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M. P. Ravindra Nathan
Heart Disease in Indian Americans(Part 1) What you should know now
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal

About two and a half decades ago a prominent Indian physician, husband of a movie star, living in suburban New York City, died of a sudden heart attack at the young age of 49. The first reaction from the Indian community was shock followed by dismay and grief. But they soon reconciled and hoped this was an isolated incident.

But it was not meant to be. In fact, it was just the beginning.

Soon, cases after cases of coronary heart disease (CHD) in Indians started popping up all over USA. Stories of many of our Indian friends getting ‘balloon jobs’ and ‘bypass surgeries’ became common news, creating anxiety and panic attacks.

A new dramatic epidemic was just unfolding right in front of our eyes.

Everyone was stymied. Why should these “mild mannered, not so overweight, mostly vegetarian people,” fall victims to such a deadly disease, which usually affected the westerners? What is the cause? Why is it that the other immigrant population like the Chinese and the Japanese don’t have this problem? And what can we do now?

Well, the answers to all these questions and more can be found in the new book, “How to Beat The Heart Disease Epidemic Among South Asians,” authored by Dr Enas A. Enas with Sudesh Kannan, PhD. More about the book later.

Let us first define ‘South Asians.’ They are people whose lineage can be traced to India, Pakistan, Sri Lanka, Bangla Desh, Nepal and Bhutan and often collectively referred to as ‘Indians.’ Yes, certainly we all came from the Indian subcontinent and hence share similar genetic composition, skin color, looks and other bodily features. So it would be logical to conclude that we may all suffer from similar health problems as well.

First recognized in Singapore in 1977, this increase in CHD among Indian descendants appears to be a world wide phenomenon. Heart disease rate among Indian immigrants in USA is 3-4 times higher than that of general population. Reports from other countries like Canada, Fiji, Malaysia, Singapore, South Africa etc suggest that people of Indian origin, wherever they are settled now, are at high risk for premature CHD and its devastating sequelae. Just browsing through the enormous database on this subject itself was a remarkable experience. Recently, the incidence has skyrocketed not only in India but in most of Asia too.

In 2004, Time Asia wrote about “Asia’s war with Heart Disease.” Even in Okinawa, Japan, envied for the longevity of its residents, heart disease and related deaths have soared in the past decade. In Tampa Bay too, many of our friends had a brush with the disease and a few have succumbed.

It turns out that there are many risk factors prevalent in the Indian community. The traditional risk factors would include: gender (males have more incidence than females), family history, ethnicity (Chinese and Japanese are blessed with lower incidence of heart disease as opposed to Indians and Caucasians), hypertension (the silent killer), smoking (including beedies, chewing tobacco, snuff etc), a different pattern of blood cholesterol abnormalities - mainly ‘low HDL, high LDL and high Triglycerides, ‘thrifty genes’ (what may have served us well during the time of famine and scarcity in the past may be detrimental during prosperity which we enjoy now, and leads to obesity, insulin resistance, metabolic syndrome etc), dietary habits and diabetes mellitus.

The emerging or non-traditional risk factors include: Lipoprotein (a), (a deadly subclass of LDL especially common among Indians), insulin resistance, metabolic syndrome (a conglomeration of many risk factors), obesity (especially abdominal variety, simply called paunch), elevated homocysteine levels, physical inactivity and lack of fitness, C-Reactive protein (a sign of silent inflammation), chronic kidney disease obstructive sleep apnea, teeth infections, history of heart disease and more. In fact, new risk factors are being identified frequently, so beware. Pile-on is a common problem in the origin of many diseases and multiple risk factors in the same person have a mutually synergistic effect.

Dr. Vibhuthi Singh and Dr. Prakash Deedwania who have studied the problem of heart disease in Indians, concur with many of the above observations. They feel, “As a group, Asian Indians, both in the United States and in India, have one of the highest rates of heart disease in the world, more than three times higher than the rate in the US

Deedwania . Many Asian Indians have very high levels of triglyceride and low levels of HDL, as well as a high incidence of diabetes. It appears that a genetic abnormality in triglyceride regulation, common among Asian Indians, might account for this. Studies have shown that another genetic abnormality prevalent in the Asian Indian population involves insulin regulation.”

An explanation of some of the terms used in this article and considered as risk factors is relevant here.

Total Cholesterol – the central component of lipid abnormalities, often referred as the “Arch villain of atherosclerosis.”

HDL - High Density Lipoprotein, (commonly referred as the Good Cholesterol)

LDL – Low Density Lipoprotein (The Bad Cholesterol)

Triglycerides – a fat component predominantly comes from what you eat but also synthesized in liver

Lp (a) – pronounced Lipoprotein little a, a genetic variant of LDL, and highly atherogenic

Homocystine: an amino acid in your blood

Cardiologist Dr. M. P. Ravindra Nathan lives in Brooksville.

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