Triglycerides and small dense low density lipoprotein in the discrimination of coronary heart disease risk in South Asian populations.
BACKGROUND
Coronary heart disease (CHD) is exceptionally prevalent amongst globally dispersed migrant groups originating from the Indian subcontinent, but the contribution of dyslipidaemia to their increased risk remains poorly defined.


METHODS
Fasting lipids and lipoproteins, apolipoproteins (Apo), low density lipoprotein (LDL) diameter and oxidised LDL were measured amongst rural Indians in India (n=294) and their migrant contemporaries in the UK (n=242). The performance of qualitative and quantitative measures of lipid metabolism were compared in the discrimination of WHO defined metabolic risk and raised Framingham CHD risk scores (>15%) using Receiver Operating Characteristic (ROC) curves.


RESULTS
LDL diameter was correlated with triglycerides (R(2)=0.12, P<0.001) and with high density lipoprotein (HDL) cholesterol levels (R(2)=0.15, P<0.001) in both groups. Migrants had less small dense LDL (95% CI: 12.5-14.2%) vs. rural Indians (15.7-17.2, P<0.05). On ROC analysis, triglycerides were the only consistent discriminators of metabolic and CHD risk scores (all P< or =0.001). Apo B was also a strong indicator of raised CHD risk scores. Irrespective of site, individuals with raised triglycerides also had higher total cholesterol and Apo B, denser LDL, lower HDL and more oxidised LDL (all P< or =0.01).


CONCLUSIONS
Fasting triglycerides reflect both qualitative and quantitative aspects of lipid metabolism, and are a comprehensive discriminator of CHD risk in this South Asian population.
Patel
J V
JV
Clinical Epidemiology & Cardiovascular Medicine Group, University Department of Medicine, University of Manchester, UK. Jeetesh.Patel@swbh.nhs.uk
Caslake
M J
MJ
Vyas
A
A
Cruickshank
J K
JK
Prabhakaran
D
D
Bhatnagar
D
D
Reddy
K S
KS
Lip
G Y H
GY
Mackness
M I
MI
Hughes
E A
EA
Durrington
P N
PN
D000328:Adult; D001055:Apolipoproteins B / Q000097:blood; D044466:Asian People; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology / Q000208:ethnology; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D014171:Transients and Migrants; D014280:Triglycerides / Q000097:blood*; D006113:United Kingdom / Q000453:epidemiology
D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; C099252:oxidized low density lipoprotein