Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors

PURPOSE OF THE STUDY: The purpose of this study is to describe the prevalence of coronary artery disease (CAD) and provide a review of the risk factors associated with CAD in Asian Indians. SEARCH METHODS USED: The authors extensively reviewed numerous British and international studies and the more limited number of studies in India and the US. SUMMARY OF IMPORTANT FINDINGS: Asian Indians have one of the highest rates of CAD. Conventional risk factors such as high blood pressure, high serum total cholesterol level, cigarette smoking, high fat diet, and obesity consistently fail to fully explain these high rates. There appears to be a strong role of insulin resistance and abdominal obesity, both of which have a high prevalence in Asian Indians. Various dyslipidemic disorders in Asian Indians such as low levels of HDL cholesterol, elevation of triglyceride, elevation of LDL cholesterol and elevation of lipoprotein (a) may also have a role. CONCLUSIONS: We hypothesize that against a background of higher susceptibility to CAD among Asian Indians, as characterized by insulin resistance, abdominal obesity and dyslipidemic disorders, conventional risk factors for CAD are also important. A genetic predisposition to CAD is suggested by high levels of lipoprotein (a) in Asian Indians. This would suggest that more aggressive identification and modulation of all known risk factors are necessary among Asian Indians along with a compelling need for further epidemiological studies in this population. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: The marked differences in the rates of CAD among Asian Indians, compared with Chinese, Japanese, Filipino, other Asians and Whites are discussed. KEY WORDS: Asian Indians, coronary artery disease, epidemiology, disease prevalence, risk factors, insulin resistance, dyslipidemic disorders, triglycedide, high density lipoprotein; lipoprotein (a)     

Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women

BACKGROUND: Although people from the Indian subcontinent have high rates of cardiovascular disease (CVD), studies of such in Indian and Pakistani women living in the United States are lacking. OBJECTIVE: This study accounted for variability in serum lipid (total cholesterol and triacylglycerol) and lipoprotein [LDL cholesterol, lipoprotein(a), and HDL cholesterol] concentrations in Indian and Pakistani compared with American premenopausal women in the United States. Body composition, regional fat distribution, dietary intake, and energy expenditure were compared between groups. DESIGN: The 2 groups were 47 Indian and Pakistani and 47 American women. Health was assessed via medical history, physical activity, body composition (via anthropometry and dual-energy X-ray absorptiometry), dietary intake (via 7-d food records), and serum lipids. RESULTS: Serum total cholesterol, triacylglycerol, LDL cholesterol, lipoprotein(a), the ratio of total to HDL cholesterol, and the ratio of LDL to HDL cholesterol were greater (P <0.03), whereas HDL-cholesterol values were lower (P = 0.011) in Indians and Pakistanis than in Americans. Multiple regression analysis indicated that approximately 18% of the variance in total cholesterol (P = 0.0010) and LDL cholesterol (P = 0.0009) was accounted for by ethnicity, energy expenditure, and the ratio of the sum of central to the sum of peripheral skinfold thicknesses. Ethnicity, sum of central skinfold thicknesses, ratio of polyunsaturated to saturated fat, and monounsaturated fat intake accounted for approximately 43% of the variance in triacylglycerol concentration (P < 0.0001). Monounsaturated fat, percentage body fat, and alcohol intake accounted for approximately 26% of variance in HDL cholesterol. Ethnicity contributed approximately 22% of the 25% overall variance in lipoprotein(a). CONCLUSIONS: Results suggest that these Indian and Pakistani women are at higher CVD risk than their American counterparts, but that increasing their physical activity is likely to decrease overall and regional adiposity, thereby improving their serum lipid profiles.     

Accuracy of lipoprotein lipids and apoproteins in predicting coronary heart disease in diabetic American Indians. The Strong Heart Study

PURPOSE: To evaluate the accuracy of lipoprotein lipids and apoproteins in predicting coronary heart disease (CHD) in diabetic American Indians. METHODS: This study included 2099 diabetic participants of the Strong Heart Study, which is a longitudinal study of cardiovascular disease (CVD) and its risk factors in American Indians in Arizona, Oklahoma, and South and North Dakota. Diabetic participants with incident CHD (N = 126) were selected as the case group, and those without CHD or any cardiovascular events were the control group (N = 1732). Previous vascular events such as stroke were the sole exclusion criterion (N = 241). Baseline measurements of lipoprotein lipids and apoproteins were used to predict CHD diagnosed at the 4-year follow-up examination by using Receiver-Operating Characteristic (ROC) curve analysis. RESULTS: The ratio of high-density lipoprotein (HDL) to total cholesterol had the highest area under the ROC curve (0.69 +/- 0.02). The areas for the ratios of HDL to low-density lipoprotein (LDL) cholesterol (0.68 +/- 0.02), apo AI/B (0.66 +/- 0.02), and the single component of total cholesterol (0.64 +/- 0.03) and LDL cholesterol (0.63 +/- 0.05) were not significantly different from the area for HDL/total cholesterol. However, the areas for apo B (0.64 +/- 0.02), HDL cholesterol (0.62 +/- 0.03), triglycerides (0.58 +/- 0.03), and apo AI (0.57 +/- 0.05) were significantly lower than the area for HDL/total cholesterol. Logistic regression analysis indicates that only HDL and LDL cholesterol were significant independent lipoprotein lipid and apoprotein predictors for CHD. The other significant predictors in the model were study center, age, gender, and albuminuria. The ROC area for this model is 0.75. CONCLUSIONS: HDL and LDL cholesterol were the most important independent predictors for incident CHD in diabetic American Indians. The ratios of HDL/total cholesterol, HDL/LDL cholesterol, and apo AI/B had higher accuracy for predicting CHD. Although the values for all lipoprotein lipids and apoproteins and their ratios were not large enough to definitely predict CHD, they can be used as screening tools for CHD in diabetic American Indians.     

Cardiovascular disease and risk factors in Montana American Indians and non-Indians

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death for both American Indian and non-Indian adults. Few published studies have compared the prevalence of CVD and related risk factors in Indians to that in non-Indians in the same geographic area. OBJECTIVE: To compare CVD and risk factors in American Indian and non-Indian populations in Montana. METHODS: Adult American Indians (n=1000) living on or near Montana's seven reservations and non-Indian (n=905) Montanans statewide were interviewed through the 1999 Behavioral Risk Factor Surveillance Survey (BRFSS). RESULTS: Indians aged > or =45 years reported a significantly higher prevalence of CVD compared to non-Indians (18% vs 10%). In persons aged 18-44 years, Indians were more likely to report hypertension (15% vs 10%), obesity (29% vs 12%), and smoking (42% vs 24%) compared to non-Indians. For persons aged > or =45 years, Indians reported higher rates of diabetes (24% vs 9%), obesity (38% vs 16%), and smoking (32% vs 13%) compared to non-Indians. Non-Indians aged > or =45 years reported having been diagnosed with high cholesterol more frequently than did Indians (32% vs 24%). CONCLUSIONS: Both Indians and non-Indians in Montana reported a substantial burden of CVD. The CVD risk patterns differ in the two populations. Prevention programs should be tailored to the risk burdens in these communities with particular emphasis on smoking cessation and the prevention of obesity.     

Increasing prevalence of cardiovascular risk factors among American Indians in Montana

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among American Indians. The objective of this study was to assess trends in CVD and CVD risk factors among American Indians in Montana. METHODS: In 1999 and 2003, 1000 American Indian adults aged > or =18 years living on or near the seven reservations in Montana were interviewed each year using an adapted Behavior Risk Factor Surveillance System survey. RESULTS: During the 5-year period from 1999 to 2003, the prevalence of CVD risk factors increased significantly: diabetes (12% to 16%), high blood pressure (26% to 34%), high cholesterol (23% to 30%), and obesity (34% to 39%). The percentage reporting current smoking was stable and remained high (38% to 36%). After adjusting for age and gender, the increases in high blood pressure, high cholesterol, and obesity remained significant. The percentage reporting two or more CVD risk factors increased significantly overall, among men and women, and among older and younger respondents during the 5-year time period. CONCLUSIONS: The prevalence of CVD risk factors among American Indian adults in Montana is high, and for many of the risk factors, has increased significantly over a 5-year period.     

Prevalence of selected cardiovascular disease risk factors among American Indians and Alaska Natives--United States, 1997

Heart disease and stroke, the principal causes of cardiovascular disease (CVD), are the first and fifth leading causes of death among American Indians and Alaska Natives (AI/AN) (1,2). Risk factors for CVD frequently cluster, which may increase CVD risk multiplicatively (3). To characterize the prevalence of risk factors for CVD (i.e., hypertension, current cigarette smoking, high cholesterol, obesity, and diabetes) among AI/AN, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated that 63.7% of AI/AN men and 61.4% of AI/AN women who participated in the survey had one or more CVD risk factors.     

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study

OBJECTIVES: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. RESEARCH METHODS AND PROCEDURES: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins. RESULTS: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. DISCUSSION: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.     

Amaranth oil application for coronary heart disease and hypertension

Cardiovascular disease (CVD) is the Nation's leading killer for both men and women among all racial and ethnic groups. Development and progression of CVD is linked to the presence of risk factors such as hyperlipidemia, hypertension, obesity, and diabetes mellitus. It is known that cholesterol is an indicator of increased risk of heart attack and stroke. Low-density cholesterol (LDL) above 130 mg/dl high-density cholesterol (HDL) cholesterol below 35 mg/dl and total blood cholesterol above 200 mg/dl are indicators of problematic cholesterol. Proper ranges of cholesterol are important in the prevention of CVD.     

Prevalence of coronary heart disease risk factors in Costa Rican adolescents.

PURPOSE: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. METHODS: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12-18 years (167 males, 161 females), randomly selected from San José's urban and rural high schools. RESULTS: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. CONCLUSIONS: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.     

Relationship between lifestyle and serum lipid and lipoprotein levels in middle-aged Japanese men

Cross-sectional associations between lifestyle factors [cigarette smoking, alcohol intake, overall obesity indicated by body mass index (BMI), eating breakfast, snacking between meals, considering nutritional balance, coffee drinking, physical exercise, and hours of work and sleep] and serum lipid and lipoprotein levels were examined in 1580 middle-aged Japanese men in Osaka, Japan. From stepwise regression analyses, significant correlates with low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and Log triglyceride levels were, in the order of relative importance: BMI, alcohol intake (negative), and age for LDL cholesterol level; BMI (negative), cigarette smoking (negative), alcohol intake, considering nutritional balance, and physical exercise for HDL cholesterol level; and BMI, cigarette smoking, working hours (negative), considering nutritional balance (negative), alcohol intake, and coffee drinking (negative) for Log triglyceride level. The cumulative percentages of variation for LDL cholesterol, HDL cholesterol and Log triglyceride levels were 4.2%, 15.4% and 14.7%, respectively. From stepwise regression analyses, excluding BMI as a factor in the model, snacking between meals emerged as a significant factor for LDL cholesterol level and HDL cholesterol level (negative). The cumulative percentage of variation for each serum lipid and lipoprotein level was decreased (1.5% for LDL cholesterol, 6.8% for HDL cholesterol, and 3.1% for Log triglyceride). These results suggest that BMI has the strongest association with serum lipid and lipoprotein levels and that good daily lifestyles may have an anti-atherogenic effect by altering serum lipid and lipoprotein levels in middle-aged Japanese men.     

Status of novel cardiovascular risk factor and cardiovascular disease risk in an urban Cuban population--a pilot study

Cardiovascular disease is the main cause of death in Cuba, yet the prevalence of novel risk factors is not known. To examine the prevalence of risk factors of traditional and novel cardiovascular diseases (CVDs) among an urban Cuban population, a cross-sectional pilot survey was undertaken in Havana city, Cuba. Ninety-seven adults aged 45-60 years registered to receive medical care at a policlinic. The prevalences of rates of CVD risk factors were: hypertension (> or =140/90 mmHg) (53.6%), hypercholesterolaemia (total cholesterol >5.2 mmol/L) (47.0%), low high-density lipoprotein (HDL)-cholesterol (<1.03 mmol/L) (64.3%); diabetes (self-reported) (24.6%); metabolic syndrome (ATP III criteria) (58.2%); overweight and obesity (body mass index > or = 25 kg/m2) (78.0%); current smoking (39.3%); elevated level of C-reactive protein (3 15 micromol/L) (11.1%). The total carotenoid status was independently associated with waist-circumference and risk of diabetes and metabolic syndrome. In this small unrepresentative sample of people aged 40-65 years from Havana city, there was a high prevalence of traditional and novel CVD risk factors. The total serum carotenoid status appeared to be associated with an increased prevalence of CVD risk factors.     

Adverse influences of alcohol, tobacco, and oral contraceptive use on cardiovascular risk factors during transition to adulthood

Risk factors for cardiovascular disease were measured in 990 young adults, aged 17-24 years, in a 1982-1983 survey of the biracial (black-white) community of Bogalusa, Louisiana. Even after controlling for age and obesity, several lifestyle factors (cigarette smoking, alcohol consumption, and oral contraceptive use) were independently related (p less than 0.05) to levels of serum lipids, lipoprotein cholesterol fractions, and blood pressure. Oral contraceptive use was associated with increased levels of both serum triglycerides (20 mg/dl, blacks; 25 mg/dl, whites) and low density lipoprotein (LDL) cholesterol (19 mg/dl, whites), and decreased levels of high density lipoprotein (HDL) cholesterol (-6 mg/dl, whites). Linear regression analyses also showed that cigarette smoking was associated with elevated levels of serum triglycerides (ranging from 15 to 26 mg/dl) and decreased levels of HDL cholesterol (ranging from -9 to -11 mg/dl) in white males and females. Although persons who smoked cigarettes were also likely to consume alcohol, alcohol intake in nonsmokers was positively associated with levels of serum triglycerides, LDL cholesterol, and very low density lipoprotein cholesterol in white males, and with blood pressure levels in black males. A statistically significant association between alcohol intake and HDL cholesterol levels (r = 0.24) was observed only in white females who did not smoke. These adverse influences of lifestyle factors on cardiovascular disease risk may provide a rational basis for intervention during adolescence and early adulthood.     

Dietary Cholesterol Affects Plasma Lipid Levels,the Intravascular Processing of Lipoproteins and Reverse Cholesterol Transport without Increasing the Risk for Heart Disease

The associations between dietary cholesterol and heart disease are highly controversial. While epidemiological studies and clinical interventions have shown the lack of correlation between cholesterol intake and cardiovascular disease (CVD) risk, there is still concern among health practitioners and the general population regarding dietary cholesterol. In this review, several clinical studies utilizing cholesterol challenges are analyzed in terms of changes that occur in lipoprotein metabolism resulting from excess consumption of cholesterol. Dietary cholesterol has been shown to increase both LDL and HDL in those individuals who respond to a cholesterol challenge without altering the LDL cholesterol/HDL cholesterol ratio, a key marker of CVD risk. Further, dietary cholesterol has been shown to increase only HDL with no changes in LDL with average cholesterol consumption and during weight loss interventions. Ingestion of cholesterol has also been shown to increase the size of both LDL and HDL particles with the associated implications of a less atherogenic LDL particle as well as more functional HDL in reverse cholesterol transport. Other changes observed in lipoprotein metabolism are a greater number of large LDL and decreases in small LDL subfractions. All this information put together points to specific roles of dietary cholesterol in substantially altering intravascular processing of lipoproteins as well as reverse cholesterol transport.     

Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St James Survey, Trinidad

A ten-year community survey was undertaken to investigate the high coronary heart disease (CHD) incidence among people of Indian (South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69 years, 2215 (89%) were examined and 2069 (83%) found to be clinically free of CHD at baseline. After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European and 467 adults of Mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian origin had higher prevalence rates of diabetes mellitus, a low concentration of high-density lipoprotein (HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thicknesses than other men. In participants free of CHD at entry, the age-adjusted relative risk of a cardiac event believed due to CHD was at least twice as high in Indian men and women as in other ethnic groups. In men, blood pressure, diabetes mellitus and low-density lipoprotein (LDL) cholesterol concentration were positively and independently related to risk of CHD, whereas alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrasts in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic group was predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset of risk and examination of other potential risk factors such as insulin concentration.     

Lipoproteins as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results form the Lipid Research Clinics Follow-up Study

Because alcohol consumption is associated with increased high density lipoprotein (HDL) cholesterol and decreased low density lipoprotein (LDL) cholesterol, and cigarette smoking is associated with lower HDL cholesterol and higher LDL cholesterol, there has been speculation that the protective effect of moderate alcohol consumption and/or the noxious effect of cigarette smoking for cardiovascular disease might be mediated in large part by a lipoprotein mechanism. The authors examined this question in a prospective study of 7,461 men and women in 10 North American populations initially seen in 1972-1976 and followed for an average of 8.5 years. Moderate alcohol consumption was weakly protective for cardiovascular disease, while cigarette smoking was strongly and significantly associated with cardiovascular disease mortality. As expected, LDL cholesterol was positively related and HDL cholesterol was inversely related to cardiovascular disease mortality. However, multivariable analysis of cardiovascular disease mortality alternately excluding and including HDL cholesterol and LDL cholesterol as covariates indicated that the effect of alcohol consumption on cardiovascular disease mortality was independent of an LDL cholesterol pathway and only partially mediated by an HDL cholesterol pathway, while the effect of cigarette smoking was independent of both the HDL cholesterol and LDL cholesterol pathways, suggesting alternative biologic mechanisms of action for both alcohol consumption and cigarette smoking on cardiovascular disease.     

Smoking cessation and prevention: an urgent public health priority for American Indians in the Northern Plains

OBJECTIVE: The purpose of this study was to compare the prevalence of cigarette smoking and smoking cessation among American Indians living on or near Montana's seven reservations to those of non-Indians living in the same geographic region. METHODS: Data for Montana Behavioral Risk Factor Surveillance System (BRFSS) respondents (n = 1,722) were compared to data from a BRFSS survey of American Indians living on or near Montana's seven reservations in 1999 (n = 1,000). Respondents were asked about smoking and smoking cessation as well as cardiovascular disease (CVD) and selected risk factors. Quit ratios were calculated for both groups. RESULTS: American Indians were more likely to report current smoking (38%) than non-Indians (19%; p < 0.001). Thirty-seven percent of Indian respondents with CVD risk factors reported current smoking, compared with 17% of non- Indians with CVD risk factors. However, there was no significant difference in reported smoking rates between Indians (21%) and non-Indians (27%) with a history of CVD. Indian smokers were more likely to report quitting for one or more days in the past year (67%), compared with non-Indians (43%). Quit ratios were significantly lower among Indians (43%) than among non-Indians (65%). CONCLUSIONS: High smoking rates in Indians, particularly among those with other CVD risk factors, demonstrate an urgent need for culturally sensitive smoking cessation interventions among Northern Plains Indians and highlight the need for the Surgeon General's focus on smoking in minority populations.     

Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1)

OBJECTIVES: Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. METHODS: The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15,005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1,474 persons by means of two 24-hour dietary recalls. RESULTS: In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8 +/- 6.9, 11.1 +/- 1.8, and 30.9 +/- 7.2, respectively. CONCLUSION: The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.     

Lipoprotein Subfractions in Metabolic Syndrome and Obesity: Clinical Significance and Therapeutic Approaches

Small, dense low density lipoprotein (sdLDL) represents an emerging cardiovascular risk factor, since these particles can be associated with cardiovascular disease (CVD) independently of established risk factors, including plasma lipids. Obese subjects frequently have atherogenic dyslipidaemia, including elevated sdLDL levels, in addition to elevated triglycerides (TG), very low density lipoprotein (VLDL) and apolipoprotein-B, as well as decreased high density lipoprotein cholesterol (HDL-C) levels. Obesity-related co-morbidities, such as metabolic syndrome (MetS) are also characterized by dyslipidaemia. Therefore, agents that favourably modulate LDL subclasses may be of clinical value in these subjects. Statins are the lipid-lowering drug of choice. Also, anti-obesity and lipid lowering drugs other than statins could be useful in these patients. However, the effects of anti-obesity drugs on CVD risk factors remain unclear. We review the clinical significance of sdLDL in being overweight and obesity, as well as the efficacy of anti-obesity drugs on LDL subfractions in these individuals; a short comment on HDL subclasses is also included. Our literature search was based on PubMed and Scopus listings. Further research is required to fully explore both the significance of sdLDL and the efficacy of anti-obesity drugs on LDL subfractions in being overweight, obesity and MetS. Improving the lipoprotein profile in these patients may represent an efficient approach for reducing cardiovascular risk.     

Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women

BACKGROUND: Low to moderate alcohol consumption is associated with reduced mortality, primarily due to a reduction in coronary heart disease (CHD). Conversely, heavy drinking increases mortality, mainly due to haemorrhagic stroke and non-cardiovascular diseases. It is important to identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse. We examine the relationship between reported alcohol consumption, cardiovascular disease (CVD) risk factors, a 10-year CHD risk score and hypertension in women. METHODS: In all, 14 077 female employees aged 30-64 years, underwent screening for CVD risk factors. Information was available on a range of personal and lifestyle factors, including height, weight, blood pressure, lipids, lipoproteins, apolipoproteins and blood glucose. Age-adjusted means were computed for the risk factors in each of five groups of reported alcohol intake: <1 (non-drinkers), 1-7, 8-14, 15-21, > or = 22 units/week. The relationships between alcohol and a derived coronary risk score and hypertension were also examined. RESULTS: Increasing consumption was associated with an age-adjusted increase in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (both P < 0.001), a decline in body mass index, total cholesterol (TC), TC/HDL-C ratio, low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (all P < 0.001), and no trend in triglycerides (P = 0.06), lipoprotein (a) (P = 0.09) or fasting glucose (P = 0.14). Except for LDL-C (P = 0.06) the relationships remained statistically significant after adjustment for possible confounders. Compared to non-drinkers, there was a decrease in 10-year CHD risk with increasing consumption, with the greatest reduction in risk in women consuming 1-7 units/week, odds ratio (OR) = 0.79, (95% CI: 0.72-0.87), and an increase in the prevalence of hypertension among those consuming 15-21 units/week, OR = 1.68, (95% CI: 1.14-2.46). CONCLUSIONS: This study provides biological support for an inverse association between alcohol intake and CHD in women, associated with favourable changes in lipid and lipoprotein risk factors. Women consuming 1-14 units/week had a reduction in CHD risk, but there was an increased prevalence of hypertension among those consuming > or = 15 units/week. These data suggest that, in terms of the reduced risk of CVD, women should be advised to restrict their alcohol consumption to < or = 14 units/week.     

Improving the prediction of cardiovascular risk: interaction between LDL and HDL cholesterol

BACKGROUND: The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (or the ratio of low-density lipoprotein [LDL] to HDL) is currently advocated to estimate the coronary risk associated with LDL and HDL cholesterol levels. METHODS: We analyzed the relation between LDL and HDL cholesterol levels to predict the risk of future coronary events. Using data from the Lipid Research Clinics Follow-up Cohort, we developed multivariate equations to predict coronary deaths among 4684 men and women followed for approximately 12 years. We used these equations to compare the predictive power of the LDL/HDL ratio with the independent effects of LDL and HDL and an LDL-HDL interaction term. We then used each model to forecast the 10-year risk of coronary death based on various lipid levels after adjustment for conventional risk factors (eg, blood pressure, gender, cigarette smoking). RESULTS: Levels of LDL and HDL and the interaction between them are all independent risk factors for coronary death. The benefits of increasing HDL are strongest among persons with high LDL. Conversely, the benefits of decreasing LDL are greatest among those with low HDL. We confirmed these observations in a published dataset showing the effects of treatment of hyperlipidemia. Predictions of benefits of treatment that were based on interaction of LDL and HDL were more accurate than predictions without interaction. CONCLUSIONS: The LDL/HDL ratio alone may not fully capture the complex interaction between LDL and HDL and the relation of each to coronary risk.