Dyslipidaemia in ethnic populations: special considerations

There is extensive evidence of an increased risk of coronary heart disease (CHD) amongst South Asians (Indo-Asians) compared with Caucasians. This increased risk is not explained by conventional risk factors for CHD, such as smoking, hypertension and elevated total cholesterol levels. Studies have consistently demonstrated an increased prevalence of metabolic abnormalities including insulin resistance, diabetes, impaired glucose tolerance and dyslipidaemia, characterised by low plasma levels of high-density lipoprotein cholesterol (HDL-C) and high levels of triglycerides and lipoprotein a (Lp[a]), amongst South Asians. Together these factors predispose to accelerated atherosclerosis, and this is accentuated by adoption of a Western lifestyle. Nicotinic acid is the most potent lipid-modifying therapy for increasing HDL-C (by up to 30%), and is also effective in reducing triglycerides and Lp(a). Clinical studies in Caucasian patients have shown that nicotinic acid can also be safely used in patients with controlled type 2 diabetes. Long-term intervention studies have demonstrated the clinical benefits of nicotinic acid treatment, reducing cardiovascular morbidity and mortality in Caucasian patients with CHD. Nicotinic acid could potentially offer important therapeutic benefits in South Asians. Further clinical studies in this patient group are needed to substantiate this potentially useful treatment strategy and identify specific groups that would derive most benefit.