FAQs - Diabetes Prevention & Optimizing Heart Health
Coronary Artery Disease (CAD) and Diabetes Mellitus (DM) are global epidemics among people of South Asian descent, including Indians. These chronic diseases strike Indians at a younger age, and more severely than any other ethnic group. This, despite many being lifelong vegetarians who do not smoke and are not overweight.
Coronary artery disease (CAD), also known as atherosclerotic heart disease, atherosclerotic cardiovascular disease, coronary heart disease, or ischemic heart disease (IHD), is the most common type of heart disease and the cause of heart attacks. This disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.
Diabetes mellitus (DM), also known simply as diabetes, is a group of metabolic diseases that result in high blood sugar levels over a prolonged period. This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. Type 1 DM results from the body's failure to produce enough insulin. Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. Gestational diabetes occurs when pregnant women without a previous history of diabetes develop a high blood glucose level.
Indians bear 60% of the world’s heart disease burden, despite being only 17% of the world's population. Indians experience heart disease at rates at least two times higher, and diabetes at four times higher rates than any other nationality or ethnic group. Globally, 10-12% of the South Asian population in urban areas and 4-6% in rural areas is afflicted with heart disease. South Asian women also have one of the highest mortality rates due to CAD.
Traditional risk factors fail to fully explain the increased and early presentation of heart attacks in Indians. Indians don't have a higher incidence of obesity or high blood pressure. They don't usually smoke. Nearly half are lifelong vegetarians. But there are some genetic and lifestyle-related risk factors that come into play. Indians suffer from diabetes and poor cholesterol ratios at a younger age. Their laboratory results often demonstrate higher levels of emerging risk factors such as: elevated atherogenic small dense lipoprotein particles (LDL), reduced large protective high-density lipoprotein (HDL) particles, higher Lipoprotein(a), inflammatory markers and insulin and glucose abnormalities. The traditional Indian or desi diet is deficient in vegetables and high in simple carbohydrates, added sugars, salt, and saturated fats. Modern life tends to be high-stress, and many South Asians don't make time for regular exercise, adequate rest, and stress reduction. Genetics set the stage for heart disease in Indians, but it is lifestyle that brings the curtain down on far too many people, far too young.
Family history is very important. For instance, your level of Lipoprotein(a) or Lp(a), and the size and pattern of LDL cholesterol particles are genetically determined. Plus, your own risk of heart attack is doubled if your father had a heart attack before the age of 55, or your mother, before the age of 65.
Studying the medical histories of your parents and siblings can help us predict your risk for heart attack and diabetes. Diabetes is an epidemic among Indians. By 2030, Indians will bear 50% of the global burden of diabetes. Even though there may be a genetic predisposition for these chronic conditions, there is mounting evidence that this increased risk can be successfully mitigated by lifestyle interventions.
Heart attacks happen when blood flow to a part of the heart is totally obstructed. There are different causes of a heart attack, also known as a myocardial infarction or MI. The most common cause of a heart attack is coronary atherosclerosis; or the build-up of plaque due to inflammation in the arterial wall. This can be caused by high blood pressure, diabetes, tobacco use, abnormal cholesterol, or genetic predisposition. A healthy artery has endothelial cells that produce substances that keep blood from clotting. Plaque disrupts these cells and causes them to fail. At the same time, the plaque narrows the arteries so that less blood can get through. This is a recipe for clot formation. When a clot does form, it slows and eventually stops the flow of blood to the heart, causing the heart attack. The longer the heart is deprived of blood, and therefore, oxygen, the greater the chance of damage to the heart muscle.
A much less common cause of heart attack is a coronary artery spasm, which refers to a sudden, severe constriction of a coronary artery that blocks blood flow. This can happen even in an artery that has no plaque build-up. Cigarette smoking, exposure to extreme cold, emotional stress and street drugs such as cocaine and methamphetamines can all lead to this type of heart attack.
An ounce of prevention is worth a pound of cure. According to a recent World Health Organization study, 80 percent of heart attacks are preventable with the right lifestyle modifications. Coronary artery disease is a disease of lifestyle and can be managed, and even reversed, if there is a commitment to a good, regular daily routine. Unfortunately, many people don't know they're at risk until it's too late. Or they're misinformed and think that after starting medications, having a bypass operation, or a stent implanted, they are out of danger. Unfortunately, this is not true. Medical interventions like medication, bypass surgery, or stent placement are not guaranteed to prevent further damage to the arterial wall. Better outcomes are likely for those who commit to a good, all-inclusive medical regimen, with special attention to a healthy, regular routine.
The need to take medication to help prevent a first heart attack depends on the severity of your risk factors, your capacity to modify them with lifestyle and the presence or absence of atherosclerosis. Medications are mandatory for individuals with known coronary artery disease, and they enhance the benefits of a healthy lifestyle program. Statins, aspirin and beta blockers are the most commonly prescribed medications for patients at risk. Statins lower cholesterol levels in the blood and they are of benefit even if your cholesterol level is normal, while beta blockers help prevent angina, treat high blood pressure, and enhance longevity. Your physician may advise you to take aspirin regularly to inhibit clot formation. Both statins and aspirin independently have been shown to prevent heart attack in about 30 percent of patients at risk. Medications are an important aspect of prevention, but they do not take away the need for a healthy, regular routine.
• Chest discomfort or pain: This discomfort or pain can feel like a tight ache, pressure, fullness or squeezing in your chest lasting more than a few minutes. This discomfort may come and go.
• Upper body pain: Pain or discomfort may spread beyond your chest to your shoulders, arms, back, neck, teeth or jaw. You may have upper body pain with no chest discomfort.
• Stomach pain: Pain may extend downward into your abdominal area and may feel like heartburn.
• Shortness of breath: You may pant for breath or try to take in deep breaths. This often occurs before you develop chest discomfort, or you may not experience any chest discomfort.
• Anxiety: You may feel a sense of doom or feel as if you're having a panic attack for no apparent reason.
• Light-headedness: In addition to chest pressure, you may feel dizzy or feel like you might pass out.
• Sweating: You may suddenly break into a sweat with cold, clammy skin.
• Nausea and vomiting: You may feel sick to your stomach or vomit.
• Most heart attacks begin with subtle symptoms — with only discomfort that often is not described as pain. The chest discomfort may come and go. Don't be tempted to downplay your symptoms or brush them off as indigestion or anxiety.
• Women may have all, none, many or a few of the typical heart attack symptoms. While some type of pain, pressure or discomfort in the chest is still a common symptom of a heart attack in women, many women have heart attack symptoms without chest pain, such as:
• Pain in the back, shoulders or jaw
• Shortness of breath
• Abdominal pain or "heartburn"
• Nausea or vomiting
• Unusual or unexplained fatigue, possibly for days
• The elderly and diabetics may have no or very mild symptoms of a heart attack, so it's especially important not to dismiss heart attack symptoms in people with diabetes and older adults even if they don't seem serious.
You may be at risk for a heart attack despite showing no recognizable symptoms. When symptoms appear, it may already be too late. Screening is the first step in preventing chronic disease. Screening also identifies potential risk, not typically detected at an annual physical.
Being young is not cardio protective enough for South Asians, as is demonstrated in several studies in global urban and rural South Asian populations. 25% of heart attacks occur in those younger than 40 years, and 50% in those less than 55 years. By comparison, the typical age for the first heart attack in the general population is 65 years for men, and 70 years for women. Early detection is critical to prevention. We recommend that Indians start getting screened at the age of 18.
Being premenopausal is not sufficiently cardioprotective for Indian women who have one of the highest mortality rates due to CAD. Since prevention is better than cure, young Indian women should identify their risks by signing up for advanced screening. Also, as their family’s health officers, women should be leaders and embrace prevention; the rest of their family is bound to follow and benefit from adopting healthier lifestyles.
Maybe so. But ignorance is not bliss, and you should do it for the sake of your children. Knowing your risk factors and managing them with lifestyle and other interventions could result in better quality of life and longevity.
Several global studies illustrate the benefits of good lifestyle behaviours and the disease consequences of poor lifestyle. These include Meditation, Exercise, Diet and Sleep, and these therapeutic components are most relevant for risk reduction in Indians and are, therefore, the key offering in our programs.
Lifestyle modifications involving diet, exercise and stress reduction have been shown to improve longevity and reduce risk for chronic disease. Throughout our programs we provide expert counselling focused on personalized lifestyle changes. We know that lifestyle changes are easier said than done. That is the reason why our lifestyle coaches help participants make and sustain lifestyle habits.
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