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POST TIME: 10 September, 2018 00:00 00 AM
Is poor heart health in South Asians’ DNA?
Yahoo News Health

Is poor heart health in South Asians’ DNA?

Ameya Kulkarni, M.D.,

Every moment before the artery is open feels simultaneously frenzied and elegant. The rush to the hospital. A targeted history. Practiced teams of hands in a synchronized blur to prep and drape and wire and balloon.

And suddenly, calm.

The artery is open, the patient is better, blood flow to a dying heart is restored, and the crisis, for the moment, is averted. The minutes after are decidedly more deliberate. Sizing of the stent. Careful selection of post-procedural medications. And the inevitable question from the patient and his or her family: How did this heart attack happen?

Of course, the answer for everyone is different. For some, it's a lifetime of poor habits in eating, smoking or physical activity. For others, it's family history. Increasingly though, for patients who share my heritage, the answer is our ancestry.

For South Asians, the statistics are daunting. More than half of the world's heart disease occurs in people of South Asian descent.

In the United States, we are three to five times more likely than other groups to have a cardiac event, and coronary disease happens, on average, 10 years earlier than it does in other populations. In fact, about one-third of heart attacks in South Asians occur before age 45, which means that many will have their first heart attack before their children are in middle school. And the actual impact of this is felt more deeply than a conglomeration of numbers could suggest. Families are growing up without their fathers and, in a cruel irony, immigrants who came to the United States to forge a better life for their children are left in the unenviable position of outliving them.

Adding insult to injury is the fact that we still don't completely understand why coronary artery disease is more aggressive and deadlier in South Asians.

Some studies have implicated diet or a sedentary lifestyle; others suggest a variation in the way fat and cholesterol are processed, and still others blame a common genetic code. Likely, the truth is a combination of these factors -- a fact, though true, that is less than comforting to me, a cardiologist of Indian descent in my late thirties seeing my patients, and now more frequently my peers, developing heart disease.

Still, we are not without hope. Much can be done to reduce our risk of heart disease, and not all of the changes require wholesale shifts in lifestyle. Even small increments of change can have a meaningful impact on risk, especially when combined with our most potent weapon in the fight against heart disease: our communities. I've begun to ask my own small community to work on five small changes to improve heart health:

1. Reduce carbohydrates. One recent study suggested that South Asians who received more than 70 percent of their calories from carbohydrates were at increased risk for heart attacks and strokes. Traditional food from the region, heavy in either rice or rotis, can significantly increase the percentage of our diet that is carbohydrate rich. In the spirit of starting small, I suggest cutting out one serving per day. It could be substituting the roti with dinner, replacing it with quinoa or cauliflower rice, or cutting out the morning toast.

2. Learn hands-only CPR. A potential consequence of the early and aggressive coronary disease is cardiac arrest. In these situations, early CPR can more than double the chance of survival. It takes less than one minute to learn

hands-only CPR -- everyone should learn it.

3. Know your numbers. There are a few medicines, such as aspirin and statins, that can significantly reduce the risk of a heart attack. These medicines are not right for everyone, but knowing your numbers -- blood pressure, blood glucose and cholesterol levels -- can facilitate a decision on when certain medications are appropriate. In particular, the early onset of undiagnosed diabetes among South Asians may be a key risk in the development of heart disease. The only way to know is to check.

4. Be active. Many of us have sedentary careers that require hours of sitting at a desk or a computer. Family obligations, as well as an overall lack of cultural emphasis or importance put on exercise, often make physical activity a low priority. But there are many chances to be active that don't involve a gym. Taking the stairs instead of the elevator, parking in the furthest spot in the parking lot, changing one virtual conversation to an in-person one every day has measurable impact on its own and may be the first step toward a more robust exercise routine.

5. Show love, not food. Culturally, every South Asian community has a tradition of showing love through food. In my mother tongue, Marathi, the word agrah means to show love by insisting your guest eat more. Though it certainly was an elegant way to bridge the communication gap between my grandmother and me, the unintended result can have serious consequences. So continue to show love, but perhaps with less agrah.

How our collective communities respond to this crisis will be crucial to how well we survive it. I am certain that small steps, taken thousands of times together, have the power to save our lives. Join me in starting with the important first step today.

Ameya Kulkarni, MD, is a board-certified interventional cardiologist with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He serves as the group's assistant chief of cardiology for the Northern Virginia Service Area and is co-director of the Louise Olmstead Sands Cardiac Catheterization Laboratory at Virginia Hospital Center. Dr. Kulkarni has strong interests in the application of technology to medicine and treating adults with congenital and structural heart disease.

He sees patients in the Kaiser Permanente Tysons Corner Medical Center in McLean, Virginia.

 

Courtesy: U.S.News & World Report