Nontraditional risk factors beneficial in CVD screening for South Asians in US
MIAMI — Utilization of risk factors including ethnicity, coronary artery calcium scores, lipoprotein(a) levels and family history should be used as a method of early screening and prevention in the population of South Asian adults living in the United States, Dinesh Kalra, MD, FACC, FSCCT, FSCMR, said during a presentation at the National Lipid Association Scientific Sessions.
“We don’t have a lot of evidence-based medicine in terms of screening and early prevention strategies specifically in the group of South Asians,” Kalra, an assistant professor in the division of cardiology and the director of advanced cardiac imaging at Rush University Medical Center in Chicago, said during the presentation. “But this is what I think is a reasonable approach to identify this type of ... solution because the guidelines have just begun to incorporate this group, but we don’t have any formal guidelines for this group yet.”
Risk prediction models fail sometimes
Kalra, in his presentation, said in determining risk for MI and atherosclerosis, risk prediction models “fail sometimes,” leading to a need for better strategies that incorporate high-risk features that may be found in the population of South Asian adults in the United States.
In determining risk in Pooled Cohort Equations, much of the broad U.S. population is served, but does not often apply to groups considered higher risk such as healthier, older adults as well as underestimated populations with chronic inflammatory diseases and lower socioeconomic statuses, Kalra said.
The use of CAC CT scans in detecting plaque buildup in its early stages could open a window in the progression of atherosclerosis early on, he said.
Although calcium scores can be an important part of screening, they do not dovetail the risk factors, Kalra said.
“There are people with zero risk factors who have very high calcium scores, and there are folks with more than three risk factors who may have a calcium score of 0 and that is where this really acts as a tiebreaker,” Kalra said during the presentation.
He referenced the MESA study in which 44% of patients with a CAC score of 0 did not need statin therapy based on the Pooled Cohort Equation.
Even with the use of statin therapy, Lp(a) would still play a risk in MI and ASCVD. Kalra, in his presentation, noted half of patients hospitalized with CAD have an LDL level less than 100 mg/dL. Twenty percent of Americans have a high Lp(a) of more than 50 mg/dL, which is associated with higher CV events in statin therapy patients.
All plant-based diets not the same
The implementation of a plant-based diet can help with the regression of plaque, but Kalra said an unhealthy plant-based diet showed similarities to animal protein-based diet in increasing the hazard ratio for CHD.
“Not all plant-based diets are the same,” Kalra said. “In plant-based energy intake, we have helpful diets and unhelpful vegetarian diets. Indians eat a lot of ghee, refined carbohydrates, sugar, sweets, and although they come under the umbrella of vegetarian diets, they are extremely unhealthy. So, a true vegetarian diet emphasizes greens, leafy vegetables, nuts, legumes, beans, etc.” – by Earl Holland Jr.
Kalra D. Early Screening and Prevention Strategies. Presented at: National Lipid Association Scientific Sessions; May 16-19, 2019; Miami.
Disclosure: Kalra reports no relevant financial disclosures.