Stent re-stenosis risk in South Asians

We are getting a decent amount of questions on the re- stenosis (narrowing) of the stents happening very early in our south Asian population. When you look at the data, the reported re-narrowing rate is 2 to 4% at 1 yr and 1-2 % at 6 months in general population but in South Asians it is 1-1/2 to 2 times higher and close to 8-10 % in some studies . This has been identified due to many risk factors in SA like a very high prevalence of diabetes, smaller artery lumen due to increased plaque burden, uncontrolled LDL above 55, high triglycerides, lack of adherence with antiplatelet Therapy. So important recommendations after any stent to prevent stenosis are as follows 1.Aspirin 81 mg life long. 2.Ticagrelor 90 mg twice daily preferred). Note that Clopidogrel 75 mg daily does not work very well in South Asians The Duration of treatment : 12 months minimum. Cannot stop early Consider >12 months if you have diabetes, long stent, small vessel,and previous heart attack 3. Lipid therapy: High-intensity statin Rosuvastatin 20–40 mg OR Atorvastatin 40–80 mg. Add Ezetimibe if LDL >55. Add PCSK9 inhibitor if still >55 or high Lp(a)/ High Apo b. 4: Diabetes try tight control to keep A1c < 6.5 5: If High TG> 150 Add EPA Icosapent Ethyl Brand name (Vascepa )special Omega acid that lowers heart attack risk 6: If high hS -CRP lower it to < 1 . Usually statins do it 7 If deficiency of B12 or Folate is noted treat but in normal population it has not shown to improve heart risk All of this has to be done with healthy diet, exercise and stress reduction etc . Hoping that helps