Variant metabolic risk factor profile leading to premature coronary disease: time to define the syndrome of accelerated atherocoronary metabolic syndrome in Asian Indians

Jayasinghe SR, Jayasinghe SH
Correspondence: Prof Rohan Jayasinghe, rohan_jayasinghe@health.qld.gov.au

ABSTRACT
Coronary artery disease (CAD) is fast becoming a major morbidity and mortality burden in the developing world. The magnitude of the problem is predicted to exceed that of the developed world due to the sheer population numbers at risk. The Indian subcontinental ethnicity has been associated with a more severe form of CAD that has its onset at a younger age. This form of coronary disease and its risk factors seem quite different from what has been previously described in studies done among non-Asian Indian populations (mainly Caucasians living in the West). This fact has led to a situation where the current preventative and management protocols that have worked well in the non-Asian Indian populations, have failed to bring about the anticipated control over this disease condition, its progression and its incidence in this population. The time has come to identify the variant of CAD in the Asian Indian ethnic population and the associated metabolic factors, as a separate and distinct entity, and as a unique syndrome. This distinction may facilitate more focused and ethnicity-specific studies to be carried out to unravel the mysteries surrounding the clinical, pathological and molecular biological aspects of the CAD syndrome among Asian Indian ethnics. The outcomes and findings of such investigations may help gain a stranglehold on this rapidly-progressing disease condition among the populations in emerging and densely-populated economies of the South Asian region, as well as among millions of Asian-Indian ethnics living all over the world. Thus we may brace ourselves to better address or even prevent what has been dubbed “the next major clinical epidemic of our times”.

Keywords: atherosclerosis, coronary artery disease, cardiovascular prevention, metabolic syndrome
Singapore Med J 2009; 50(10): 949-955