TURNING THE CLOCK BACK ON SOUTH ASIAN HEART DISEASE EPIDEMIC

CALL TO ACTION

Everyone knows someone who has had heart attack or worse died from it so this is a personal issue for many of us yet we wake up only when it is too late. It is about time we embark on a multi-year global campaign of education and awareness involving physicians, patients and south Asian community in general. We all know prevention is the best intervention so there is need for a short check list of actionable items as a road map and our next generation to control this epidemic.

South Asians constitute about 25% of the world population but account for 60% of global cardiovascular burden. We are the highest risk ethnic group for cardiometabolic disorders. AHA has finally recognized this fact and issued guidelines last November 2019 urging physicians to consider ethnicity when determining cardiovascular risk as conventional models underestimate it. While there is consensus about higher risk there is no single “smoking gun”. Most experts think South Asian cardiometabolic epidemic is mainly mediated by visceral obesity induced insulin resistance but genetic/epigenetics and inflammation also play their role.

Cardiovascular atherosclerosis in South Asians strikes a decade earlier and many times, sudden death could be the first symptom. The nature of this atherosclerosis is also unique in that it is diffuse and progresses rapidly in relatively smaller caliber vessels making them less amenable to percutaneous or surgical interventions resulting in less than optimal outcomes. If we are serious about fighting this epidemic then we all need to fight at multiple levels at the same time.

First we need a massive campaign of awareness about this using every media and organize community outreach programs .Second educating about early check- up given our phenotype which makes us more susceptible to cardio-metabolic disease at lower BMI and Hgb1c levels is crucial. Third we need to emphasize the value early imaging like coronary calcium score /coronary CTA to detect subclinical atherosclerosis. Fourth we need a national registry of cardiac arrest from premature South Asian CVD and put it on our website and keep it updated with latest research. Fifth we should participate in our own ongoing cohort studies to build our data base whether clinical, biological or genetic to advance science in understanding this disease. Finally let us train every South Asian household in basic “Hands only CPR “to rescue our loved ones in crucial first few minutes which can make a difference between life and death before any help arrives.

We realize the task is daunting and will need entire AAPI village including all stake holders including local and regional chapters as well other associations. So Let us begin and learn as we go. To paraphrase JFK “If not us, who? If not now, when”? Lastly I want to our President Dr. Suresh Reddy and secretary Dr. Ravi Kolli for their support and trust .Looking forward for to work with you all. Please write Brahmasharma102@gmail.com for any interest or suggestions Brahma Sharma MD FACC Chair, AdHoc Committee South Asian Cardiometabolic disease.