Indian-American doctor Nirmal Joshi says South Asian Americans at high risk of heart disease

indica News Bureau-

Noted doctor, Nirmal Joshi, MD, president of the Joshi Health Foundation and Chief Medical Officer, Mount Nittany Health in an article on Pennlive said that the South Asian Americans from countries like India, Pakistan, , Bhutan, Sri-Lanka and Nepal suffer from ‘ high rate of heart disease with alarmingly high death rates’.

Recalling an incident from his own family he wrote, “I remember the phone call from my brother. Raj, our cousin was no more. He had gone to bed after celebrating Diwali, the festival of lights, with family and never woke up. Within the next couple of years we heard of Prakash, another cousin, who went to the bathroom early in the morning, collapsed and died suddenly. Both Raj and Prakash were in their early fifties, leaving behind young families.”

He further said that around 5.5 million-strong South Asian community in the United States suffers from high rate of heart diseases and also a high death rate due to the same.

Citing examples from different studies undertaken in the US, he added that in the late seventies, research studies from Northern California began to show significantly higher rates of hospital admission for heart disease among South Asians. Since then, numerous studies have demonstrated a high death rate from heart disease in this population. In an analysis of over 10 million national death records, South Asians had a proportionately high mortality rate from heart disease with Asian Indian men leading the pack. Most alarmingly, Asian Indians suffer from heart attacks at a substantially younger age than do other populations—in some studies up to a decade earlier.

Throwing light on the reason for such high rates of heart disease in South Asian Americans, especially Indian Americans he said that they have a 2-fold higher risk of Type 2 Diabetes  which is a strong risk factor for heart disease. South Asians born in the United States demonstrate a high incidence of MetS (Metabolic Syndrome)- a combination of altered cholesterol levels, high blood insulin levels and a specific type of obesity, he added.

Dr Joshi further said that physical activity rates in South Asians are lower than other ethnicities; in one cohort only 52 percent of participants met the recommended guidelines through leisure-time activities. Finally, although many Asian Indians are vegetarians, their diet is often rich in refined carbohydrates and saturated fat and low in fruits and vegetables that contributes to the lifestyle disease.

Citing another study called MASALA (Mediators of Atherosclerosis in South Asians Living in America) – a study following 900 Asian Indians for the last seven years in the San Francisco Bay Area and Chicago, he said that the study showed that Asian Indians have a high risk of diabetes and other risk factors at lower body weights compared to other groups and they have a  tendency to store fat in unusual places such as around the abdomen, and internally around the liver. This may cause more metabolic damage than fat stored under the skin and other locations.

MASALA investigators also found that if the standard Western cut off of greater than 25 for BMI (Body Mass Index, a risk score combining weight and height) was used among Asian Indians, almost a third of high-risk patients may be missed. These findings have led the American Diabetes Association to recommend screening for diabetes in Asian Indians at BMI above 23.

On a happier note, Joshi said that though the data seems alarming, the risk factors are modifiable with changes in diet, exercise and lifestyle and better risk scoring methods.

“Physicians must stay updated on the unique risks and needs of this population. Risk factors must be treated vigorously and early. Screening for diabetes must occur at a BMI of over 23. Standard risk scoring methods seriously underestimate risk. A scoring index called the QRISK2 may be used. It has been validated in over two million Asian Indians in the UK (but not the US), accounts for ethnicity and may come closest to assessing true risk”, said Dr Joshi.

Advising all Asian Indians to get proper exercise to burn off excess cholesterol and fat, along with keeping their blood pressure in control, he said, “Asian Indians must engage in a regular program of exercise—at a minimum 30 minutes of brisk exercise 4-5 times a week (sorry leisurely strolls don’t count!)Third, Asian Indian patients must commit to controlling high blood pressure, high cholesterol and diabetes aggressively with little room for laxness. Finally, changing dietary habits–reducing refined sugars and increasing the intake of fruits, vegetables and sources of protein–is imperative. High-calorie fatty snacks, weekend food binging at social get-together, and excessive alcohol consumption are common offenders and must be curtailed. Sources of protein such as soy products and lentils should be added to snacks and food.”