Cardiometabolic risk factors associated with coronary artery disease in Asian Indian population

Authors

  • Kaur S Department of Microbial Biotechnology, Panjab University, Chandigarh, India
  • Bhatti GK UGC Centre of Excellence in Nano applications, UIPS building, Panjab University, Chandigarh, India
  • Saini NK Department of Biotechnology and Bioinformatics, Sri Guru Gobind Singh College, Chandigarh, India
  • Vijayvergiya R Advanced Cardiac Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • Tewari R Department of Microbial Biotechnology, Panjab University, Chandigarh, India
  • Bhatti JS Department of Microbial Biotechnology, Panjab University, Chandigarh, India

DOI:

https://doi.org/10.56511/JIPBS.2016.v3.i03.pp160-175

Abstract

Coronary artery disease (CAD) has become a leading cause of mortality in both developed and developing countries. The present study was intended to explore the metabolic risk factors associated with high prevalence of CAD in Asian Indians. We recruited 1375 human subjects (660 angiographically confirmed CAD patients and 715 healthy controls) aged 25-85 years from north India. Standard anthropometric, socioeconomic and quantitative measurements were done in all the participants. Alcohol consumption and smoking emerged as a major risk factor for developing CAD (Odd ratio; 2.9 (2.22-3.89) p≤0.000 and 5.2 (3.34-8.09) p=0.000) respectively. The physical activity was significantly lower in CAD patients than controls. CAD patients had marked abdominal adiposity as reflected by their significantly higher Waist to Hip Ratio (WHR) and waist circumference. Also significantly higher body fat (%) was observed in women CAD patients (43.8±5.9) than their male counterparts (26.9±6.1). The reduced HDL-cholesterol and elevated creatinine values observed in CAD patients may have contributed to the pathophysiology of CAD and renal dysfunctioning in this study. The atherogenic indices i.e. TC/HDL ratio and the LDL/HDL ratios significantly predicted the primary cardiovascular risk in control subjects. In conclusion, the present study established low socioeconomic status, unhealthy diet and sedentary lifestyle, abdominal obesity, high alcohol consumption and smoking and dyslipidemia emerged as the metabolic risk factors contributing to the pathophysiology of CAD in Asian Indians. Large studies are necessary to determine the genetic predisposition in the pathogenesis of CAD in this population.  

           

Keywords:

Cardiovascular disease, central adiposity, dyslipidemia, metabolic risk factors

Downloads

Download data is not yet available.

References

Gaziano TA: Cardiovascular disease in the developing world and its cost-effective management. Circulation 2005; 112:35473553.

Joshi SR, Parikh RM: India--diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India 2007; 55:323-324.

Gaziano T, Reddy KS, Paccaud F, Horton S, Chaturvedi V: Cardiovascular Disease. In Disease Control Priorities in Developing Countries. 2nd edition. Edited by Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P. Washington (DC); 2006

Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349:14981504.

Ortega FB, Lavie CJ, Blair SN: Obesity and Cardiovascular Disease. Circ Res 2016; 118:1752-1770.

Reddy KS, Yusuf S: Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998; 97:596-601.

Yusuf S, Reddy S, Ounpuu S, Anand S: Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104:2746-2753.

Reddy KS: Cardiovascular disease in nonWestern countries. N Engl J Med 2004; 350:2438-2440.

WHO: The World Health Report 2002. Geneva, Switzerland 2002.

Eisenmann JC, Malina RM: Age-related changes in subcutaneous adipose tissue of adolescent distance runners and association with blood lipoproteins. Ann Hum Biol 2002; 29:389-397.

Ali MK, Bhaskarapillai B, Shivashankar R, Mohan D, Fatmi ZA, Pradeepa R, Masood Kadir M, Mohan V, Tandon N, Venkat Narayan KM, Prabhakaran D: Socioeconomic status and cardiovascular risk in urban South Asia: The CARRS Study. Eur J Prev Cardiol 2015.

Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, Pandey RM: Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009; 9:28.

WHO: Cardiovascular Diseases (CVDs).WHO Fact Sheet. 2011.

WHO: Obesity: Preventing and managing the global epidemic. In WHO Technical Series 894. Geneva: WHO; 2000.

Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW: Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290:891-897.

Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ: Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290:898-904.

Lean ME, Han TS, Bush H, Anderson AS, Bradby H, Williams R: Ethnic differences in anthropometric and lifestyle measures related to coronary heart disease risk between South Asian, Italian and generalpopulation British women living in the west of Scotland. Int J Obes Relat Metab Disord 2001; 25:1800-1805.

Snehalatha C, Viswanathan V, Ramachandran A: Cutoff values for normal anthropometric variables in asian Indian adults. Diabetes Care 2003; 26:13801384.

Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S: Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008; 94:16-26.

Ramaraj R, Chellappa P: Cardiovascular risk in South Asians. Postgrad Med J 2008; 84:518-523.

Nag T, Ghosh A: Cardiovascular disease risk factors in Asian Indian population: A systematic review. J Cardiovasc Dis Res 2013; 4:222-228.

Raj R, Bhatti JS, Badada SK, Ramteke PW: Genetic basis of dyslipidemia in disease precipitation of coronary artery disease (CAD) associated type 2 diabetes mellitus (T2DM). Diabetes Metab Res Rev 2014.

Prasad DS, Das BC: Physical inactivity: a cardiovascular risk factor. Indian J Med Sci 2009; 63:33-42.

Jepson R, Harris FM, Bowes A, Robertson R, Avan G, Sheikh A: Physical activity in South Asians: an in-depth qualitative study to explore motivations and facilitators. PLoS One 2012; 7:e45333.

Panagariya A: India: The emerging giant. Oxford University Press; 2008.

Marmot M: Health in an unequal world: social circumstances, biology and disease. 2006.

Ajay V, Prabhakaran D, Jeemon P, Thankappan K, Mohan V, Ramakrishnan L, Joshi P, Ahmed F, Mohan B, Chaturvedi V: Prevalence and determinants of diabetes mellitus in the Indian industrial population. Diabetic Medicine 2008; 25:1187-1194.

Reddy KS, Prabhakaran D, Jeemon P, Thankappan K, Joshi P, Chaturvedi V, Ramakrishnan L, Ahmed F: Educational status and cardiovascular risk profile in Indians. Proceedings of the National Academy of Sciences 2007; 104:1626316268.

Mohan V, Deepa R, Rani SS, Premalatha G: Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol 2001; 38:682-687.

Ghaffar A, Reddy KS, Singhi M: Burden of non-communicable diseases in South Asia. BMJ 2004; 328:807-810.

Ahmad N, Bhopal R: Is coronary heart disease rising in India? A systematic review based on ECG defined coronary heart disease. Heart 2005; 91:719-725.

Tsiara S, Elisaf M, Mikhailidis DP: Influence of smoking on predictors of vascular disease. Angiology 2003; 54:507530.

Gupta R, Gupta VP, Sarna M, Bhatnagar S, Thanvi J, Sharma V, Singh AK, Gupta JB, Kaul V: Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J 2002; 54:59-66.

Yagalla MV, Hoerr SL, Song WO, Enas E, Garg A: Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States. J Am Diet Assoc 1996; 96:257-261.

Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S: Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996; 48:343-353.

Abbasi F, McLaughlin T, Lamendola C, Kim HS, Tanaka A, Wang T, Nakajima K, Reaven GM: High carbohydrate diets, triglyceriderich lipoproteins, and coronary heart disease risk. Am J Cardiol 2000; 85:45-48.

Prabhakaran D, Chaturvedi V, Shah P, Manhapra A, Jeemon P, Shah B, Reddy KS: Differences in the prevalence of metabolic syndrome in urban and rural India: A problem of urbanization. Chronic Illness 2007.

Gupta R: Trends in hypertension epidemiology in India. J Hum Hypertens 2004, 18:73-78.

Mohan V, Sandeep S, Deepa R, Shah B, Varghese C: Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007, 125:217-230.

Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW: Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290:891-897.

Albert MA, Ridker PM: C-reactive protein as a risk predictor: do race/ethnicity and gender make a difference? Circulation 2006; 114:e67-74.

Dasgupta K, Padwal R, Poirier L, Quinn RR, Bacon S, Feldman RD, Hackam DG, Herman RJ, Khan N, Rabi DM, et al: Managing hypertension: evidence supporting the 2013/2014 recommendations of the Canadian Hypertension Education Program. CMAJ 2015; 187:116-119.

Ghosh A, Bose K, Chaudhuri ABD: Association of food patterns, central obesity measures and metabolic risk factors for coronary heart disease (CHD) in middle aged Bengalee Hindu men, Calcutta, India. Asia Pacific journal of clinical nutrition 2003; 12:166-171.

Bhatti GK, Bhadada SK, Vijayvergiya R, Mastana SS, Bhatti JS: Metabolic syndrome and risk of major coronary events among the urban diabetic patients: North Indian Diabetes and Cardiovascular Disease Study-NIDCVD-2. J Diabetes Complications 2016; 30:72-78.

Ali MK, Narayan KM, Tandon N: Diabetes & coronary heart disease: current perspectives. Indian J Med Res 2010; 132:584-597.

Mohan V, Venkatraman JV, Pradeepa R: Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diabetes Sci Technol 2010; 4:158-170.

Shah B, Mathur P: Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian J Med Res 2010; 132:634-642.

Gupta R, Deedwania PC, Sharma K, Gupta A, Guptha S, Achari V, Asirvatham AJ, Bhansali A, Gupta B, Gupta S, et al: Association of educational, occupational and socioeconomic status with cardiovascular risk factors in Asian Indians: a cross-sectional study. PLoS One 2012; 7:e44098.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937952.

Hayes L, White M, Unwin N, Bhopal R, Fischbacher C, Harland J, Alberti KG: Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health Med 2002; 24:170-178.

Gupta R: Burden of coronary heart disease in India. Indian Heart J 2005; 57:632-638.

Fischbacher CM, Hunt S, Alexander L: How physically active are South Asians in the United Kingdom? A literature review. J Public Health (Oxf) 2004; 26:250-258.

McKeigue PM, Pierpoint T, Ferrie JE, Marmot MG: Relationship of glucose intolerance and hyperinsulinaemia to body fat pattern in south Asians and Europeans. Diabetologia 1992; 35:785791.

Wang Y, Chen HJ, Shaikh S, Mathur P: Is obesity becoming a public health problem in India? Examine the shift from underto overnutrition problems over time. Obes Rev 2009; 10:456-474.

Joshi PP: Why is coronary heart diseases increasing in Indians? Cardiovascular risk factors in the Indian scenario. South Asian J Prev Cardiol 2003; 7:4.

Reddy KK, Rao AP, Reddy TP: Socioeconomic status and the prevalence of coronary heart disease risk factors. Asia Pac J Clin Nutr 2002; 11:98-103.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, Joshi SR, Sadikot S, Gupta R, Gulati S, et al: Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57:163-170.

Rossi R, Iaccarino D, Nuzzo A, Chiurlia E, Bacco L, Venturelli A, Modena MG: Influence of body mass index on extent of coronary atherosclerosis and cardiac events in a cohort of patients at risk of coronary artery disease. Nutr Metab Cardiovasc Dis 2011; 21:86-93.

Thomas CS, Krishnaswami S: Distribution of Body Mass Index in Indian patients with coronary artery disease. Indian Heart J 1995; 47:134-137.

Tavani A, Bertuzzi M, Gallus S, Negri E, La Vecchia C: Diabetes mellitus as a contributor to the risk of acute myocardial infarction. J Clin Epidemiol 2002; 55:1082-1087.

Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, Ernst ND, Horan M: Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000; 8:605-619.

Wilkins K, Campbell NR, Joffres MR, McAlister FA, Nichol M, Quach S, Johansen HL, Tremblay MS: Blood pressure in Canadian adults. Health Rep 2010; 21:3746.

Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113:898918.

Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A, Sarwar N, Kizer JR, Lawlor DA, Nordestgaard BG, et al: Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011; 377:1085-1095.

Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol 2006; 26:968-976.

Poirier P, Eckel R: Obesity and cardiovascular disease. Curr Atheroscler Rep 2002, 4:448-453.

Rabkin SW, Mathewson FA, Hsu PH: Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol 1977; 39:452-458.

Hubert HB, Feinleib M, McNamara PM, Castelli WP: Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67:968-977.

Gazi IF, Tsimihodimos V, Tselepis AD, Elisaf M, Mikhailidis DP: Clinical importance and therapeutic modulation of small dense low-density lipoprotein particles. Expert Opin Biol Ther 2007; 7:53-72.

Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ, Despres JP: Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Quebec Cardiovascular Study. Circulation 1997; 95:69-75.

Karthikeyan G, Teo KK, Islam S, McQueen MJ, Pais P, Wang X, Sato H, Lang CC, SitthiAmorn C, Pandey MR, et al: Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians: an analysis from the INTERHEART Study. J Am Coll Cardiol 2009; 53:244-253.

Labreuche J, Touboul PJ, Amarenco P: Plasma triglyceride levels and risk of stroke and carotid atherosclerosis: a systematic review of the epidemiological studies. Atherosclerosis 2009; 203:331345.

Jukema JW, Bruschke AV, van Boven AJ, Reiber JH, Bal ET, Zwinderman AH, Jansen H, Boerma GJ, van Rappard FM, Lie KI, et al.: Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS). Circulation 1995, 91:2528-2540.

Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA, Crowe T, Howard G, Cooper CJ, Brodie B, et al: Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291:10711080.

Okazaki S, Yokoyama T, Miyauchi K, Shimada K, Kurata T, Sato H, Daida H: Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study. Circulation 2004; 110:1061-1068.

Nissen SE, Yock P: Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation 2001; 103:604-616.

Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation 1998, 97:1837-1847.

Millan J, Pinto X, Munoz A, Zuniga M, Rubies-Prat J, Pallardo LF, Masana L, Mangas A, Hernandez-Mijares A, GonzalezSantos P, et al: Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009; 5:757-765.

Grover SA, Dorais M, Paradis G, Fodor JG, Frohlich JJ, McPherson R, Coupal L, Zowall H: Lipid screening to prevent coronary artery disease: a quantitative evaluation of evolving guidelines. CMAJ 2000; 163:1263-1269.

Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB: Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 1986; 256: 2835-2838.

Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C: Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med 1993; 329:1988-1992.

Reaven GM: Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988; 37:1595-1607.

Despres JP, Lamarche B, Mauriege P, Cantin B, Dagenais GR, Moorjani S, Lupien PJ: Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996; 334:952-957.

McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG: Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation 1993; 87: 152-161.

Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C, Lonn E, Gerstein H, et al: Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 2000; 356:279-284.

Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H: The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr 2007; 2:267275.

Basit A, Shera AS: Prevalence of metabolic syndrome in Pakistan. Metab Syndr Relat Disord 2008; 6:171-175.

Misra A, Misra R, Wijesuriya M, Banerjee D: The metabolic syndrome in South Asians: continuing escalation & possible solutions. Indian J Med Res 2007; 125:345-354.

Gerstein HC, Pais P, Pogue J, Yusuf S: Relationship of glucose and insulin levels to the risk of myocardial infarction: a casecontrol study. J Am Coll Cardiol 1999; 33:612-619.

Published

05-07-2016
Statistics
218 Views | 156 Downloads

How to Cite

Kaur S, Bhatti GK, Saini NK, Vijayvergiya R, Tewari R, and Bhatti JS. “Cardiometabolic Risk Factors Associated With Coronary Artery Disease in Asian Indian Population”. Journal of Innovations in Pharmaceutical and Biological Sciences, vol. 3, no. 3, July 2016, pp. 160-75, doi:10.56511/JIPBS.2016.v3.i03.pp160-175.

Issue

Section

Research Article