Managing cardiovascular disease risk in South Asian kidney transplant recipients

Table 1 Features of cardiovascular disease particular to South Asians when compared to other ethnic groups

Epidemiology	Clinical features	Laboratory features
↑ Prevalence, ↑ mortality	↑ Type 2 diabetes	↑ Serum triglycerides
↓ Age at presentation, ↓ age at mortality	↓ Hypertension awareness	↓ Serum HDL cholesterol
↑ Severity by angiography	↑ Central obesity	↑ Small-dense HDL cholesterol
↑ Difficult revascularization	↑ Intra-abdominal adiposity	↑ Small-dense LDL cholesterol
↑ Carbohydrate intake	↑ Insulin resistance	↓ Serum total and high molecular weight adiponectin
↑ Saturated fat intake	↓ Age at pancreatic β-cell dysfunction	↑ Serum leptin
↓ Physical activity	↑ Fatty liver	↑ Serum homocysteine
	↑ Metabolic syndrome	↑ Vitamin D deficiency
	↓ Left ventricular mass index	↓ Non-HDL-cholesterol/apolipoprotein B ratio
	↓ Skeletal muscle mass	↓ Endothelial NO
	↓ Accurate estimate of glomerular filtration rate	↑ Lipoprotein (a)
		↑ Fibrinogen

HDL: High-density lipoprotein; LDL: Low-density lipoprotein; NO: Nitric oxide.

Table 2 Possible interventions to manage cardiovascular risk in South Asian kidney transplant recipients

Pre-transplant	Post-transplant
No lower age limit for screening	Diabetes	Screen for post-transplant diabetes
Consider earlier cardiologist referral		Consider using any oral antihyperglycemic including newer agents
Use oral glucose tolerance test/HbA1c	Hypertension	Consider using any antihypertensive agent
Maximize cardioprotective medication		Consider vitamin D deficiency
		Monitor for adherence
	Dyslipidemia	Recognize that lipid profiles do not necessarily reflect increased cardiovascular risk
		Monitor HDL cholesterol and triglycerides
		Recognize potential for increased exposure from standard statin doses
	Obesity and metabolic syndrome	Monitor waist-hip ratio
		Target counseling about potential weight gain and abdominal girth increase even if body mass index is normal
		Screen for presence of metabolic syndrome
		Target interventions to individual components of metabolic syndrome
	Health behavior	Decrease carbohydrate and saturated fat intake
		Increase monounsaturated fat and fiber intake
		Implement structured, graded exercise programs

HbA1c: Glycosylated hemoglobin; HDL: High-density lipoprotein.