Julie Beck tells us that throughout much of history the heart was the essence of what made humans human. We use heart metaphors very often: “he has a heart of stone,” or a “heart of a lion,” or a “heart of gold.”’ She “poured her heart out.”‘“He broke my heart.” We use the heart to express ourselves and to serve as the counterpoint to our logical minds.
Pause to think about the amazing machine and what a marvel of evolution the heart is and how hard it works – you stop if it does. A muscular organ located between your lungs, it’s the size of your clenched fist and weighs about 11 ounces. If you live to be 70, it will have exceeded 2 billion heartbeats. It circulates all the blood in your body about 1,500 times every day. If you used it as a pump, it would empty a 2,000-gallon tank of blood in a day.
Are you doing all that you can to look after this precious organ that “works its heart out’ for you?” You may be shocked to learn that South Asians in the Bay Area have four times greater risk of heart disease and a much greater chance of having a heart attack before age 50 than the general population. I sat down to discuss this with Dr. Abha Khandelwal, a cardiologist at Stanford and a leader of the Stanford South Asian Translational Heart Initiative (SSATHI) . “South Asians are the fastest growing minority in the Bay Area,” she says, “and their #1 health risk is cardiovascular, and they tend to be typically ten years younger than their Caucasian counterparts when they present for their first event.” Although many do not have traditional risk factors such as smoking and obesity, SSATHI has identified other risk factors for South Asians including insulin resistance, hypertension and certain genetic factors. “Some genetic cholesterols like lipoprotein(a) that are independent risk factors for coronary disease are more prevalent in South Asians,” Dr. Khandelwal continues, “and such people are not identified and intervened early enough” to prevent a cardiac event. Additionally, some advanced imaging parameters such as LV Mass typically used to assess risk may not be indexed to account for the body surface area of people of different frames.
What can you do? “Recognize things within your control,” she says “exercise, diet, whether you smoke, your weight, how much you sleep, and to some degree how well you control your stress. Work to the best of your ability to improve each of these.” Each of us should make the time to address our health, just as we take time out for other things like educating our children.
The earlier you make health a priority, the more likely you are to enjoy good health in the long term. Most studies show that plaque buildup begins by the age of 25. Start with your primary-care physician to establish your own baseline and determine if you have any traditional risk factors such as hypertension or diabetes. The Heart Foundation says that the best way to look after your heart is with a healthy lifestyle comprising eight steps: 1. Be smoke-free. 2. Manage blood cholesterol. 3. Manage blood pressure. 4. Manage diabetes. 5. Be physically active. 6. Achieve and maintain a healthy weight. 7. Enjoy a variety of nutritious foods. 8. Look after your mental health.
If you have a family history of heart disease, Dr. Khandelwal recommends you consider a special program such as SSATHI at Stanford or AIM To Prevent at El Camino Hospital’s South Asian Heart Center to get an advanced evaluation, personalized guidance and counseling. SSATHI uses the specialized calculator QRISK2 – the only diagnostic tool that has been developed and validated in South Asians – that is tuned to provide a more accurate assessment of the true risk for ethnic populations. The result from such an evaluation is usually around 1.4 times the standard risk score.
Dr. Khandelwal has a message for South Asian women in particular. “Whether they like it or not, they are the cornerstone of their family unit and invest so much time in taking care of their family members that they often neglect their own health. When the woman is fit, eating well and exercising, the family benefits.” In particular women should be targeting exercises to minimize fat around the waistline and hips.
Promote a heart-healthy lifestyle. “If you have young children, start talking to them about nutrition and healthy eating,” Dr. Khandelwal recommends, “my son is 5 ½ and he looks at what he eats, and has opinions about what he will eat, what’s heart healthy and what’s not. Children are never too young to start; exercise and outdoor activity are equally important as math and science.”
Your heart. Love with it. Live with it!
Sukham Blog – This is a monthly column focused on health and wellbeing.
Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. Sukham provides information, and access to resources on matters related to health, aging, life’s transitions including serious illness, palliative and hospice care, death in the family and bereavement. If you feel overcome by a crisis and are overwhelmed by Google searches, Sukham can provide curated resource help. To find out more, visit https://sukham.org, or contact the author at sukhaminfo@gmail.com.