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1/ I would like to take a few minutes to review increased risk of heart diseases in South Asians (if you are from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan or Sri Lanka – this is you!). @globalsouthAsians @SouthAsianAnd @BrownGirlMag @SouthAsians4USA @masala_study
2/ South asians experience ischemic heart disease at a younger age, and at a higher rate. In the event, we do develop ischemic heart disease, we are more likely to die from it. Increased risk of heart disease attributable to higher prevalence of diabetes and high cholesterol.
3/ CT heart images show variable blood flow, greater obstruction, increased calcification and smaller luminal diameters in South Asians, predisposing to increased mean % obstruction of blood flow and higher prevalence of multi- vessel disease, unlikely to be treated with stents.
4/ Prevalence of diabetes is more than double than in most others, with onset at a younger age. Diabetics have a 2-3X increased risk of death from heart disease. We may have lower beta-cell function (insulin-producing cells)- this is still under investigation. @alka_kanaya
5/ We tend to have high triglycerides and low HDL cholesterol. Despite, apparent normal levels of LDL, we are more likely to have qualitatively abnormal LDL which can be highly atherogenic. We also have higher incidence of elevated lipoprotein (a), significance of this unclear.
6/ @masala_study study showed that South Asians are less physically active with lower cardiorespiratory fitness, have less total lean abdominal muscle mass and higher visceral and liver fat. Abdominal obesity is a predictor of heart disease in South Asians.
7/ @masala_study showed high BP associated with diabetes. Asian Americans are at higher risk of kidney disease likely due to high prevalence of high BP and diabetes. Plus, higher rates of obesity in South Asians. nytimes.com/2019/02/12/wel…
8/ We tend to eat fewer servings of fruits and vegetables. Our risk of heart disease may be increased by prothrombotic milieu with higher levels of homocysteine along with proinflammatory state - higher levels of inflammatory markers like CRP, IL-6, TNF. ahajournals.org/doi/full/10.11…
9/ Adiponectin levels among South Asians are lower compared with people from other races with parallel increase in insulin resistance, impaired fibrinolysis, and altered endothelial function. All of this contributes to our predisposition to developing ischemic heart disease.
10/Evolutionary theories to explain ethnic diff– thrifty gene (positive selection of variants favoring energy storage, for famines), drifty gene (absence of + selection on leanness) and descendants migrating to cold acquired variants conferring higher BMR, resistance to obesity.
11/ More South Asians may have #atypical chest pain than others, delaying access to care. Post-bypass, we tend to have poorer outcomes. This is likely from limited understanding of our diagnosis. We typically eat high percentage of carbohydrates and saturated fats. @JournoDevRaj
12/ Some observations suggest that incretin-based antidiabetic may be more beneficial for South Asians like DPP-4 inhibitors and GLP-1 analogs, although this is not confirmed. @lalitkjha
13/ Take-away: Calorie-restricted low carbohydrate diet beneficial. Incorporate whole grains as carb-substitute. Seek medical advice. In the end, we are all more similar than different;though we may have certain unique factors that add to our risk of ischemic heart disease. [end]
