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Coronary artery disease in East and South Asians: differences observed on cardiac CT
  1. Alexander Chua1,
  2. Daniel Adams1,
  3. Damini Dey2,
  4. Ron Blankstein3,
  5. Timothy Fairbairn4,
  6. Jonathon Leipsic5,
  7. Abdul Rahman Ihdayhid1,
  8. Brian Ko1
  1. 1 MonashHEART, Monash Health and Monash University, Clayton, Victoria, Australia
  2. 2 Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  3. 3 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, Merseyside, UK
  5. 5 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Brian Ko, MonashHEART, Monash Health and Monash University, Clayton, Victoria, Australia; brianshiuhangko{at}


Epidemiological studies have observed East Asians (EAs) are significantly less likely to develop or die from coronary artery disease (CAD) compared with Caucasians. Conversely South Asians (SAs) develop CAD at higher rate and earlier age. Recently, a range of features derived from cardiac CT have been identified which may further characterise ethnic differences in CAD. Emerging data suggest EAs exhibit less coronary calcification and high-risk, non-calcified plaque compared with Caucasians on CT, with no difference in luminal stenosis. In contrast, SAs exhibit similar to higher coronary calcification and luminal stenosis, smaller luminal dimensions and more high-risk, non-calcified plaque than Caucasians. Beyond demonstrating ethnic differences in CAD, cardiac CT may enhance and individualise cardiovascular risk stratification in EAs and SAs. While data thus far in EAs have demonstrated calcium score and CT-derived luminal stenosis may incrementally predict cardiovascular risk beyond traditional risk scores, there remains a paucity of data assessing its use in SAs. Future studies may clarify the prognostic value of cardiac CT in SAs and investigate how this modality may guide preventative therapy and coronary intervention of CAD in EAs and SAs.

  • CT angiography
  • coronary artery disease
  • risk factors
  • global health
  • epidemiology

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  • Contributors All authors planned, drafted and critically revised the work for important intellectual content. All authors provided final approval of the work and are responsible for its overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DD has received software royalties from Cedars-Sinai Medical Center and research support from the National Institute of Health/National Heart, Lung, and Blood Institute (grant 1R01HL148787-01A1). RB has received research support from Amgen and Astella. TF has served on the speakers' bureau for HeartFlow. JL has served as a consultant for Edwards Lifesciences, Circl CVI and HeartFlow; has served on speakers' bureau for Philips; has received research support from GE Healthcare; and owns stock options in Circl CVI and HeartFlow. ARI has received honoraria from Canon Medical, Artrya and Boston Scientific. BK has received honoraria from Abbott and Medtronic and research support from Canon Medical.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.