title: Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians: an analysis from the INTERHEART Study.
abstract: OBJECTIVE
  This study sought to determine the prevalence of lipid and lipoprotein abnormalities and their association with the risk of a first acute myocardial infarction (AMI) among Asians.
  
  
  BACKGROUND
  Patterns of lipid abnormalities among Asians and their relative impact on cardiovascular risk have not been well characterized.
  
  
  METHODS
  In a case-control study, 65 centers in Asia recruited 5,731 cases of a first AMI and 6,459 control subjects. Plasma levels of lipids and apolipoproteins in the different Asian subgroups (South Asians, Chinese, Southeast Asians, and Japanese) were determined and correlated with the risk of AMI.
  
  
  RESULTS
  Among both cases and controls, mean low-density lipoprotein cholesterol (LDL-C) levels were about 10 mg/dl lower in Asians compared with non-Asians. A greater proportion of Asian cases and controls had LDL-C </=100 mg/dl (25.5% and 32.3% in Asians vs. 19.4% and 25.3% in non-Asians, respectively). High-density lipoprotein cholesterol (HDL-C) levels were slightly lower among Asians compared with non-Asians. There was a preponderance of people with low HDL-C among South Asians (South Asia vs. rest of Asia: cases 82.3% vs. 57.4%; controls 81% vs. 51.6%; p < 0.0001 for both comparisons). However, despite these differences in absolute levels, the risk of AMI associated with increases in LDL-C and decreases in HDL-C was similar for Asians and non-Asians. Among South Asians, changes in apolipoprotein (Apo)A1 predicted risk better than HDL-C. ApoB/ApoA1 showed the strongest association with the risk of AMI.
  
  
  CONCLUSIONS
  The preserved association of LDL-C with risk of AMI among Asians, despite the lower baseline levels, suggests the need to rethink treatment thresholds and targets in this population. The low HDL-C level among South Asians requires further study and targeted intervention.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: McQueen
authors.forename: Prem
authors.initials: P
authors.lastname: Pais
authors.forename: Xingyu
authors.initials: X
authors.lastname: Wang
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Chim Choy
authors.initials: CC
authors.lastname: Lang
authors.forename: Chitr
authors.initials: C
authors.lastname: Sitthi-Amorn
authors.forename: M R
authors.initials: MR
authors.lastname: Pandey
authors.forename: Khawar
authors.initials: K
authors.lastname: Kazmi
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001053:Apolipoproteins / Q000097:blood*; D044466:Asian People / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000208:ethnology*; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D017678:Sex Distribution
chemical_list: D001053:Apolipoproteins; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids