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Canadian Journal of Cardiology

The Morphology of Coronary Artery Disease in South Asians vs White Caucasians and Its Implications

      Abstract

      South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes compared with White Caucasians (WCs) following invasive revascularisation procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and to discuss their potential impact on the development of coronary disease, acute coronary syndrome, and revascularisation outcomes. SAs have a more diffuse pattern with multivessel involvement compared with WCs. However, less is known about other morphologic characteristics, such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher noncalcified plaque composition, elevated thrombosis, and inflammatory markers likely contribute to the disease pattern. Although the current evidence on the role of coronary vessel size remains inconsistent, smaller diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularisation outcomes. In conclusion, SAs have a unique CAD risk profile composed of traditional and novel risk factors. Our findings highlight the need for additional awareness of health professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.

      Résumé

      Les populations sud-asiatiques (SA) présentent une prévalence plus élevée et une apparition plus précoce de la maladie coronarienne, et ont de moins bons pronostics que les Blancs caucasiens (BC) après des procédures de revascularisation invasive, fondement de la gestion de la maladie coronarienne (MC). Nous avons cherché à examiner les différences dans le canevas de la MC et les facteurs de risque entre les patients SA et BC, puis à discuter de leur impact potentiel sur le développement de la maladie coronarienne, le syndrome coronarien aigu et les conséquences d'une revascularisation. Les SA présentent un profil plus diffus avec une atteinte multivasculaire, comparés aux BC. Cependant, on en connaît moins les autres caractéristiques morphologiques, telles que la calcification de la plaque athérosclérotique et le diamètre coronaire dans les populations SA. Malgré une charge de calcification coronaire similaire, une composition plus élevée en plaque non calcifiée, une thrombose élevée et des marqueurs inflammatoires contribuent probablement à l'évolution de la maladie. Bien que les données actuelles sur le rôle de la taille des vaisseaux coronaires restent inconsistantes, des diamètres plus petits dans les SA pourraient jouer un rôle dans la prévalence plus élevée de la maladie. Ceci est particulièrement important étant donné l'impact du diamètre des artères coronaires sur les conséquences de la revascularisation. En conclusion, les SA présentent un profil de risque de MC unique, incluant des facteurs de risque traditionnels et nouveaux. Nos résultats soulignent la nécessité de sensibiliser davantage les professionnels de la santé à ce profil de risque spécifique et aux cibles thérapeutiques potentielles, ainsi que la nécessité de poursuivre les recherches sur cette population vulnérable.
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