We thank Vivian Rambihar for taking an interest in our study1 and recognize his important contribution to the field of heart disease in South Asian Canadians. Although we agree that novel risk factors such as lipoprotein (a) (Lp[a]) and homocysteine may be implicated in the excess cardiovascular disease noted in South Asian Canadians, this was not the focus of our study. Regarding implications for care, pharmacologic intervention for elevated Lp[a] and/or homocysteine has not yet been shown to affect outcomes. Because our study was a matched case–control comparison, we are unable to comment on the prevalence of premature cardiovascular disease in our study population. However, we have shown in a related study2 that South Asian Canadians undergoing coronary angiography are significantly younger than patients of European origin. In that study, South Asian Canadians had more severe angiographic disease in each coronary artery, despite being younger and having fewer traditional coronary risk factors.
Milan Gupta William Osler Health Centre Brampton, Ont. Narendra Singh Rouge Valley Health System Scarborough, Ont. Sonia Anand Salim Yusuf McMaster University Hamilton, Ont.