I read with great interest the excellent review by Pahor et al1 highlighting the role of emerging risk factors in the development of coronary artery diseases (CAD). Some of these risk factors appear to be of greater significance among people of certain ethnic origins. Asian Indians have the highest rates of CAD despite the fact that nearly half of them are life-long vegetarians.2 When compared with Americans, Europeans, and other Asians, CAD rates among Asian Indians worldwide are 2- to 4-fold higher at all ages and 5- to 10-fold higher for those younger than 40 years.2 The excess risk of CAD in Asian Indians is accompanied by a low prevalence of high blood pressure, high cholesterol levels, cigarette smoking, and obesity. However, they have a high prevalence of emerging biochemical risk factors.
Enas EA, Jacob ST. Emerging Noninvasive Biochemical Measures: Potential Explanation for Ethnic Differences in Cardiovascular Risk. Arch Intern Med. 1999;159(15):1811-1817. doi: