Premature Heart Attack In Young Individual of Southeast Asian Origin

A 33 years old Indian man with heart attack. Proximal left anterior descending (LAD) artery with 99% stenosis that caused  su

I was motivated to write this blog with a recent experience of a 33-year-old Indian male  who literally droped dead in a parking lot, requiring cardiopulmonary resuscitation to bring him back. Fortunately spontaneous circulation was achieved because of a very quick response by the emergency medical team and a bystander who knew cardiopulmonary resuscitation. He was taken to the Cath Lab and had nearly 100% blocked artery  that was opened using a baloon and a stent (angioplasty). Fortunately he survived with permanent damage to a  very small area of  his heart muscle.

Unfortunately people of Southeast Asian (Greater India) origin make up only 25% of the  human population but account for 60% of world's cardiovascular events, heart attack and strokes.

I  go back to India each year and work in the cathlab there for 3 days. During those 3 days I see at  least  one patient that is less than 30 yrs old  with a major heart attack (ST elevation Myocardial Infaction).  Over the last 16 years, the number of such cases are only on a rise due to westeriznation of lifestyle in India on top of their genetic predisposition.

It is common for people of southeast asian origin to ignore symptoms and not believe in seeking preventive care  prior to the risk factors causing permanent damage.  Indians  have atypical symptoms of coronary artery disease. Commonly described symptoms are feeling "gabhrahat" or "gabhraman", epigastric discomfort with a gassy feeling and uncomfortable burping.  Also a commonly described is that burping relieves the epigastric discomfort and the patient describes that once the gas is released they feel better.  Unfortunately these epigastric discomfort is commonly mistaken as gas trouble or acidity or stomach issue and they miss major or minor  heart attack without seeking care.

Unfortunately the dietary habit of  eating excessive salt, fried foods, high-calorie foods, late dinners,  higher content of dairy product, and lack of exercise are all  high risk factors. Familial dyslipidemia with low HDL, high triglyceride, high total cholesterol and high non-HDL cholesterol is very common trait. 

The prevalence of diabetes in black and Latino patient population is 16 and 17%, while the prevalence of diabetes in Southeast Asian population in the United States is 23%.  Unfortunately in the South East population diabetes is not  associated with obesity but a  genetic predisposition of insulin receptor resistance which makes them more vulnerable for extensive atherosclerotic changes (heart artery blockage formation process).

Recently The MASALA study (Mediators of atherosclerotic disesase in Southeast Asian population)  found that there is visceral fat around the organ in people of Southeast Asian origin.  This visceral fat around the organ leads to stress on the heart.  Which in turn leads to atherosclerotic changes and fat deposition in the arterial wall, the reason for early, premature,  severe presentation of atherosclerosis in this population.  Another hypothesis suggests that the  Southeast Asian population has smaller heart artery diameter in compared to their body mass index, which leads to premature and more extensive atherosclerotic changes in the heart arteries. 

It is important to see a cardiologist on a regular basis to ensure you do not have heart issues.  We have multiple tools in our armamentarium to detect patients vulnerable for premature heart attack and stroke and mitigate the risk factors by using adequate information, education, and if required medications. Commonly used tests are the lipid panel, CRP level, imaging study with coronary calcium scoring, exercise treadmill EKG test or exercise nuclear stress test. Every 6 months checking with your primary care physician for routine checkup and fasting lipid panel and HBA1c check can help detect the problmes early before damage is started. 

I encourage people reading my blog to spread this education.  Please motivate your family members and friends to take care of themselves so we can prevent young people suffering heart attach or sudden cardiac death.

No age is too young to have heart problem if you are from India, Srinlanka, Pakistan or Bangladesh.  Even the people of Guyana, Trinidad, Jamaican Indians, face the same risk of premature coronary artery disease, heart attack, stroke and suffering heart failure.

Prevention is always better than Cure!


Kintur Sanghvi MD FACC FSCAI Kintur Sanghvi MD FACC FSCAI Dr. Kintur Sanghvi has been intensely focused in learning, researching and teaching cardiovascular medicine since age 23. After practicing in a legendary academic teaching hospital for 11 years in NJ, acquiring experience of over 10,000 cardiovascular procedures; publishing multiple research articles, book chapters, and training over 100 cardiologist, he has decided to open NJ Heart & Vascular Care to provide: A personalized, compassionate and comprehensive care in all the areas of Cardiology, Interventional cardiology and Endovascular Medicine. He has been internationally acclaimed and has given talks as guest faculty in multiple countries across 5 continents. . With deep interest in problems solving, he has innovated and published multiple new procedures, techniques, and device solution and owns multiple patents. The Practice’s motto is: It is truly a privilege to provide cutting edge, evidence-based care to each patient, one at a time.

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