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Special Populations
Chart 11. South Asians (SAs)
Recommendations
Strength Quality
In general, patients of SA ethnicity should be treated
according to the NLA Recommendations for Patient-
Centered Management of Dyslipidemia – Part 1 with the
following special considerations.
A High
Clinicians should be aware that SAs (including individuals
who trace their ancestry to Bangladesh, Bhutan, India, the
Maldives, Nepal, Pakistan, and Sri Lanka; and also members
of the SA diaspora–past generations of SAs who originally
settled in other parts of the world, including Africa, Canada,
the Caribbean, Europe, the Middle East, and other parts of
Asia and the Pacific Islands) as a group are at increased risk
for ASCVD.
A Moderate
Patients of SA descent in the United States have a greater
prevalence of insulin resistance than NHWs, and some of
the metabolic disturbances that accompany this condition
include high TG, low HDL-C, and dysglycemia.
A Moderate
SAs have increased prevalence of metabolic syndrome
compared to NHW Americans. Clinicians should be aware
that Asians have different waist circumference cut-points
for defining overweight/obesity for the definition of the
metabolic syndrome than those recommended for Caucasian
populations (≥37 inches [≥94 cm] for men and ≥32 inches
[≥80 cm] for women).
A Moderate
Clinicians should be aware that risk assessment methods
may under- or over-estimate ASCVD risk when used
in populations different from those in which they were
developed. ASCVD risk equations may underestimate risk
for SAs in particular, although the degree of underestimation
is uncertain. Clinicians should consider this when making
decisions about risk stratification and treatment.
B Moderate
Due to the possibility of genetic variation in drug
metabolism (as demonstrated mainly in studies of Chinese
and Japanese patients), starting with a moderate intensity
statin dosage and titrating upward to reach atherogenic
cholesterol goals, or downward if intolerance occurs, is
recommended for patients of Asian ethnicity.
B Moderate
Because SAs are at increased risk for diabetes, vigilant
monitoring for the potential of new-onset diabetes with
statin treatment is warranted.
A Moderate
