 1.72 and 1.19, respectively (P < 0.01). The Sac1 and -75G>A SNPs along with hypertension showed maximized correlations with TC, TG and Apo B by association analysis.The APOC3-Sac1 SNP is an important genetic variant that is associated with CAD through its interaction with plasma lipids and other standard risk factors among Asian Indians.Lipids and lipoproteins have been traditionally associated with high risk of incident coronary artery disease (CAD). The Apolipoprotein A1-C3-A4-A5 gene cluster on chromosome 11q23 (Apo11q) is among the most well characterized regions of the human genome with reference to their dynamic association with plasma lipids and lipoproteins [1]. The associated haplotypes constitute a highly informative genetic marker [2]. Extensive interactions both within and between the genetic variants within this cluster contribute to the quantitative variation in the blood lipid phenotypes [3]. The NCBI db SNP Build 116 has established over 182 single nucleotide polymorphisms (SNPs) and 4 ins/del variants in this genetically rich region [4]. A complex pattern of gene expression has been demonstrated through in vivo studies, wherein the Apo CIII enhancer acts as a common regulatory element for the APOA1-C3-A4 genes
The Association between Acculturation and Dietary Patterns of South Asian Immigrants  [PDF]
Iris A. Lesser, Danijela Gasevic, Scott A. Lear
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0088495
Abstract: Dietary acculturation, specifically the adoption of western dietary habits, may result in adverse health effects such as obesity and type 2 diabetes. Therefore, it is necessary to explore the role of acculturation in dietary patterns as well as awareness and knowledge of healthy nutrition among South Asian immigrants. This is an especially important population to target as South Asians have higher prevalence rates of type 2 diabetes and cardiovascular disease, which may be magnified with immigration. The current investigation is a sub-study of the Multi-Cultural Community Health Assessment Trial (M-CHAT). There were 207 participants of South Asian origin included in the initial study, 129 were born outside of Canada and had immigrated after the age of 18. The length of residence in Canada was used as a marker for acculturation. A questionnaire addressing perceived changes in dietary patterns, food preparation, and nutrition knowledge and awareness since immigration was used to assess dietary practices. The association between length of residence and variables related to perceived changes in dietary patterns was explored with Spearman correlation and significant associations were subsequently analyzed with ordinal logistic regression analysis adjusted for age, sex, education and body mass index. South Asian immigrants in Canada reported a variety of positive dietary practices, including an increased consumption of fruits and vegetables and an improvement in food preparation (including an increase in grilling and a decrease in deep frying when cooking). However, there was a reported increase in the consumption of convenience foods, sugar-sweetened beverages, red meat and in dining out. South Asian immigrants in Canada reported a variety of positive dietary practices including an improvement in food preparation. Future health promotion strategies should encourage cultural sensitivity in efforts to reduce the consumption of sugar-sweetened beverage, convenience foods and to encourage eating at home rather than dining out.
Apolipoprotein E (Apo E) Gene Polymorphism in the Bangladeshi Population and its Comparison with Other Asian Populations
Minhaz Uddin Ahmed,Sharif Akhteruzzaman
Journal of Medical Sciences , 2006,
Abstract: Apolipoprotein (Apo E) gene polymorphism was determined in 53 unrelated Bangladeshi individual by using restriction enzyme isoform genotyping. This gene is polymorphic, with three common alleles coding for three major isoforms ε2, ε3 and ε4, resulting in six genotypes (ε2/ε2, ε3/ε2, ε4/ε2, ε3/ε3, ε4/ε3 and ε4/ε4). These isoforms differ from each other by a single amino acid substitution. Apo E functions as ligands of various receptors and determines the metabolic fate of lipoproteins. The genetic variations at the Apo E locus could thus be a major determinant of the inter-individual variation in susceptibility to coronary artery disease. The allele frequencies for Apo ε2, ε3 and ε4 alleles were found to be 0.05, 0.80 and 0.15, respectively in Bangladeshi population. The allele frequencies found in this study were compared with other Asian populations using Chi-square (χ2) test and cluster analysis. The Bangladeshi population shows close relationship with Japanese population living in Tokyo, Sendai and Indian populations living in Singapore. This study found ε3 to be the predominant isoform but the relative proportions of the three isoforms have shown variation among populations.
The Association of the Triglyceride-to-HDL Cholesterol Ratio with Insulin Resistance in White European and South Asian Men and Women  [PDF]
Samiul A. Mostafa, Melanie J. Davies, Danielle H. Morris, Tom Yates, Balasubramanian Thiagarajan Srinivasan, David Webb, Emer Brady, Kamlesh Khunti
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0050931
Abstract: Introduction There is recent interest surrounding the use of the triglyceride-to-HDL cholesterol ratio as a surrogate marker of insulin resistance in clinical practice, as it may identify people at high risk of developing diabetes or its complications. However, it has been suggested using this lipid ratio may not be appropriate for measuring insulin resistance in African-Americans, particularly women. We investigated if this inconsistency extended to South Asian women in a UK multi-ethnic cohort of White Europeans and South Asians. Methods Cross-sectional analysis was done of 729 participants from the ADDITION-Leicester study from 2005 to 2009. The association between tertiles of triglyceride-to-HDL cholesterol ratio to fasting insulin, homeostatic model of assessment for insulin resistance (HOMA1-IR), quantitative insulin sensitivity check index (QUICKI) and glucose: insulin ratio was examined with adjustment for confounding variables. Results Incremental tertiles of the triglyceride-to-HDL cholesterol ratio demonstrated a significant positive association with levels of fasting insulin, HOMA1-IR, glucose: insulin ratio and a negative association with QUICKI in White European men (n = 255) and women (n = 250) and South Asian men (n = 124) (all p<0.05), but not South Asian women (n = 100). A significant interaction was demonstrated between sex and triglyceride-to-HDL cholesterol ratio tertiles in South Asians only (p<0.05). The area under the receiver operating characteristic curve for triglyceride-to-HDL cholesterol ratio to detect insulin resistance, defined as the cohort HOMA1-IR≥75th percentile (3.08), was 0.74 (0.67 to 0.81), 0.72 (0.65 to 0.79), 0.75 (0.66 to 0.85) and 0.67 (0.56 to 0.78) in White European men and women, South Asian men and women respectively. The optimal cut-points for detecting insulin resistance were 0.9–1.7 in mmol/l (2.0–3.8 in mg/dl) for the triglyceride-to-HDL ratio. Conclusion In South Asian women the triglyceride-to-HDL cholesterol ratio was not associated with insulin resistance; therefore there may be limitations in its use as a surrogate marker in this group.
Apolipoprotein E gene polymorphism and dyslipidaemia in adult Asian Indians: A population based study from calcutta, India  [cached]
Das Mithun,Pal Susil,Ghosh Arnab
Indian Journal of Human Genetics , 2008,
Abstract: Aim : The study was aimed to determine the association of Apolipoprotein E (apo E) gene polymorphisms on lipid levels in Asian Indian population. Methods : A total of 350 (184 males and 166 females) adult (30 years and above) Asian Indians of Calcutta and suburb participated in the study. Anthropometric measures, lipids profiles, and blood glucose measures were collected. Out of 350 subjects, a sample of 70 individuals was selected randomly for genotyping after adjusting for age and sex. The apo E gene polymorphisms were determined by agarose gel electrophoresis. Results : The apo E polymorphism showed significant association with dyslipidaemia (P=0.0135) with e3/4 combination has had the highest occurrence of dyslipidaemia and metabolic syndrome (MS) followed by ε4/4 <ε3/3 <ε2/4 <ε2/3 in decreasing order. Conclusions : The ε4 allele of apo E gene independent of other risk factors is associated with dyslipidaemia in particular with low HDLc and high TC: HDLc ratio.
Epidemiology of Cigarette and Smokeless Tobacco Use among South Asian Immigrants in the Northeastern United States  [PDF]
Cristine D. Delnevo,Michael B. Steinberg,Shawna V. Hudson,Rajiv Ulpe,Robert S. DiPaola
Journal of Oncology , 2011, DOI: 10.1155/2011/252675
Abstract: As the most preventable cause of death in the world today, understanding tobacco use among one of the fastest growing ethnic/racial groups is warranted. We explore cigarette and smokeless tobacco (SLT) use among South Asians in NJ and the Northeast using the Tobacco Use Supplement to the Current Population Survey. Overall, tobacco use rates among South Asians were similar or lower than the population. However, in NJ, South Asian males had the highest SLT rate (2.7%) and in the Northeast, White (AOR = 5.8, 95%? CI = 3.7–9.4) and South Asian males (AOR = 4.0, 95%? CI = 1.5–10.6) had significantly higher odds of current SLT use relative to non-White males. Tobacco use among South Asians was not homogeneous; Pakistanis are overrepresented among cigarette smokers while Indians are overrepresented among SLT users. Given the differential tobacco use among and within South Asian, disaggregating data to understand tobacco use behaviors is necessary to develop effective interventions for tobacco cessation. 1. Introduction Tobacco is the single most preventable cause of death in the world today, including South Asian countries like India where there are disparities in chronic diseases like cancer and cardiovascular disease that have surpassed infectious disease as the leading causes of death. South Asians are the third largest Asian group in the United States, comprising 1.89 million people and are among the fastest growing racial groups in New Jersey and the Northeast [1]. In 2000, one out of three South Asians reside in the Northeast, and there were almost 170,000 South Asians living in New Jersey, representing the 3rd largest statewide South Asian population in the country with the large majority of South Asian immigrants coming from India, Pakistan, Bangladesh, and Sri Lanka [1]. Despite marked health disparities in South Asians internationally compared to the US population (e.g., cancer, heart disease, and diabetes) [2–4], little is known about the health status of South Asians residing in the US Paradoxically, the South Asian population in the US is generally viewed as a successful immigrant group, resulting in a characterization known as the “Model Minority Myth.” This concept describes a minority ethnic, racial, or religious group whose members achieve a higher degree of success, affluence, and thus good health, than the population as a whole. However, recent data strongly contradict the notion that South Asians are uniformly affluent and healthy and highlight the growing heterogeneity of this group [1, 2, 5, 6]. Indeed, India is the second largest
Genetic study of common variants at the Apo E, Apo AI, Apo CIII, Apo B, lipoprotein lipase (LPL) and hepatic lipase (LIPC) genes and coronary artery disease (CAD): variation in LIPC gene associates with clinical outcomes in patients with established CAD
Marco G Baroni, Andrea Berni, Stefano Romeo, Marcello Arca, Tullio Tesorio, Giovanni Sorropago, Umberto Di Mario, David J Galton
BMC Medical Genetics , 2003, DOI: 10.1186/1471-2350-4-8
Abstract: 102 subjects with established coronary artery disease and 104 unrelated normal subjects were studied. CAD Patients were followed up for 8 years, and clinical CAD outcomes (a second coronary angioplasty (PTCA), myocardial infarction, coronary artery by-pass graft (CABG), cardiovascular deaths), available from 60 subjects, were related to the genetic variants by multiple regression analysis. Results. Of the six lipid loci studied (for a total of 11 polymorphisms) only the apolipoprotein E, Apo B and LIPC polymorphisms distinguished between case and controls. However, multivariate analysis accounting for clinical and metabolic predictors of CAD showed that only the ApoB Xba1 and ApoE4 polymorphism associated with CAD in this Italian population. When lipid parameters were related to genotypes, the ApoE, ApoB, and LIPC gene polymorphisms were associated to various markers of dyslipidaemia in the CAD patients, confirming previous reports. When the occurrence of a second cardiovascular event was related to genotypes, an independent role was observed for the LIPC gene T202T variant.variation in LIPC (hepatic lipase) gene associates with clinical outcomes in Italian patients with established CAD. Further studies on the LIPC gene in CAD patients are warranted, in particular looking at the possible influences on clinical outcomes.Coronary artery disease (CAD) accounts for roughly one-half of all cardiovascular deaths and is a major cause of morbidity and mortality. Twin studies [1,2] have demonstrated that the concordance rates for monozygotic twins are higher than those for dizygotic twins and familial aggregation of CAD has long been known [1,3,4]. Current evidence demonstrates that positive family history and several alterations in lipid metabolism, including high LDL (low density lipoprotein) and low HDL (high density lipoprotein) cholesterol levels (separately as well as jointly), high triglycerides levels, high apoB levels, high lipoprotein (a) (Lp(a) levels, are all imp
Refugees into Immigrants: Assessing the Adjustment of Southeast Asian Refugees in the U. S., 1975-1990  [PDF]
Newbold, K. Bruce
Canadian Studies in Population , 2002,
Abstract: English Embodying a differential set of skills, refugees experience varying obstaclesand reception upon entry into their host country. Starting in 1975, the U.S. received large numbers ofrefugees from Southeast Asia. Although these arrivals are no longer labeled as 'refugees', theirinitial immigration status raises interesting questions, including whether or not they match theattainment of those who arrived in the U.S. at the same time. Using the 1980 and 1990 Public UseMicrodata Files (PUMS), this paper traces the adaptation of post-1975 Southeast Asians within the U.S.through the lens of segmented assimilation. Refugee flows are disaggregated into Sino-Vietnamese,Ethnic-Vietnamese, Hmong, Cambodians, and Laotian identities and contrasted to Chineseimmigrants. French Présentant des compétences différentes, les réfugiés vivent des expériences et des accueils différents à leur arrivée dans leur pays h te. Depuis 1975, les Etats-Unis ont re u un grand nombre de réfugiés de l'Asie du Sud-Est. Bien que ces nouveaux arrivants ne soient plus étiquetés de " réfugiés ", leur statut d'immigrant soulève tout de même quelques questions intéressantes, à savoir s'ils obtiennent le même succès que ceux qui sont arrivés aux Etats-Unis au même moment. Ce document retrace, au moyen des fichiers de microdonnées à grande diffusion (FMGD) de 1980 et de 1990, l'adaptation des immigrants de l'Asie du Sud-Est arrivés aux Etats-Unis après 1975 du point de vue de l'assimilation segmentée. Les groupes de courants de réfugiés sont divisés en Sino-vietnamiens, Vietnamiens ethniques, Hmong, Cambodgiens et Laotiens et comparés aux immigrants chinois.
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