Carotid intima media thickness and low high-density lipoprotein (HDL) in South Asian immigrants: could dysfunctional HDL be the missing link?
BACKGROUND
South Asian immigrants (SAIs) in the US exhibit higher prevalence of coronary artery disease (CAD) and its risk factors compared with other ethnic populations. Conventional CAD risk factors do not explain the excess CAD risk; therefore there is a need to identify other markers that can predict future risk of CAD in high-risk SAIs. The objective of the current study is to assess the presence of sub-clinical CAD using common carotid artery intima-media thickness (CCA-IMT), and its association with metabolic syndrome (MS) and pro-inflammatory/dysfunctional HDL (Dys-HDL).


METHODS
A community-based study was conducted on 130 first generation SAIs aged 35-65 years. Dys-HDL was determined using the HDL inflammatory index. Analysis was completed using logistic regression and Fisher's exact test.


RESULTS
Sub-clinical CAD using CCA-IMT ≥ 0.8 mm (as a surrogate marker) was seen in 31.46%. Age and gender adjusted CCA-IMT was significantly associated with type 2 diabetes (p = 0.008), hypertension (p = 0.012), high-sensitivity C-reactive protein (p < 0.001) and homocysteine (p = 0.051). Both the presence of MS and Dys-HDL was significantly correlated with CCA-IMT, even after age and gender adjustment. The odds of having Dys-HDL with CCA-IMT were 5 times (95% CI: 1.68, 10.78).


CONCLUSIONS
There is a need to explore and understand non-traditional CAD risk factors with a special focus on Dys-HDL, knowing that SAIs have low HDL levels. This information will not only help to stratify high-risk asymptomatic SAI groups, but will also be useful from a disease management point of view.
Department of Internal Medicine, University of Jacksonville, Florida, USA.
Sunita
S
Dodani
Department of Biostatistics, University of Kansas Medical Center, Kansas City, USA.
Lei
L
Dong
Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA.
Faheem W
FW
Guirgis
Department of Medicine, University of California Los Angeles, Los Angeles, USA.
Srinivasa T
ST
Reddy
South Asians; common carotid artery intima media thickness; coronary artery disease; dysfunctional high-density lipoprotein; risk factors