Dr. Makover
Chief Medical Officer JIB
Our health depends on three things: Our genes, what happens to us in the womb as we develop from a single cell into the baby we are born as and what happens after
that.
Genes are the starting point
Our genes are our heritage. Someday, a complete genetic analysis will tell us everything about what we are genetically made of, likely much more than we want to or need to know, but that is pretty far off.
Until that time we have to look for indirect clues, which we find from three sources: Our family history (our close relatives, our ancestors and other blood relations), our heritage (what area of the world and what kind of folks did our relatives and ancestors come from) and, less often, physical clues that can point to certain genetic variation.
A family history of heart disease and stroke, especially when younger, means higher risk for offspring
For example, if you have relatives who had early heart attacks, that means you might carry those same genes, since early onset is not usually just due to unhealthy lifestyle, etc. Of course, not all children get the parents’ bad genes.
Ethnic background can provide invaluable clues.
Ethnic and regional background also provides clues, but they must be used very cautiously as they are only the most general of guidelines.
Ethnic differences are not caused by a person’s religion or the geography of where someone lives or did in the past. People who are similar in religion, nationality or skin color tend to marry people like themselves, which concentrates the type of genes they have. That is why some genes run more commonly in some groups (but it certainly does not mean everyone in that group has the same genes). In other ways, culture very much affects lifestyle, which of course is a major factor in health.
South Asian heart disease highest rates in the world
Several physicians whose heritage is from India have begun programs in Chicago and Los Angeles to help reduce the remarkably high rate of heart disease among people whose heritage is from the South Asian area (India, Pakistan, Bangladesh, Tibet, Bhutan, Nepal, Sri Lanka, the Maldives, Afghanistan). It is likely that the peoples of the other ‘-stans’ (means ‘land of’), Kazakhstan, Tajikistan, Uzbekistan, Kyrgyzstan, Turkmenistan, might have a similar heritage, especially the more southern they are).
Dr. Shoeb Sitafawalla of Chicago, advised in a medical lecture that South Asians have the highest rate of heart disease in the world, likely over 100 million cases and very high rates of diabetes. Fifty percent of the heart attacks they suffer strike before age 50 and many before age 35.
I have talked with many people whose heritage is South Asian and they all have many relatives with heart disease, most at younger ages and the medical literature provides much confirmation.
Of course, not everyone with that heritage has the same dire outcomes, but anyone with that background should certainly get checked very early and often and take important preventive steps.
Why so much heart disease from South Asia?
Dr. Sitafawalla and others think there are a number of reasons for the difference:
1.‰ÛâInherited genetic factors that cannot yet be measured.
2.‰ÛâA high rate of elevated Lipoprotein (a). Lipoprotein (a) is a variant of LDL, what people call the ‘bad’ cholesterol, but a lot badder. When above a certain level (50 mg/dl), it means much higher risk. It is inherited and not related to lifestyle.
3.‰ÛâHigh rates of diabetes.
4.‰ÛâExcess belly fat is very common among South Asians, even in people who otherwise look lean. Any excess abdominal weight means excess visceral fat. Visceral fat is hidden away inside your belly, around your intestines, liver and heart. It is an important contributing cause for many common cancers, metabolic syndrome, diabetes, atherosclerosis, gout, osteoarthritis and hypertension. The less visceral fat the better.
5.‰ÛâMuch of South Asian cooking includes very unhealthy saturated fats, even if vegetarian.
a.‰ÛâGhee, for example, a staple of South Asian and Arabic cooking, is a special kind of clarified butter, composed almost entirely of fat, 62% of which is saturated fats plus some cholesterol. A cheaper form sometimes used contains partially hydrogenated fats that are high in even more dangerous trans fats.
6.‰ÛâSmoking adds to the risk but it is still extremely high even in non-smokers.
What can you do if you are South Asian in heritage?
Heart disease is remarkably preventable.
1.‰ÛâYou cannot change your genes, but you can learn to enjoy a healthier lifestyle and you can find out where you stand.
2.‰ÛâThe JIB Medical CardioPrevention Program (CPP) is designed to detect risk very early and to advise you what you can do to help protect yourself and your blood relatives who share the same risk. Atherosclerosis (hardening of the arteries from high cholesterol) is a silent, stealth disease you don’t know you have until very advanced and too often too late unless you look for it, as the CPP does.
One of the most effective things you can do is to be on medicines when needed that will help you get your cholesterol extremely low. The lower the LDL cholesterol, the lower your risk and there has been no evidence of harm from even extremely low cholesterol from medications or in people born with genetic conditions that make their cholesterol extremely low. Keeping cholesterol extremely low (as it is in babies and in all other animal species) will help protect against those hidden genes for which there is currently no specific treatment.
