Definitions
ApoB What it is: ApoB is a protein found on LDL and other cholesterol-carrying particles. Each particle has one ApoB, so its level shows how many potentially harmful particles are in the blood. What it does: In South Asians, ApoB often gives a clearer picture of heart risk than just LDL cholesterol levels. High ApoB means more particles that can cause artery plaque, even if LDL cholesterol looks normal. Related resources: - Biochemistry, Apolipoprotein B (https://www.ncbi.nlm.nih.gov/books/NBK538139/) - Clinical Feature: The Unique South Asian Phenotype and Opportunities for Early Intervention to Prevent Diabetes and ASCVD (https://www.lipid.org/lipid-spin/summer-2020/clinical-feature-unique-south-asian-phenotype-and-opportunities-early)
Lp(a) What it is: Called "L P little a", is a molecule in the blood stream who's main job is to transport fats through the bloodstream. Unlike regular LDL, Lp(a) is mostly genetic but can also see spikes due to menopause or some other health conditions such as diabetes or chronic kidney disease. Many people with healthy lifestyles and no symptoms can still have higher Lp(a) levels. As it is genetic, even children can present with higher Lp(a) levels. South Asians are a group that are prone to higher Lp(a) levels. What it does: Lp(a) has an extra protein that makes it stick to the walls of blood vessels and produce more clots. These blockages directly increase the risk of a heart attack or stroke. For this reason, higher Lp(a) levels mean that overall heart health should be controlled through lifestyle choices and when needed, the appropriate medication. Related resources: - Lipoprotein (a) (https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a) - Lp (a) in Indians | Cadi (https://cadiresearch.org/topic/lipoproteina/lpa-in-indians) - Lipoprotein: Myth vs Facts (https://www.heart.org/en/-/media/Files/Health-Topics/Cholesterol/Lpa-Myths.pdf)
HDL What it is: HDL (high-density lipoprotein) is often called “good cholesterol” because it helps carry excess cholesterol from the blood and artery walls back to the liver for removal. What it does: In South Asians, higher HDL doesn’t always mean lower heart risk like it does in other groups. Some research shows HDL function may be different or less protective. So, just looking at HDL numbers can be misleading, other factors like inflammation and particle quality matter more. Related resources: - Clinical Feature: The Unique South Asian Phenotype and Opportunities for Early Intervention to Prevent Diabetes and ASCVD (https://www.lipid.org/lipid-spin/summer-2020/clinical-feature-unique-south-asian-phenotype-and-opportunities-early)
LDL What it is: LDL (low-density lipoprotein) carries cholesterol from the liver to cells. When there’s too much LDL cholesterol, it can build up in artery walls and form plaque, which narrows arteries and raises heart disease risk. What it does: South Asians often have normal or slightly lower LDL levels but still face high heart risk. This suggests LDL particle number or quality (like ApoB) might matter more than just LDL cholesterol levels. Related recources: - Clinical Feature: The Unique South Asian Phenotype and Opportunities for Early Intervention to Prevent Diabetes and ASCVD (https://www.lipid.org/lipid-spin/summer-2020/clinical-feature-unique-south-asian-phenotype-and-opportunities-early) - Leading Causes of Death among Asian American Subgroups (https://pubmed.ncbi.nlm.nih.gov/25915940/)
Lipids What it is: Lipids are fats and fat-like substances in the blood, including cholesterol and triglycerides. They’re important for energy and cell function but can harm arteries if out of balance. What it does: South Asians tend to have higher triglycerides and other lipid abnormalities even if cholesterol looks normal, which raises their heart disease risk in ways standard tests might miss. Related resources: - Elevated cholesteryl ester transfer protein (CETP) activity, a major determinant of the atherogenic dyslipidemia, and atherosclerotic cardiovascular disease in South Asians (https://academic.oup.com/eurjpc/article/22/4/468/5926591)
PCSK9 Inhibitors What it is: PCSK9 inhibitors are newer drugs that lower LDL cholesterol by helping the liver remove more LDL from the blood. What it does: These drugs are promising for South Asians with very high cholesterol or genetic conditions. Access and cost can be barriers, but they offer another option when statins aren’t enough. Related resources: - PCSK9 Inhibitors Show Value for Patients and the US Health Care System (https://www.sciencedirect.com/science/article/pii/S1098301517302620)
Statins What it is: Statins are drugs that lower LDL cholesterol by blocking its production in the liver. They reduce plaque buildup and lower the risk of heart attacks and strokes. What it does: Statins work well for South Asians but side effects are fairly common especially with more aggressive doses. Because risk is higher in this group, earlier or more aggressive statin use might be needed. Related resources: - Clinical Feature: The Unique South Asian Phenotype and Opportunities for Early Intervention to Prevent Diabetes and ASCVD (https://www.lipid.org/lipid-spin/summer-2020/clinical-feature-unique-south-asian-phenotype-and-opportunities-early)