South Asians Cardiovascular Disease Ashley Marion University of Guelph-Humber Brampton Civic Hospital Cardiac Rehabilitation

Background Geography Geography –location –Climate Culture Culture –Diet –Views on exercise –Prevention and awareness Physiological differences Physiological differences t_does_south_asian_diaspora_mean/&docid=_DVBn8r4DRN7QM&imgurl= 5ggfbl8xr&zoom=1&iact=hc&vpx=612&vpy=321&dur=1043&hovh=216&hovw=233&tx=112&ty=120&sig= &page=1&tbnh=132&tbnw=143&start=0&ndsp=20&ved=1t:429,r:10,s:0

What puts South Asians at higher Risk? INTERHEART case-control study, 52 countries, all ethnic groups, including South Asians INTERHEART case-control study, 52 countries, all ethnic groups, including South Asians –9 risk factors account for >90% of the population’s noticeable higher risk of MI  smoking, raised apolipoprotein B/apolipoprotein A1 ratio (), hypertension, diabetes mellitus, abdominal obesity, and psychosocial stress

Physiological Differences Phenotype Phenotype Biochemical Biochemical Differences in body Characteristics* Differences in body Characteristics*

Physiological Differences Exp. Arterial diameter Arterial diameter Altered adipokine activity (leptin, adiponectin) Altered adipokine activity (leptin, adiponectin) –Inflammation = biomarker of atherosclerosis –Raji et al,  Adiponectin= improves insulin sensitivity  good  Adiponectin levels lower in Asian Indians than in whites  increased whole body insulin resistance  impaired fibrinolysis (process of preventing clots)  altered endothelial function  Adipokines  insulin resistance  atherosclerosis

Raji et al

Conditions to take note… Ischemic Heart Disease Ischemic Heart Disease Stroke Stroke Peripheral vascular disease Peripheral vascular disease

Stroke Adiponectin levels lower  increased whole body insulin resistance  impaired fibrinolysis+ Arterial diameter= Increased number of strokes Adiponectin levels lower  increased whole body insulin resistance  impaired fibrinolysis+ Arterial diameter= Increased number of strokes

Peripheral vascular disease What is PVD? What is PVD? –Condition of blood vessels  Leads to narrowing/hardening of arteries  Lower Limbs and feet –Caused by arthrosclerosis South Asians= increase in atherosclerosis South Asians= increase in atherosclerosis

Ischemic Heart Disease Aka. Myocardial Ischemia Aka. Myocardial Ischemia –Heart muscle damage/inefficient –Reduced blood supply to heart –Reduced blood flow= ATHEROSCLEROSIS –Risks  Increases with age  Smokers  Diabetics  HPT

Barriers What are some of the barriers to working with this population? What are some of the barriers to working with this population? –Language –Culture and tradition  tradition does not change over-night

Recap –Adipokines  insulin resistance  atherosclerosis –Insulin resistance  diminished adiponectin levels

Considerations for Screening/Diagnostics What do physicians need to consider? What do physicians need to consider? –Aware of prevalence of metabolic syndrome and glucose intolerance in South Asians –Screen  waist circumference and waist-hip ratio, rather than BMI.  Assessment of fasting glucose and a complete lipid profile  a strong family history of diabetes, or impaired fasting glucose, an OGTT should be considered

Treatment no evidence to suggest that treatment targets should differ between ethnic groups. no evidence to suggest that treatment targets should differ between ethnic groups. –Exercise* –Diet change –Stress level changes… Not enough studies with regards to different responses to pharmaceutics Not enough studies with regards to different responses to pharmaceutics

Example Exercise program Start slowly with aerobics (3 x 30 min with 10 min warm-up and cool down) Start slowly with aerobics (3 x 30 min with 10 min warm-up and cool down) –Walking, swimming –Cycling for most obese, not as hard on joints Strength training Strength training –Lighter weights higher reps –Continuous –Breath, no max lifts

Barriers to Exercise Diet Diet HR? HR? –Beta blockers (HPT) –RPE –Beware starting BP –Strenuous= atherosclerosis BMI BMI

Work Cited Brookes, Linda (2004). Brookes, Linda (2004). INTERHEART: A Global Case-Control Study of Risk Factors for Acute Myocardial Infarction. Lancet. Retrieved from Gulshinder, Chattha (2010). Top Ten Risks of the South Asian Diet. Retrieved from Gupta, Milan., Singh, Narendra., Verma, Subodh (2006). South Asians and Cardiovascular Risk What Clinicians Should Know. Circulation. 2006; 113: e924-e929. Retrieved from Gupta, Milan., Singh, Narendra., Verma, Subodh (2006). South Asians and Cardiovascular Risk What Clinicians Should Know. Circulation. 2006; 113: e924-e929. Retrieved from n.a (2012). Peripheral Artery Disease. Medline Plus. Retrieved from n.a (2012). Stroke In South Asians. Coronary Artery Disease in Asian Indians. Retrieved from The Epidemic of Coronary Heart Disease in South Asian Populations: Causes and Consequences; First Edition. Retrieved from Patel, Kiran C R (2004). The Epidemic of Coronary Heart Disease in South Asian Populations: Causes and Consequences; First Edition. Retrieved from Raji A, Gerhard-Herman MD, Warren M, Silverman SG, Raptopoulos V, Mantzoros CS, Simonson DC. Insulin resistance and vascular dysfunction in nondiabetic Asian Indians. J Clin Endocrinol Metab. 2004; 89: 3965–3972. Retrieved from ype2=tf_ipsecsha.