Cadi > Research > CADI Research > Pioneering Contributions

Pioneering Contributions

During the past twenty years, CADI Research under Dr Enas’ leadership has achieved several scientific breakthroughs in understanding the biological basis of the ethnic differences in CVD (cardiovascular disease). In addition to the high rates of heart disease and diabetes, his research has demonstrated a high prevalence of several emerging risk factors that are implicated in the development of extremely premature and malignant heart disease among young Indians.

  • Dr Enas was the principal investigator of the CADI Study, which for the first time proved a 3-4 fold high rate of heart disease among Indian physicians and their family members in the United States.1
  • The CADI Study also for the first time, proved the high rate of diabetes (8%) among Indians in the United States.1 Subsequent studies have shown that the prevalence of diabetes has increased to 17%-26%.
  • Made great strides in understanding the causes of the excess burden of CAD (coronary artery disease) and diabetes in a predominantly vegetarian population of more than a billion people.2-6 (see Contaminated Vegetarianism)
  • Identified and reported, for the very first time, a genetic predisposition to CAD among Asian Indians, mediated through lipoprotein(a) – the deadliest cholesterol of all and a genetic variant of LDL cholesterol.7-10 Also explained the crucial role of lipoprotein(a) in early heart attacks in Indians and other South Asians.11
  • Collaborated with experts in the US, Canada, and India to do several studies and published results showing that approximately 35- 42% of Asian Indians have dangerously high levels of lipoprotein(a), making them unusually vulnerable to heart disease at a very young age (less than 40 years of age).7, 11, 12
  • Collaborated with experts in India and demonstrated the role of lipoprotein(a), in CAD in patients with and without diabetes.11, 13-16
  • Identified two hitherto unknown abnormalities of HDL cholesterol. Discovered for the first time small dense dysfunctional HDL among Asian Indians.17, 18 Large HDL particles confer longevity and maximum protection against heart disease, whereas small HDL particles confer the least protection. Asian Indians have unusually small HDL particles that are incapable of resisting the ravages of high LDL and high lipoprotein(a).
  • Asian Indians worldwide are known to have low levels of HDL or good cholesterol (80% – 90%). People with low HDL have increased risk of a heart attack similar to having high levels of LDL or bad cholesterol.19
  • Reported the beneficial effect of physical activity in increasing the cardioprotective large HDL particle among Asian Indians.20
  • Identified and reported very high prevalence of low levels of HDL2b among Asian Indians. HDL2b fraction confers the maximum protection against heart disease and usually account for 20% or more of the HDL. Approximately 90% of all Indians have low levels of HDL2b- the very best HDL fraction.12 Approximately 50% Indians with normal HDL levels have low levels of HDL2b.
  • The combination of high lipoprotein(a) and low HDL2b is particularly deadly, conferring an 8-fold risk of heart disease and is found in 42% of Asian Indians compared to 22% of Europids.12
  • This combination of abnormalities, along with high non-HDL cholesterol, explains most of the otherwise unexplained heart disease among South Asians which is not detected on routine lipid profile.9
  • Dr Enas and CADI Research continue to educate the physicians and public alike about the several unique aspects of CAD among Asian Indians. These include high rates of heart attack and death at lower body mass index and lower waist circumference.21-26 (see Cardinal Features) More importantly, both heart attack and death occur at a very young age, even among non-smoking vegetarians who exercise regularly.
  • Published: “HOW TO BEAT THE HEART DISEASE EPIDEMIC AMONG SOUTH ASIANS: A Prevention and Management Guide for Asian Indians and their Doctors” This is the only data-based book and can be previewed and ordered directly from this website.
  • Dr. Enas is available for medical seminars and lectures for physicians and public alike. Many of the landmark articles can be downloaded from this website.

Sources

  1. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J. Jul-Aug 1996;48(4):343-353.
  2. Enas EA. Why Indians are more susceptible to Coronary artery disease: Role of specific risk factors In: Chatterjee SS, ed. Update in Cardiology Hyderabad: Cardiology Society of India; 2007.
  3. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol. Mar 1995;18(3):131-135.
  4. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic USA; 2010.
  5. Enas EA. Why is there an epidemic of malignant CAD in young Indians? Asian J Clin Cardiol. 1998;1:43-59.
  6. Enas EA. Coronary artery disease epidemic in Indians: a cause for alarm and call for action. J Indian Med Assoc. Nov 2000;98(11):694-695, 697-702.
  7. Anand SS, Enas EA, Pogue J, Haffner S, Pearson T, Yusuf S. Elevated lipoprotein(a) levels in South Asians in North America. Metabolism. Feb 1998;47(2):182-184.
  8. Enas EA. Lipoprotein(a) is an important genetic risk factor for coronary artery disease in Asian Indians. Am J Cardiol. 2001;88:201-202.
  9. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. Nov 2007;9(5):367-374.
  10. Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)–a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. Jan 2006;52(1):5-50.
  11. Gupta R, Kastia S, Rastogi S, Kaul V, Nagar R, Enas EA. Lipoprotein(a) in coronary heart disease: A case-control study. Indian Heart J. 2000;52(4):407-410.
  12. Superko HR, Enas EA, Kotha P, Bhat NK, Garrett B. High-density lipoprotein subclass distribution in individuals of asian Indian descent: the National Asian Indian Heart Disease Project. Prev Cardiol. Spring 2005;8(2):81-86.
  13. Mohan V, Deepa R, Haranath SP, et al. Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India. Diabetes Care. Nov 1998;21(11):1819-1823.
  14. Velmurugan K, Deepa R, Ravikumar R, et al. Relationship of lipoprotein(a) with intimal medial thickness of the carotid artery in Type 2 diabetic patients in south India. Diabet Med. Jun 2003;20(6):455-461.
  15. Enas EA, Senthilkumar A, Juturu V, Gupta R. Coronary artery disease in women. Indian Heart J. May-Jun 2001;53(3):282-292.
  16. Enas EA, Yusuf S, Mehta J. Meeting of the International Working Group on Coronary Artery Disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J. Nov-Dec 1996;48(6):727-732.
  17. Bhalodkar NC, Blum S, Rana T, et al. Comparison of levels of large and small high-density lipoprotein cholesterol in Asian Indian men compared with Caucasian men in the Framingham Offspring Study. Am J Cardiol. Dec 15 2004;94(12):1561-1563.
  18. Bhalodkar NC, Blum S, Rana T, Kitchappa R, Bhalodkar AN, Enas EA. Comparison of high-density and low-density lipoprotein cholesterol subclasses and sizes in Asian Indian women with Caucasian women from the Framingham Offspring Study. Clin Cardiol. May 2005;28(5):247-251.
  19. Enas EA, Dhawan J, Petkar S. Coronary artery disease in Asian Indians: lessons learnt and the role of lipoprotein(a). Indian Heart J. Jan-Feb 1997;49(1):25-34.
  20. Bhalodkar NC, Blum S, Rana T, Bhalodkar A, Kitchappa R, Enas EA. Effect of leisure time exercise on high-density lipoprotein cholesterol, its subclasses, and size in asian indians. Am J Cardiol. Jul 1 2005;96(1):98-100.
  21. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr. Fall 2007;2(4):267-275.
  22. Enas EA, Yusuf S. Third Meeting of the International Working Group on Coronary Artery Disease in South Asians. 29 March 1998, Atlanta, USA. Indian Heart J. Jan-Feb 1999;51(1):99-103.
  23. Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol. Oct 1 1992;70(9):945-949.
  24. Jha P, Enas E, Yusuf S. Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors. Asian Am Pac Isl J Health. Autumn 1993;1(2):163-175.
  25. Enas EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian Heart J. 2009;61:265-74.
  26. Enas EA, Singh V, Munjal YP, Bhandari S, Yadave RD, Manchanda SC. Reducing the burden of coronary artery disease in India: challenges and opportunities. Indian Heart J. Mar-Apr 2008;60(2):161-175.

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