South Asians get heart smart
New South Asian Heart Center addresses higher risk of coronary disease among certain ethnic groups
Last year, Nanda Nandkishore had a shock. He attended a heart health screening believing he'd pass with flying colors — after all, at almost 50, he was in good shape, with a healthy diet, a ski exercise machine at home, and only a little weight around his midriff.
Last time he'd taken the standard cholesterol test, his doctor told him his cholesterol was a bit on the high side, but nothing to worry about. And a year before, after a thorough check-up for insurance, he'd been given a clean bill of health and the best rate possible.
The heart health screening offered by the new South Asian Heart Center (SAHC) based at El Camino Hospital was, he knew, a little different. It was especially designed for people of South Asian descent — from India, Pakistan, Sri Lanka, Bangladesh and Nepal — and Nandkishore came from South India to California 25 years ago.
"I went in very cocky, saying I'll be in great shape," Nandkishore recalled. "I came back feeling I could have had a heart attack at any time, and I didn't even know that."
At the follow-up consultation after a series of tests, he'd discovered he had an elevated risk of cardiovascular disease. (There was also some concern about artery damage, which later proved to be unfounded.) At 255, his cholesterol level was too high, and his "good" HDL cholesterol was less than 10 percent. These numbers were worrying but they didn't tell the whole story.
Over the next few weeks, Nandkishore and his wife Purnima learned that South Asians have a unique susceptibility to coronary artery disease and that his experience is part of a far bigger trend. Doctors at El Camino Hospital have noticed over the past few years that South Asians are turning up with coronary artery disease (CAD) far more often than other ethnic groups.
In fact, research shows that they are four times more likely to suffer heart attacks, which tend to occur without prior symptoms or warning and are more often fatal. Heart disease is showing up at a much younger age in both men and women, even non-smoking, lifelong vegetarians who exercise regularly.
"As a result of a large influx of engineers and entrepreneurs in Silicon Valley, this epidemic has presented itself at the door of the emergency department," said Dr. Cesar Molina, medical director of the SAHC and a specialist in cardiovascular diseases. "Less than 3 percent of people serviced by El Camino Hospital are South Asian, yet 6 percent of heart attacks are occurring in this population. And they're happening much younger — in fact, the youngest heart attack here was 24 years old."
This year, the South Asian Heart Center took the lead in combating these startling statistics with a pioneering 5-year program to screen 5,000 people. There is nothing else like it anywhere in the world, and already people from other U.S. states and South Asia are showing an interest. There's now a waiting list of more than 200 for the screening and follow-up consultations. These include individually tailored exercise programs, nutritional counseling, and referrals to yoga and meditation teachers for stress reduction, which Molina sees as a vital part of the treatment program.
Though the SAHC evaluation and counseling are free, there are charges for the classes, as well as for lab work. Drugs are prescribed by a patient's primary care doctor.
Screenings done at SAHC are far more extensive than the standard screenings done at most doctor's offices, and include an advanced lipid panel and metabolic evaluation designed to uncover genetic factors that play a key role in heart disease for people of South Asian descent. For example, they can detect metabolic syndrome/insulin resistance, a pre-diabetic condition. (Diabetes is common in South Asian communities.) Important risk factors that do not necessarily show up in regular tests — for example, higher concentrations of lipoprotein(a) and homocysteine, and lower levels of HDL2b, a protective particle — give a far more accurate picture of an individual's true health status. In regular screenings, these risks are often underestimated or ignored.
"Heart disease is disruptive and devastating," said Ashish Mathur, executive director of SAHC, who once suffered a heart attack that brought him to El Camino's emergency room. Later, his work as a hospital volunteer and his friends' desire to know what caused his health crisis made him realize the need to address the issue more broadly.
The founding of SAHC has provoked an extraordinary response from the South Asian community, both in financial contributions, volunteer work and its drive to educate and support one another in combating heart disease. People are grateful and excited to be among the first to understand a health risk that severely affects them, both here and in their countries of origin.
"Now people are sitting up and taking notice," said Mathur. "At social get-togethers, people are asking, 'How's your cholesterol?' instead of 'How's business?'"
This increased interest — resulting in a commitment of seed money, expertise and volunteer physician hours from El Camino — led to the opening of the center in July. An open house is planned for this Tuesday, Sept. 19, from 5 to 8 p.m.
'An awakening for me'
Like all other patients who come to SAHC, Nandkishore, a Los Gatos resident, was referred to a nutritionist and a fitness specialist, who put him on a regimen of diet and exercise.
"It was an awakening for me," said Nandkishore, who quickly became committed to taking more direct control of his health. He learned that he had some bad eating habits. For example, food and TV were escapes when he felt stressed; or he would skip a meal to lose a little weight, then end up eating more because he was hungry late at night. He also discovered that his waist had gone up to 36 inches (one of the clearest indicators of pre-diabetic conditions or insulin resistance is the ratio of waists to hips).
Another surprise was that it's OK to eat snacks like fruit and nuts every few hours, and then to have regular meals — but control the portions.
"My wife came with me and took notes." said Nandkishore, whose wife Purnima is now working on a cookbook that will include many healthy adaptations of the typical Indian diet. For example, ghee (clarified liquid butter used in many Indian recipes) and coconut oil are replaced with olive or other unsaturated oils, basmati with brown rice, and whole wheat and other healthy grains are used to make breads and snacks.
Nandkishore increased his time on the ski machine and started visiting a gym three times a week, keeping a log of his times on an Excel spreadsheet. Strength training, which he'd never considered important before, became part of the routine when he learned that muscle mass increases metabolism and burns calories more effectively. His job as a business broker could be stressful, but the exercise relieved the tightness he felt after dealing with difficult client situations.
"The best thing was that I was able to pull in my belt, which I'd been wearing on the last hole," he said.
When Nandkishore was tested again, his cholesterol levels showed a dramatic improvement and he was able to come off the statin medication.
Enthusiastic though he was about his new heart-healthy regime, fear was also a driving force. Nandkishore knew many people who had heart disease, including one who had recently undergone quadruple bypass surgery.
By educating the South Asian community and physicians on a global scale, SAHC aims to dramatically reduce such incidents.
What: South Asian Heart Center Open House
When: Sept. 19, 5-8 p.m.
Where: 2400 Grant Road (downstairs behind YMCA El Camino branch)
Info: To schedule a screening, volunteer time or donate to SAHC, visit www.southasianheartcenter.org, or call (650) 940-7242