73
4.2.8.5. Considerations Based on Ancestry
Table 21. Considerations According to Ancestry Groups
Observed Higher Risk in Demographic Groups
• South Asian ancestry is a high-risk demographic group and considered a risk enhancer.
• Increased prevalence of diabetes at lower BMI and waist circumferences across
Asian populations.
• Increased CKM syndrome risk factors among Filipino American individuals,
including hypertension, hyperlipidemia, and obesity.
Variation in Lipid Measures
• Higher levels of Lp(a) are found in non-Hispanic Black individuals, but associated
increase in CVD relative risk is similar to other groups.
• Elevated Lp(a) is associated with a higher population-attributed risk for MI among
South Asian and Latin American people.
• Baseline CK levels are higher in non-Hispanic Black individuals but may not portend
greater risk for statin-associated adverse events.
Statin Sensitivity
• Some individuals of Chinese, Japanese, or Korean ancestry have been observed to
have higher plasma concentrations of rosuvastatin, resulting in heightened sensitivity,
and may benefit from starting rosuvastatin therapy at a lower dose.
BMI indicates body mass index; CK, creatine kinase; CVD, cardiovascular disease; Lp(a),
lipoprotein (a); and MI, myocardial infarction.
4.2.8.6. Adults With Heart Failure
COR LOE
Recommendation
3: No
Benefit
A
1. In adults with HFrEF who do not have clinical ASCVD
or another indication for LLT, initiation of LLT is not
recommended to reduce clinical events or mortality.
