Answers are still being hunted, but the reality of early heart disease in South Asians is undeniable. At the Stanford South Asian Translational Heart Institute, specialists are determined to provide life-saving outreach, writes Rajesh Dash, MD, PhD
Years before I became a cardiologist, I received my introduction to a medical phenomenon that would become as personal as it is professional. I was 12, on a family vacation to Florida, when my mother got a phone call. Her brother, not yet 50, had had a massive heart attack and died.
I was too young to have any sense of why that might have happened; what I knew was that my cousins would grow up without a father. The possibility of early death from a heart condition, however, became part of my consciousness.
Years later, the mechanisms of cardiovascular disease were at the center of my education as a physician. By then, I was driven to understand and heal not just by the death of my uncle, but also by several subsequent deaths in my family from heart-related issues. And the most alarming reality was a lack of knowledge and awareness of numbers that make the problem very frightening:
South Asians have are four times more likely to develop heart disease than any other ethnic group.
More than half the heart attacks experienced by South Asians occur before the age of 50; one in four of those heart attacks happens before age 25. By 2020, South Asians will represent 25% of the world’s population—and suffer more than 50% of all cardiovascular deaths.
When they do have a heart attack, South Asians are 30 % to 40 % more likely to die from that heart attack than the average population.
All of us have families — and almost everyone you talk to, has lost someone. There is still much we do not know about why this happens. We are working to find answers to several important questions. In the meantime, a group of doctors here at Stanford decided to establish a clinic where families would have access to the remarkable resources.
In addition to the most advanced evaluation and treatment, we want that clinic — the Stanford South Asian Translational Heart Institute (SSATHI) — to become a center for research that will change that landscape of elevated risk and mortality to one where we can more precisely predict an individual’s risk, catch disease earlier and refine treatments. To do that, we need more information. At Stanford, we will ask patients to let us bank their DNA to create a biobank we believe will reveal some of the mysteries of heart disease in South Asians. We want to create the largest biobank possible, so we are reaching out to our fellow specialists here in the Bay Area and to medical centers in India, Nepal and other South Asian countries. The problem is not just local — it is global.
While that broader reach may take some time, we are taking assertive steps to treat certain health conditions well known to increase the overall risk for cardiovascular disease. Diabetes, for example, is a risk factor that you might call a low hanging fruit. We know how to treat it and how to manage it over time. Although we don’t yet know how well those standard treatments will work for our South Asian heart patients, we suspect it will have an impact. Insulin resistance, a major factor in the development of diabetes, is quite common in the South Asian demographic. We have a special project devoted to exploring the relationship between insulin resistance, diabetes and cardiovascular disease.
We also commend the work done by our colleagues at the South Asian Heart Center at El Camino Hospital in Mountain View, PRANA at PAMF, and the UCSF team that studied 150 Asian Indian heart patients for almost three years. We look forward to working with them and other interested colleagues around the world.
Until we understand more about the reasons behind cardiovascular disease in South Asians, we will follow the philosophy inherent in our program’s name: In many South Asian languages, the word ‘sathi’ translates to ‘companion’. Our goal is to be such a companion to our patients as we help them understand, manage and prevent cardiovascular disease. We have quite a large community of South Asians in the Bay Area — about 300,000 — and we would very much like to help them understand their individual cardiovascular risk. It is one thing to know that adults in this community are at risk, but we are especially eager to identify and treat children who may already be showing clinical indications of heart disease. Indeed, we have already identified children whose risk biomarkers are double the upper limits of normal.
One of Stanford’s particular strengths is in genomic sequencing and an association of genetic variation to disease risk. We plan to offer such sequencing to our patients as part of our research. Most of our research programs will be additional to our clinical evaluations and will be supported by Stanford Hospital and grant funding, so no one will be deterred by cost from determining their risk.
Interested readers can contact SSATHI to be seen as a patient or for more information via email at firstname.lastname@example.org, or on the Web at Stanford South Asian Translational Heart Initiative. To make an appointment directly, please call (650) 723-6459.