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Experts Stress Need to Promote Awareness of Cardiovascular Ailments Among High Risk South Asian Americans

Experts Stress Need to Promote Awareness of Cardiovascular Ailments Among High Risk South Asian Americans

  • While Indians have lower rates of obesity in terms of body mass index, their high waist-hip ratio is the greater hazard.

With the Diwali festivities coming to a close, it is most timely to take note of the health hazards that lurk around the corner, especially with the copious amount of delicious ghee and sugar loaded goodies we have all consumed.

A recent article published in The Washington Post once again sounded alarm bells on the disproportionately higher risk of heart disease and other cardiovascular ailments that people of South Asian descent face. Worldwide, South Asians account for 60 percent of all heart disease cases, even though at 2 billion people they make up only a quarter of the planet’s population.

According to the article, in the United States, where people of South Asian descent are growing in number, estimated at about 5.4 million, more attention is being focused on these risks. Healthcare professionals attribute the risks to a mix of genetic, cultural and lifestyle factors. Researchers are seeking more resources to fully understand the causes and find strategies to combat them.

The Post article states that Representative Pramila Jayapal (D-Washington) has sponsored a legislation that would direct $5 million over the next five years toward research into heart disease among South Asian Americans and raising awareness of this issue. The bill passed in the House of Representatives in September and is up for consideration in the Senate.

There is a belief that the issue could gain more attention now that Sen. Kamala Harris is set to take office as Vice-President. Her mother came to the U.S. from India and went on to do breast cancer research, eventually succumbing in 2009 to colon cancer.

The report quoted a 2018 study for the American Heart Association (AHA) that found South Asian Americans more likely to die of coronary heart disease than other Asian Americans and non-Hispanic white Americans. The study pointed to their high incidences of diabetes and pre diabetes as risk factors, as well as high waist-to-hip ratios. 

People of South Asian descent have a higher tendency to gain visceral fat in the abdomen, which is associated with insulin resistance. They also were found to be less physically active than other ethnic groups in the U.S.

Prof. Madhav Swaminathan of Duke University told American Kahani, “Mortality from cardiovascular disease is higher among South Asians compared to Caucasian populations and rising at a faster rate. One issue in applying risk data from population studies is that most of them examine Caucasian groups disproportionately compared with other ethnic groups, making comparisons challenging and intervention strategies flawed.”

He said infusion of funds into research on this issue is very welcome. The sum of $5 million is only a small step but in the right direction, he says. “A lot more will be needed, if we are to change the trajectory of the burden of cardiovascular and metabolic diseases in this population,” he says.

Compared to an average Caucasian or African American person who may be obese, in a South Asian person the risk of diseases is much higher. 

Dr. Shivani Maffi, former associate professor at University of Texas Rio Grande Valley and currently a senior scientist at Azymus Therapeutics, said, “More research needs to be geared towards factors that will help people stay healthy or start a healthy lifestyle. The vegetarian diet that many Indians subscribe to, tends to be high in carbohydrates. The lentils we consume are a good source of protein and fibre but adding a lot of fried foods does no good. Lack of exercise, long hours of work in sedentary jobs and stress, all combine to increase our risk of heart disease.” 

“There are different types of obesity and while Indians have lower rates of obesity in terms of body mass index, their high waist-hip ratio is the greater hazard,” she added.

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Dr. A.K. Nagendra, urological surgeon practicing in Wisconsin, says in his 45 years medical practice, he has to deal regularly with complications arising from diabetes, blood pressure and heart disease. Compared to an average Caucasian or African American person who may be obese, in a South Asian person the risk of diseases is much higher. 

Citing the book published in 2005 by Dr. Enas A. Enas and Dr. Sudesh Kannan, “How to beat the Epidemic of Heart Disease among South Asians,” he said enough studies have been conducted on the subject and any further infusion of funds would be a waste. He mentioned that Dr. Enas, who came to the U.S. in 1970 from Kerala, conducted extensive and exhaustive research, traveling to Pakistan, Bangladesh, Nepal, India and the Maldives. He has done groundbreaking work in this field for over 30 years and was the founding director of Coronary Artery Disease in Indians (CADI) Research Foundation.

In an interview published in India abroad in 2019, Dr. Enas had said that the heightened risk of heart disease applied to all South Asians, regardless of where they lived. He had discovered that established risk factors such as smoking, high blood pressure, high cholesterol and diabetes, though important, fail to explain the excess burden of heart disease in South Asians. Genetics play a big role. The key was the discovery of high levels of a little known cholesterol called lipoprotein(a) or Lp(a) in South Asians, who have the second highest Lp(a) levels among the seven largest ethnic groups and the highest risk of heart attacks from elevated levels. South Asians develop heart disease 10 years earlier than others. Lp(a) is a risk factor even surpassing diabetes. But, he said, about 65 per cent of heart attacks in South Asians is linked to abnormal lipids or LDL cholesterol and another 10 percent to Lp(a).

Dr. Enas recommended statin therapy to lower and maintain LDL cholesterol to less than 70 mg per deciliter. In 2018 the AHA and the American College of Cardiology released new cholesterol guidelines that validated his recommendation and lowered the threshold of initiating statin therapy from LDL 100 to 70 mg per deciliter. He said that Lp 9a) can be measured in the blood after age 5. High level identifies individuals at high risk at an earlier age. But he lamented that despite the wealth of knowledge available on the subject, most cardiologists do not take seriously enough the magnitude of challenge facing young South Asians. This is probably where the funds proposed in the legislation could be used more effectively — to raise and spread awareness.

Alpana Varma worked as a Research Assistant at the Delhi University and then as a journalist for over 10 years for several leading national dailies. After leaving India for Europe, she has been working as a teacher, translator and freelance writer and editor. She lived in Mexico briefly where she worked in intercultural communications. Currently she is based in Miami. 

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