HEALTHY LIFE EXPECTANCY IN CENTRAL ASIA: THE ATHEROGENIC ENVIRONMENT AND REGIONAL FEATURES OF CARDIOMETABOLIC PREVENTION

In Central Asian countries, rising life expectancy coexists with persistently high cardiovascular mortality. It is assumed that an atherogenic environment (energy-dense diets, low everyday physical activity, heat exposure, air pollution and chronic stress) amplifies insulin resistance and triglyceride-driven atherogenicity in middle-aged and older adults.

Aim. To characterize the lipid and metabolic profile of Central Asian residents aged ≥50 years; to assess indices of triglyceride-mediated atherogenicity and insulin resistance and their association with sex, arterial hypertension (AH), type 2 diabetes (T2D), carotid atherosclerosis and statin use; and to demonstrate that the impact of a shared urban environment outweighs ethnic differences.

Materials and methods. We conducted a single-centre cross-sectional study in Tashkent (December 2024 – August 2025; cut-off date 4 September 2025). We enrolled 167 participants (Uzbeks n=108, Russians n=46, Koreans n=13; 66% women) aged ≥50 years, born and living in Central Asian countries. Anthropometry, biochemical and hematological tests, and carotid duplex ultrasonography were performed. The following indices were calculated: non-HDL-C, AIP, TG/HDL-C, remnant cholesterol, HOMA-IR, QUICKI, TyG and eGFR (CKD-EPI 2021). Statistical analyses included the t-test/Mann–Whitney test, Fisher’s exact test and Spearman’s ρ; multiple testing was controlled using Benjamini–Hochberg FDR correction; α=0.05.

Results. Across all ethnic groups, women showed a more favorable lipid profile (higher HDL-C, lower Castelli I/II, AIP and TG/HDL-C), whereas men more often exhibited a combined dyslipidemia phenotype (elevated TG, non-HDL-C and AIP). Among Uzbek men, HOMA-IR 5.0±3.7 and QUICKI 0.33±0.03 reflected marked insulin resistance; similar patterns were observed in the Russian and Korean strata. The presence of T2D was associated with higher glucose, insulin, HOMA-IR, AIP, non-HDL-C and triglycerides, and with lower eGFR in all sex-ethnic subgroups. In patients with AH, BMI, TG, AIP and HOMA-IR were higher. Under statin therapy, total cholesterol/LDL-C/non-HDL-C were reduced, but AIP and TG/HDL-C remained elevated; fewer than 40% of treated patients achieved LDL-C targets. Correlation analysis demonstrated robust positive associations of AIP, TG/HDL-C and non-HDL-C with HOMA-IR and TyG, and inverse correlations with HDL-C. The direction of effects was preserved after stratification by sex and ethnicity.

Conclusions. Within a common urban environment in Central Asia, triglyceride-driven atherogenicity on a background of insulin resistance predominates, with a less favorable phenotype in men and in those with T2D and AH, irrespective of ethnic origin. Practical priorities include expanded lipid assessment (non-HDL-C, remnant-C, AIP, TyG), intensification of lipid-lowering therapy (high-intensity statins ± ezetimibe/EPA), early detection of insulin resistance and environment-focused preventive measures (nutrition, physical activity, urban environment). Such a strategy at both clinical and community level has the potential to increase healthy life expectancy in the region.

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