The Hidden Risk for Heart Attack in Indians.

Most people are aware of the well known risk factors for Coronary artery disease which leads to heart attack. Some risk factors like increasing age, male sex and hereditary factors including race and family history are unchangeable. Risk from factors like smoking, high blood pressure, diabetes, high cholesterol, obesity, inactivity and stress can be reduced through life style changes and treatment.
Most Indians on the routine screening have total cholesterol in the normal range. Recent studies on Indians from different parts of the world have shown that these people who have normal total cholesterol can still have a high risk. This is because the cholesterol abnormality that is often found in Indians is not the elevation of the total cholesterol, but the decrease in the amount of “Good” cholesterol HDL which has a protective action and the increase in “Bad” cholesterol LDL and high triglycerides. This was also seen in the Indians living in Kuwait at a screening camp conducted at the Al Dhamer Center for Medical Specialties (ACFMS), Jahra recently. Of the 76 Indians screened only 18 had high total cholesterol. However 43 had high LDL (Bad cholesterol) , 45 had low HDL (Good Cholesterol) and 41 had high triglycerides making them more prone for coronary heat disease and other blood vessel related diseases.
Dr. Noble Zachariah, chief physician of ACFMS cautions his fellow Indians that those with other risk factors like family history, high blood pressure, diabetes or prediabetes etc. should not be complacent with a normal reading of total cholesterol. They should get a lipid profile done and if LDL is high or HDL is low, should take remedial measures. LDL lowering is achievable without much difficulty with diet and medications. Elevating the HDL is more difficult. Exercise, smoking cessation, diet rich in mono unsaturated fatty acids (Olive oil, canola oil, Almonds, peanut butter etc) increase HDL. Studies in the west have shown that HDL level in people who consume alcohol in small amounts is higher, but recommending it as a means of raising HDL is controversial and definitely not recommended here. Consuming more than one or two drinks is harmful and can lead to heart and liver diseases. Medicines are not as successful in raising HDL as they are in lowering LDL and only small raises of 5 – 10 % are obtained with statins the popular cholesterol medicine. Niacin in high doses raises HDL but is often associated with unpleasant side effects and can worsen blood sugar control in diabetics. Torcetrapib, a novel cholesteryl ester transfer protein (CETP) inhibitor either by itself or in combination with atorvastatin has been shown to increase HDL significantly. This drug is not available in Kuwait.
5 diabetics, 16 prediabetics and 9 people with high blood pressure were also detected at this free screening camp conducted as a good will gesture on the Indian Republic Day. Of the 11 persons with chronic cough, 7 were detected to have asthma through lung function test. It is known that longevity is decreased in persons with low FEV1 which is one of the abnormal findings in asthma. So it was a very useful opportunity for the attendees to detect these dangerous but silent diseases which produce serious complications if not detected and controlled early.
Dr. Abdulla Al Dhamer, the director and CEO of ACFMS was overwhelmed by the results and has promised to co-operate with the Indian social organisations in conducting similar free medical camps in the future. He also offered to give heavy discounts for the further investigations and management of the patients attending these medical camps as most were either middle class or economically weak.