University of Florida College of Medicine, USA
Even though Coronary artery diseases (CAD) event rates have decreased by 50% in the US over the past 30 years, rates have doubled in many ethnic minorities, including South Asian immigrants (SAIs) that represent the fastest growing Asian immigrant group in the US. Neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome can account for this excess risk, therefore some unknown risk factors need to be explored. Among Dyslipidemias, HDL is considered to be CAD protective and low HDL is an independent risk factor for CAD. However in recent studies, HDL has been found to not only be ineffective as an antioxidant but, paradoxically, to increase LDL oxidation. Such HDL is called Dysfunctional HDL that may contribute to excess CAD risk. Additionally, most clinicians are aware of the low HDL levels in SAIs, but whether this is due to Dys-functional HDL is unknown. Moreover, the quality of HDL and its role in CAD protection is rapidly emerging. SAIs are under-represented in major clinical trials. We present her an overview of CAD problem in SAIs in general and most recent theories related to Dys-functional HDL in particular. Early detection of risk factors of CAD and atherosclerosis in this high risk group could prevent coronary events and substantially reduce the level of mortality and morbidity attributable to CAD in SAIs.