High prevalence of cardiovascular disease in South Asians: Central role for brown adipose tissue?

Abstract

Cardiovascular disease (CVD) is the leading cause of death in modern society. Interestingly, the risk of developing CVD varies between different ethnic groups. A particularly high risk is faced by South Asians, representing over one-fifth of the world’s population. Here, we review potential factors contributing to the increased cardiovascular risk in the South Asian population and discuss novel therapeutic strategies based on recent insights. In South Asians, classical (‘metabolic’) risk factors associated with CVD are highly prevalent and include central obesity, insulin resistance, type 2 diabetes, and dyslipidemia. A contributing factor that may underlie the development of this disadvantageous metabolic phenotype is the presence of a lower amount of brown adipose tissue (BAT) in South Asian subjects, resulting in lower energy expenditure and lower lipid oxidation and glucose uptake. As it has been established that the increased prevalence of classical risk factors in South Asians cannot fully explain their increased risk for CVD, other non-classical risk factors must underlie this residual risk. In South Asians, the prevalence of “inflammatory” risk factors including visceral adipose tissue inflammation, endothelial dysfunction, and HDL dysfunction are higher compared with Caucasians. We conclude that a potential novel therapy to lower CVD risk in the South Asian population is to enhance BAT volume or its activity in order to diminish classical risk factors. Furthermore, anti-inflammatory therapy may lower non-classical risk factors in this population and the combination of both strategies may be especially effective.

• Endothelial dysfunction
• HDL dysfunction
• inflammation
• insulin resistance
• type 2 diabetes

Declaration of interest

The authors report that they have no conflicts of interest. M. R. Boon is supported by the Board of Directors of the Leiden University Medical Center (LUMC). P. C. N. Rensen is an Established Investigator of the Netherlands Heart Foundation [Grant 2009T038]. We also thank Roba Metals B. V. IJsselstein (Utrecht, The Netherlands) for financial support. The funders did not have any role in the design or interpretation of the study.

Notes

Referee: Dr. Jeanine Roeters van Lennep, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.