Asians Are More Susceptible to Heart Attacks

HOUSTON: On Sunday, December 3, the parking lot of India House was full and some of the usual visitors were wondering; once they came in, they found out that besides many usual Sunday activities, a Heart Health Symposium was going on. Many inquisitive people who had not pre-registered decided to come in if they were allowed and of course the registration was free and they joined the group.

This was the first of a quarterly symposium that has been planned jointly for the coming months by Indo-American Chamber of Commerce of Greater Houston, Indian Doctor’s Association (IDA) and India House. The subject was quite interesting “Are Asian Indians, men and women, at a higher risk of Heart Attacks and if so how to reduce it”. Chair person was Dr. Prasun Jalal, a G.I., particularly Liver specialist and current President of IDA and speakers were Dr. Virendra Mathur and Dr. Sheila Heinle, both of Texas Heart Institute and Baylor College of Medicine and Dr. Atasu Nayak, Cardiologist of Kelsey Seybold Clinic joined the panelists for Q & A.

Col. Vipin Kumar, Executive Director of India House opened the symposium welcoming the full house of attendees, male and female about 50-50 % and presented a brief introduction of India House mission and regular activities through a brief Video.

First speaker, the senior cardiologist of Baylor, Dr. Virendra Mathur presented data indicating how serious are Cardiovascular diseases, the leading cause of death in both men and women, and 92 million Americans are currently victims of these and over 800,000 die each year. Heart attack itself hits about 800,000 Americans annually and 114,000 lose their life. If a person has the misfortune of getting a Cardiac arrest outside hospital, 90% don’t make it.  Heart attack occurs every 40 seconds and a heart related death every minute in USA. The most frightening message was the fact that heart disease as well as most of the other deadly diseases are silent killers that do not announce themselves by pain or other prominent symptom and by the time symptoms appear, disease will be very advanced and hard to manage.  The common mistake that >90% people make is to assume that pain/symptom is indicator of disease and absence of pain/symptom equals absence of serious disease. Unfortunately, by the time pain or other symptoms appear, all the serious killers of mankind have already spread and are at a very serious stage. Many of these “silent” killers are detectable if people pay attention to their health and see an attentive physician regularly.

The main theme of the symposium was about the differences in South Asians and the audience was shocked to hear that heart disease is 4 times as common and Diabetes is 6 times more common in Asian Indians than most other ethnic groups. In addition, the disease in South Asians is even more serious, it hits persons at a younger age, it is more serious and more fatal, mortality in women is even higher. Data was presented from several countries confirming the higher prevalence and severity of heart disease. Another point that Dr. Mathur emphasized was that the most obvious reason identified was higher incidence of Diabetes and he wanted everybody to know that so called ‘Diabetes’ is really indicator of the real problem which is not ‘sugar’ but several abnormalities together, known as “Metabolic Syndrome” or the Insulin resistance syndrome.  This includes high Blood pressure, higher levels of Sugar, Triglycerides, lower HDL level, obesity especially abdominal with a bigger girth.  Elevated sugar level is just an indicator of this disease or a messenger while simultaneously disease is damaging all the arteries of the body and other organs like Liver, Kidney, Eyes etc. Just lowering sugar level does not kill the ‘enemy’ or protect the damage to the arteries; only very strict life style correction is the proven benefit to reduce mortality risk. Metabolic syndrome prevalence is increasing like an epidemic and is being diagnosed in children and young teenagers. In Indian male adults above 40, it is prevalent in 50%. There are indicators that South Asians have proportionately less lean muscle mass, more fat and more intra-muscular and visceral fat and hormones of visceral fat are much more dangerous for the arteries.

He concluded with a ray of hope, an encouraging fact that death rate from Cardiovascular diseases has dropped 70% since 1968 and 25% from 2004 to 2014 with the advances in medicines, techniques, devices, procedures and surgery and it is ongoing at an accelerating pace.

Dr. Heinle then took the difficult task of discussing the prevention and management to reduce the damage and mortality risk. Most people are aware that Cardiovascular diseases (CVD) include Coronary Artery disease (CAD) responsible for heart attacks and angina pain, Stroke, High Blood Pressure (BP) Limb or Peripheral arterial disease (PAD), Heart failure, Arrhythmias (irregular heartbeats) and Valve diseases and some others. CAD is not only the commonest but also the deadliest. It is caused by buildup of Cholesterol laden material in the wall of the coronary arteries, blocking the passage inside.

She encouraged the audience to remember all the “risk factors” which increase the frequency as well as the severity of CAD. These include Family history, age, smoking, high BP, high Cholesterol, specially LDL, Diabetes, Obesity and very important Physical Inactivity. Dr. Heinle reminded that 1 in 3 deaths are related to C.V. D.  More important 90% of CVD events/deaths are due to “preventable” risk factors. The cost burden of USA is $ 200 billion per year. By focusing on health and risk factors it is possible to delay or avoid the deadly complications and reduce mortality. She defined “Ideal CV Health” as a person who a) never smoked, b) had light physical activity of 150 minutes /week or 75 minutes/week of more vigorous activity, c) satisfied 4-5 points of healthy diet, d) had Cholesterol of <200 mg/dl, e) fasting glucose of <100 mg/dl and BP < 120/80

Dr. Heinle presented data that smoking alone can increase the risk >5 times by smoking 15 Cigs/day. Importance of physical activity also can be seen by the data of age adjusted death rate which can be reduced from 60/10,000 to 20/10,000 in males if low fitness level is changed to high fitness level; for females, rate drops from 40 to 8/10,000. There is data to show that regular exercise not only reduces CV mortality, including heart attacks, strokes, PAD and BP but it also has beneficial effect on Diabetes, Obesity, Osteoporosis, Muscle loss, depression, Dementia, Breast and Colon Cancers and E.D. In a large study, difference of mortality was 6 fold higher in obese women (BMI >32) versus thin (BMI <19). Besides overall obesity the difference of fat distribution makes a difference, apple shape with most of weight above waist, compared to “pear” shape with most below waist. She presented data showing significant improvement in Metabolic Syndrome (and Diabetes) with life style modification. Dr. Heinle also defined good diets having more fruits, nuts, fish, vegetables, whole grains, legumes, beans, Yogurt, moderate use of Cheese, eggs, poultry, low fat milk and harmful foods included Butter, Red meat, refined grains, starches, sugars, processed meats, high sodium foods and trans-fats

Dr. Heinle also pointed out that South Asian persons do less exercise, even vegetarian diet has high proportion of Carbohydrates and saturated fats and have much higher prevalence of Insulin resistance or Metabolic syndrome and body composition and central distribution of more dangerous fat; all of these factors lead to higher risk of CAD. Jokingly, she recommended Indians to eat less Samosas, Korma, Pakora, Bhajia, Saag Paneer, Sauced white rice and fried stuffed Naans & more of Papadum, Chicken Tikki or Tandoori, Tandoori Kabob, curry from vegetable oil base, daal, Gobhi-matar-tomato, matar pulao, steamed boiled rice, chapati.  She pointed out that convincing evidence of health benefit exists for high BP, CAD and Stroke and probable for Breast and Colon cancers. Possible benefit may also be in Rheumatoid Arthritis, COPD, Osteoporosis, Cataract and Macular degeneration.

She also pointed out that guidelines for defining high BP have been modified and currently ideal BP should not exceed 130/80 mm Hg. 100 million or 46% of US population has high BP and it increases risk 3 fold in men and 2 fold in women less than 45 years of age.  Only 52% young adults (20-39yrs) are aware of high BP, <36% are being treated and < 25% are controlled. In age groups of > 40 years the figures are 75% aware, 65% on treatment and only 37% controlled.

Dr. Heinle also touched about the importance in women, pointing out that more women compared to men die of heart attacks. CVD appear at a later age in women but are more serious and mortality rate  is higher.  The common risk factors are more prevalent in women with CVD compared to men.

Prevention as earlier mentioned is possible in 90% of all persons with CVD and by correcting all the risk factors, severe disease can be delayed or “prevented” until old age.   Modern medicines and procedures and technical advances have made it possible to reduce the impact of all the factors and prolong life and “healthier life”

After Q & A session, Jagdip Ahluwalia, Executive Director, IACCGH extended vote of thanks to all who had contributed in one way or the other. The audiences were then treated with delicious refreshment from Nirmanz Food Boutique.