Abstract 4367497: Comparison of Risk Factors in South Asian and White Patients Before and After Percutaneous Coronary Intervention

Abstract

Background: Prior studies have demonstrated that South Asian (SA) patients experience a disproportionately higher burden of coronary artery disease compared to other ethnic groups, thought to be due to a combination of genetic, lifestyle, and comorbid risk factors. After treatment with percutaneous coronary intervention (PCI), secondary prevention is crucial in preventing further morbidity and mortality in this vulnerable population. Research Question: Is there a significant difference between SA and White patients in traditional risk factors for CAD such as glycemic control, lipid profile, and body mass index (BMI) at time of PCI, and do these patterns persist post-PCI? Methods: A retrospective review of National Cardiovascular Data Registry (NCDR) was conducted for patients who received PCI between 2015-2023. SA were identified via self-reported ethnicity (Indian, Nepali, Bangladeshi, Pakistani, and Sri Lankan) from NCDR or medical record data. Results: 4,289 patients underwent PCI at a single center between 2015-2023. Table 1 demonstrates that lipid panels obtained on admission for PCI showed a significantly lower average total cholesterol, LDL, and HDL for SA patients compared to White patients. Average baseline BMI was similarly significantly lower for SA (25.9 +/- 3.7) patients vs White (28.1 +/- 5.5) patients (p<0.0001), while A1c was significantly higher for SA (6.9 +/- 1.4) patients vs White (6.5 +/- 1.6) patients (p=0.02). At both one-year post PCI (Table 2) and at most recent available follow-up (Table 3), there were no significant differences in average total cholesterol, LDL, and HDL between South Asian and White patients. Average A1c remained significantly higher in SA vs White patients at both one-year post PCI and at most recent follow-up. Conclusion: South Asian patients had significantly better lipid and BMI profile than White patients at time of PCI, but these differences normalized by one-year follow-up (suggestive of more aggressive risk factor modification post-PCI in White patients). On the other hand, while A1c was significantly worse at baseline in SA vs White patients, this disparity did not normalize with time, revealing a missed opportunity to optimize glycemic control in SA patients similar to lipid control in White patients. Furthermore, given that SA patients were requiring intervention despite better lipid and BMI control at presentation, more stringent guidelines may be indicated for this vulnerable population.