south asians cardiovascular disease ashley marion university of guelph-humber brampton civic...
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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 stressTRANSCRIPT
South AsiansSouth AsiansCardiovascular DiseaseCardiovascular Disease
Ashley MarionUniversity of Guelph-Humber
Brampton Civic Hospital Cardiac Rehabilitation
0671496
BackgroundBackground GeographyGeography
– locationlocation– ClimateClimate
CultureCulture– DietDiet– Views on exerciseViews on exercise– Prevention and awarenessPrevention and awareness
Physiological differencesPhysiological differenceshttp://www.google.ca/imgres?q=map+of+south+asia&hl=en&sa=X&biw=1280&bih=664&tbm=isch&tbnid=ZetMMCIZNks8iM:&imgrefurl=http://www.southasianconcern.org/south_asians/detail/what_does_south_asian_diaspora_mean/&docid=_DVBn8r4DRN7QM&imgurl=http://www.southasianconcern.org/images/sac_photos/south_asians/south_asia_map.gif&w=420&h=389&ei=eVFwT7TiLNH5ggfbl8xr&zoom=1&iact=hc&vpx=612&vpy=321&dur=1043&hovh=216&hovw=233&tx=112&ty=120&sig=115924055748486242270&page=1&tbnh=132&tbnw=143&start=0&ndsp=20&ved=1t:429,r:10,s:0
What puts South Asians at What puts South Asians at higher Risk?higher Risk?
INTERHEART case-control study, 52 INTERHEART case-control study, 52 countries, all ethnic groups, including countries, all ethnic groups, including South AsiansSouth Asians– 9 risk factors account for >90% of the 9 risk factors account for >90% of the
population’s noticeable higher risk of MIpopulation’s noticeable higher risk of MI smokingsmoking, raised , raised apolipoprotein apolipoprotein
B/apolipoprotein A1 ratio (),B/apolipoprotein A1 ratio (), hypertensionhypertension, , diabetes mellitusdiabetes mellitus, , abdominal obesityabdominal obesity, and , and psychosocial stresspsychosocial stress
Physiological DifferencesPhysiological Differences PhenotypePhenotype
BiochemicalBiochemical
Differences in body Characteristics*Differences in body Characteristics*
Physiological Differences Physiological Differences Exp.Exp.
Arterial diameterArterial diameter Altered adipokine activity (leptin, Altered adipokine activity (leptin,
adiponectin)adiponectin)– Inflammation = biomarker of atherosclerosisInflammation = biomarker of atherosclerosis– Raji et al,Raji et al,
Adiponectin= improves insulin sensitivityAdiponectin= improves insulin sensitivitygoodgood Adiponectin levels lower in Asian Indians than in Adiponectin levels lower in Asian Indians than in
whiteswhitesincreased whole body insulin resistanceincreased whole body insulin resistance impaired fibrinolysis (process of preventing impaired fibrinolysis (process of preventing clots)clots)altered endothelial functionaltered endothelial function
AdipokinesAdipokinesinsulin resistanceinsulin resistance atherosclerosis atherosclerosis
Raji et al
Conditions to take note…Conditions to take note… Ischemic Heart DiseaseIschemic Heart Disease
StrokeStroke
Peripheral vascular diseasePeripheral vascular disease
StrokeStroke Adiponectin levels lower Adiponectin levels lower increased increased
whole body insulin resistancewhole body insulin resistance impaired fibrinolysis+ Arterial impaired fibrinolysis+ Arterial diameter= Increased number of diameter= Increased number of strokesstrokes
http://www.cadiresearch.org/?page_id=442
Peripheral vascular diseasePeripheral vascular disease What is PVD?What is PVD?
– Condition of blood vesselsCondition of blood vessels Leads to narrowing/hardening of arteriesLeads to narrowing/hardening of arteries Lower Limbs and feetLower Limbs and feet
– Caused by arthrosclerosisCaused by arthrosclerosis South Asians= increase in South Asians= increase in
atherosclerosisatherosclerosis
Ischemic Heart DiseaseIschemic Heart Disease Aka. Myocardial IschemiaAka. Myocardial Ischemia
– Heart muscle damage/inefficientHeart muscle damage/inefficient– Reduced blood supply to heartReduced blood supply to heart– Reduced blood flow=Reduced blood flow=ATHEROSCLEROSISATHEROSCLEROSIS– RisksRisks
Increases with ageIncreases with age SmokersSmokers DiabeticsDiabetics HPTHPT
BarriersBarriers What are some of the barriers to What are some of the barriers to
working with this population?working with this population?– LanguageLanguage– Culture and tradition Culture and tradition
tradition does not change over-nighttradition does not change over-night
RecapRecap– AdipokinesAdipokinesinsulin resistanceinsulin resistance
atherosclerosisatherosclerosis– Insulin resistanceInsulin resistance diminished diminished
adiponectin levelsadiponectin levels
Considerations for Considerations for Screening/DiagnosticsScreening/Diagnostics
What do physicians need to consider?What do physicians need to consider?– Aware of prevalence of metabolic syndrome Aware of prevalence of metabolic syndrome
and glucose intolerance in South Asiansand glucose intolerance in South Asians– ScreenScreen
waist circumference and waist-hip ratio, rather waist circumference and waist-hip ratio, rather than BMI.than BMI.
Assessment of fasting glucose and a complete Assessment of fasting glucose and a complete lipid profilelipid profile
a strong family history of diabetes, or impaired a strong family history of diabetes, or impaired fasting glucose, an OGTT should be consideredfasting glucose, an OGTT should be considered
TreatmentTreatment no evidence to suggest that treatment no evidence to suggest that treatment
targets should differ between ethnic targets should differ between ethnic groups.groups.– Exercise*Exercise*– Diet changeDiet change– Stress level changes…Stress level changes…
Not enough studies with regards to Not enough studies with regards to different responses to pharmaceuticsdifferent responses to pharmaceutics
Example Exercise programExample Exercise program Start slowly with aerobics (3 x 30 min Start slowly with aerobics (3 x 30 min
with 10 min warm-up and cool down)with 10 min warm-up and cool down)– Walking, swimmingWalking, swimming– Cycling for most obese, not as hard on Cycling for most obese, not as hard on
jointsjoints Strength trainingStrength training
– Lighter weights higher repsLighter weights higher reps– ContinuousContinuous– Breath, no max liftsBreath, no max lifts
Barriers to ExerciseBarriers to Exercise DietDiet HR?HR?
– Beta blockers (HPT)Beta blockers (HPT)– RPERPE– Beware starting BPBeware starting BP– Strenuous= atherosclerosisStrenuous= atherosclerosis
BMIBMI
Work CitedWork CitedBrookes, Linda (2004).Brookes, Linda (2004). INTERHEART: A Global Case-Control Study of Risk Factors for Acute Myocardial Infarction. Lancet.
Retrieved from http://www.medscape.com/viewarticle/489738.
Gulshinder, Chattha (2010). Top Ten Risks of the South Asian Diet. Retrieved from http://www.desiblitz.com/content/top-10-Gulshinder, Chattha (2010). Top Ten Risks of the South Asian Diet. Retrieved from http://www.desiblitz.com/content/top-10-risks-of-the-south-asian-dietrisks-of-the-south-asian-diet
Gupta, Milan., Singh, Narendra., Verma, Subodh (2006Gupta, Milan., Singh, Narendra., Verma, Subodh (2006). South Asians and Cardiovascular Risk What Clinicians Should Know. ). South Asians and Cardiovascular Risk What Clinicians Should Know. Circulation. 2006; 113: e924-e929. Retrieved from http://circ.ahajournals.org/content/113/25/e924.full#F2Circulation. 2006; 113: e924-e929. Retrieved from http://circ.ahajournals.org/content/113/25/e924.full#F2
n.a (2012). n.a (2012). Peripheral Artery DiseasePeripheral Artery Disease. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm
n.a (2012). Stroke In South Asians. Coronary Artery Disease in Asian Indians. Retrieved from http://www.cadiresearch.org/?n.a (2012). Stroke In South Asians. Coronary Artery Disease in Asian Indians. Retrieved from http://www.cadiresearch.org/?page_id=442page_id=442
Patel, Kiran C R (2004). The Epidemic of Coronary Heart Disease in South Asian Populations: Causes and ConsequencesThe Epidemic of Coronary Heart Disease in South Asian Populations: Causes and Consequences ; First ; First Edition. Retrieved from Edition. Retrieved from http://sahf.org.uk/uploads/docs/files/21.pdfhttp://sahf.org.uk/uploads/docs/files/21.pdf
Raji A, Gerhard-Herman MD, Warren M, Silverman SG, Raptopoulos V, Mantzoros CS, Simonson DC. Insulin resistance and 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 vascular dysfunction in nondiabetic Asian Indians. J Clin Endocrinol Metab. 2004; 89: 3965–3972. Retrieved from http://jcem.endojournals.org/content/89/8/3965.abstract?http://jcem.endojournals.org/content/89/8/3965.abstract?ijkey=8fee1377e4f0b42365c1c2632ff1181012bef892&keytype2=tf_ipsecsha.ijkey=8fee1377e4f0b42365c1c2632ff1181012bef892&keytype2=tf_ipsecsha.