Billion Hearts Beating

Even before my dad had a heart attack a couple of years ago, I was keenly aware of the dangers we, South Asians, face when it comes to heart problems. Despite my slender physique and primarily vegetarian diet, I knew I wasn’t in the clear.

But I was afraid to get the tests done — what you don’t know doesn’t kill you, right? Well, sometimes it does!

When dad had his “episode,” I could no longer hide behind the comfort of ignorance.

I wanted to know what was going on inside my body and if I needed to take steps to remedy something.

So, I went and got my cholesterol levels tested. The results were…well, disturbing.

I did not have enough good cholesterol and borderline high levels of bad cholesterol.

A Google search and an interview with a nutritionist (for a story I’ve pasted below), prompted my taking some simple steps to avert a coronary mishap:

1. I avoided simple carbohydrates like sugar and soft drinks, but opted for complex carbohydrates like whole grain products and legumes.
2. I limited my intake of fried foods, which meant pooris or parathas once a month.
3. I avoided foods high in saturated fats such as desserts and full fat dairy products (this was by far the most difficult thing for me to do, given my undying love for all things chocolaty).
4. I joined a Zumba class, went on brisk 45-minute walks every day, and parked my car in the section of the parking lot farthest from my office.

This year, a repeat checkup revealed the diet and exercise plan had worked. But that in no way indicated I was good to go.

Turning a new leaf means one has to be committed to the change — it’s not a fluke and it’s not temporary. And it means saying no, emphatically, at a lot of social gatherings.

You have to be aware and give your health priority — for your own sake.

Here is a cover story from ADVANCE for Nurses that I wrote in 2007, which shows how crucial it is to take care of your body every single day — especially for us South Asians.

I hope this serves as a reminder (or a wake up call) for all of you.
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Ashish Mathur did not mind the irregularities in his life – he traveled three times a week; ate when, and whatever, he could; and caught a few hours of sleep somewhere in between making presentations and jet setting across the world.

“I was fit, I was fine, I was very healthy,” said Mathur, 50. Or so he thought.

After 25 years of keeping up with this software engineer’s hectic, stress-filled, lifestyle, his heart finally gave up.

At 44, Mathur experienced his first heart attack.

“I was scheduled to travel the next day,” he recalled. “It was two in the morning and I couldn’t sleep because of an uncomfortable feeling in my chest…I didn’t have the classical symptoms of perspiration, jaw pain or pain extending down my arm until much later…”

Within minutes of experiencing the chest pain, Mathur was being rushed by his wife to El Camino Hospital’s emergency department.

A mystifying trend
“We have seen an increasing number of South Asians getting admitted into our emergency room and to the cardiac rehab program,” said Vivian Low, RN, MPH, at El Camino Hospital’s Cardiovascular Pulmonary Wellness Center. “Statistics reflect that Asian Indians have the highest rate of hospitalization in California for coronary artery disease.”

At El Camino Hospital alone, over the past two years, a significant 5 percent of the patients that walked into the ER with a heart attack were South Asian (men and women who trace their origins from India, Pakistan, Nepal, Bangladesh and Sri Lanka), while the South Asian population of the area that the hospital serves is just over 3 percent.

“We were seeing South Asian engineers coming in to the emergency room at a young age without any of the classical risk factors for coronary artery disease,” said Cesar Molina, M.D., F.A.C.C., El Camino Hospital. “These individuals had no high blood pressure, no history of tobacco use, no obesity, and yet they were here.”

Mathur epitomized this unsuspecting, high-risk population. “After the first event, I went to the emergency twice seeming to have MI symptoms, but there was nothing wrong. I was scared,” said Mathur. “I wanted to get the mystery out of it.”

So did the doctors at El Camino Hospital.

A case of genetics
“Our investigation into the literature led to the realization that this is in fact a worldwide epidemic in the South Asian population,” said Molina. “We know at this stage that South

Asians have a four-fold higher risk of heart disease when compared to the general American population. They have elevated levels of lipoprotein A, which is also sometimes known as the deadly bad cholesterol; a lower level of HDL2b, which is the cleansing cholesterol; and they also have a higher incidence of homocysteinemia that maybe toxic to the arterial walls. That’s a significant genetic disadvantage for this population.”

In consultation with several South Asian physicians in the Bay Area, prominent community leaders and the hospital staff, El Camino Hospital opened the South Asian Heart Center in fall 2006 with the aim to provide preventive care and to bridge cultural gaps between South Asian patients and mainstream health providers.

The center provides an in-depth health risk assessment South Asians, coupled with a physical exam, advanced lipid panel blood tests, a personalized comprehensive heart health plan and one-on-one case management.

“Cultural differences require a greater understanding of behavioral lifestyles,” said Low, who manages the cardiovascular pulmonary rehabilitation services and all aspects of patient education at El Camino Hospital. “In order to develop an appropriate teaching or care plan, a nurse has to take the time to gather necessary resources to help each patient define appropriate goals. The principles have remained the same for me, but as the community has become more diverse, my knowledge base has expanded.”

Leslie Abrams, NP and case manager at the SAHC, agrees with Low.

“Each and every individual has different demands on their life, has specific limitations and different motivation levels,” she said. “Not only do I find out which country they are from, I also find out which region. In a huge sub-continent like India, for instance, people from different regions have different risks of developing heart disease. And that is the reason why it’s important to have one-on-one face time with each participant – to understand their unique histories and meet their individual needs.”

Providing comprehensive preventive care
Although genetics seem to play a huge role in this epidemic, Mathur, who is now executive director of the center, strongly believes that it’s the sedentary South Asian lifestyle that triggers the onset of coronary disease faster.

“I was sleep-deprived, was not eating right and certainly had no time to exercise,” said Mathur. “And unfortunately, none of that mattered to me until the heart attack.”

And this is, in fact, the biggest challenge that Abrams faces in her consultations.

“South Asians are a hardworking population and it’s hard for me to make them understand the importance of making time to stay healthy,” says Abrams.

Apart from referring participants to the YMCA, Abrams provides them with information on stress-relief, yoga and meditation.

Making the right choices
Another value-added service comes from an Indian nutritionist at the center.

“Heart healthy dietary information is much more meaningful when it is put in the context of the cultural cuisine of the patient,” says Low, who interacts with South Asian patients in El Camino Hospital’s cardiac rehab center.

According to Molina, now SAHC’s medical director, keeping a strict watch on one’s waist size is extremely important for South Asians.

A waist circumference of more than 32 inches in women and greater than 36 inches in men could be predictive of coronary artery disease.

“Diet and exercise have to work together,” said Vijaya Deo, clinical educator at Berkeley Heart Lab and part-time nutritionist at the South Asian Heart Center. “There’s a myth that because most South Asians are vegetarians, they have a healthier diet. But the healthy part of the diet comes from fresh fruit and vegetables, and most South Asians have a very low intake of those.”

Deo explained that the home-cooked deep-fried, starchy meals, accompanied by frequent high-calorie take-out dinners do no good to the lipid and triglyceride levels of an already susceptible immigrant population.

“I provide them with modified recipes and guide them on how to make heart-healthy choices when eating out,” said Deo.”It typically takes about three months for them to see any changes in their lipid and cholesterol levels, but for most people the dietary changes translate into an instant change in energy level. They feel a sense of satisfaction and happiness for doing the right thing.”

Sukumuar Sudhakar, 31, was diagnosed with high cholesterol in 2001, but it was only after coming to the South Asian Heart Center did he start taking concrete steps toward changing his lifestyle.

“I did not know much about saturated fats and never found the motivation to exercise even though I had a gym membership,” he said. “But after coming to SAHC I don’t remember eating any food without first looking at the saturated fat percentage and because of the constant follow-ups from SAHC, I have now started going to the gym for at least an hour, five days a week.”

As a result, Sudhakar’s cholesterol level dropped from 236 to 206 along with a loss of 15 pounds in six months.

Closing the loop
The inception of this demographic-specific heart center is an important step in providing holistic care to the community, feels Audrey Prairo, RN, CEN at El Camino Hospital.
“By creating patient awareness, identifying who is at risk and providing prevention techniques, the South Asian Heart Center is adding to the spectrum of service,” said Prairo. “These are not easily provided in the acute hospital setting.”

And by adding physician awareness in the mix, SAHC is helping emphasize the need to have doctors prescribe routine cardiac screenings for South Asian patients at an earlier age.

“Many of the situations and conditions that I see in treating CAD patients are similar regardless of the demographic,” says Low. “We live in a high-achieving, expensive and competitive community. It’s challenging for young families to settle here and when you combine that with additional risk factors, it can be significant.”

Given that more than 30 percent of deaths from heart attacks in South Asians occur in those younger than 65 years of age, a rate double that of the U.S. national average, Mathur believes that the real challenge lies in outreach.

“If we are able to prevent an MI from occurring, we would have clearly achieved our goal,” he said. “There are so many unaware people out there at high risk – they are literally walking time bombs. We need to get the word out.”
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If you are a South Asian in the Bay Area, I encourage you to get screened. If you aren’t, you can get a cholesterol test done as part of your regular annual checkup.

Despite having a disadvantage in the genetic makeup, we can still do some things to live a healthier life.

IndiBlogger, in partnership with Apollo Hospitals and the Times of India, is trying to create awareness about this epidemic through their Billion Hearts Beating campaign. I have taken a pledge to:

• Take the stairs more often instead of the elevator.
• Cut down on sweets and chocolates.
• Not work weekends.
• Give up fried foods.
• Keep my cool while driving.
• Smile more often.
• Use less oil in my cooking.
• Walk every day.
• Eat more fruit and vegetables.
• Check my blood pressure regularly.
• Take up yoga.
• Check my cholesterol regularly.
• Get enough sleep.
• Give myself a vacation.

What simple steps are you going to take for a heart-happy life?

Copyright secured by Digiprove © 2010 Mansi Bhatia

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Tags: body, doctor, health, heart, Indian, life, medicine, south asian, stroke

This entry was posted on July 16, 2010 at 7:10 am and is filed under personal. You can follow any responses to this entry through the RSS 2.0 feed.