Mass. doctors combat 'devastating' trend of heart disease in South Asian patients 

Dr. Sarju Ganatra, a cardiologist at Lahey Hospital and Medical Center, has noticed a trend among the patients who arrive at the hospital with unexpected heart problems: A disproportionate number of them are South Asian.

“It's not unusual for us, unfortunately, to see a young, relatively healthy person of South Asian origin come to our critical care unit with a cardiac arrest,” he said, which can be fatal.

South Asians are twice as likely to get heart disease as people of European ancestry. And they’re more likely to die of problems such as heart attacks at younger ages.

“These numbers are enormous when we think about it at a population level,” Ganatra said, “but also devastating for individual patients.”

Ganatra and a wave of South Asian doctors across the country, motivated by their patients — as well as their own families and friends — are working to better understand and prevent heart disease in South Asians.

Last year, Ganatra launched the South Asian Cardio-Metabolic Program at Lahey, one of just a few programs in the country designed specifically for people whose families originate from India, Pakistan, Bangladesh and other South Asian countries.

Doctors believe a combination of lifestyle and genetic factors put South Asians at higher risk of heart disease, as well as related conditions such as diabetes and stroke. But these risks often go unnoticed.

Ganatra said routine blood tests can miss important clues, such as elevated lipoprotein (a), a type of fat linked to heart disease. He often orders additional blood tests or imaging studies to get a better picture of what’s happening inside his patients’ arteries, and determine if they need to make lifestyle changes, or add cholesterol-reducing medications such as statins.

“If we don't identify the risk properly, we can't prevent it properly,” Ganatra said.

Ganatra and other doctors who work in programs designed for South Asian patients say they keep their patients’ culture and lifestyle top of mind. During appointments, they often speak in South Asian languages, such as Hindi, to help patients feel comfortable.

“We try to not just prescribe them, ‘This is what you need to do,’ ” Ganatra said. “We try to understand where they're coming from, what their beliefs are, and try to incorporate that into our suggestions.”

Pushpir Bhetia, the 52-year-old chef and owner of an Indian restaurant in Cambridge, was one of the first patients to book an appointment at Lahey’s South Asian program. Bhetia loves good food, from traditional Indian dishes to pizza and sandwiches. But he said he tries to eat healthy and exercise — because like a lot of South Asian people, heart disease runs in his family.

So Bhetia booked an appointment with Ganatra and told the doctor what was on his mind.

“My father passed away with a cardiac arrest,” Bhetia said. “And my dad’s older brother also passed away with a cardiac arrest. So that's why I thought it's better that I should do this preventive care thing.”

Bhetia described his typical meals — chicken, rice, salad — and nodded as the doctor suggested intermittent fasting as a strategy for keeping his weight and cholesterol in check.

In an interview months later, Bhetia said fasting often feels impossible because his work as a chef requires him to taste food before serving it to others. But he said he goes for a daily walk and remains mindful of his diet.

“My daughters,” Bhetia said, “they say, ‘Dad, make sure you do good. We want you to be around as much as possible.’ ”

South Asian diets tend to be high in carbohydrates and fat — think deep-fried samosas, creamy sauces, lots of rice and breads. Doctors say these diets play an important role in people’s health risks.

Dr. Jaideep Patel, a cardiologist who works with South Asian patients in the Johns Hopkins hospital system in Maryland, said he recommends healthier methods of cooking.

“It's more about how you prepare — so not necessarily frying, maybe you're steaming, maybe you're pressure-cooking,” he said.

“The other big thing is portion control,” Patel said, noting there is sometimes a belief in South Asian households that eating in excess is necessary to grow strong.

Dr. Yamini Levitzky, who leads the South Asian Heart Health and Nutrition Program at Newton-Wellesley Hospital, said her colleagues tailor their recommendations to the foods patients are used to eating at home. This includes what kind of flour to buy at the Indian grocery store to make healthier breads, such as chapati or roti.

Levitzky noted that South Asians are more likely to develop conditions like diabetes at lower weights than white patients. Studies also show South Asians tend to accumulate body fat around the liver and abdominal area, which is associated with higher risk for heart disease.

“Everybody has a friend or family member that has some form of cardiovascular disease, so I think it's very much at the forefront of this community's mind,” Levitzky said. “It doesn't take a lot of convincing to say, ‘Hey, let's just take a deeper dive into your risk factors and see what we can improve on.’ ”

Exercise is another key component of staying healthy, but developing regular exercise habits can be challenging, especially for people who grew up in South Asian homes where exercise was a low priority — considered a luxury rather than a critical aspect of health.

“What I tell people is that some movement is better than no movement,” Levitzky said. “Very often we get sucked into this concept of, ‘Well, if I don't have 45 minutes or an hour to go to the gym, I'm just not going to do anything.’ I think we need to change that mindset. Going for a five-minute walk or 10-minute walk after dinner counts. Every bit counts.”

Dr. Namratha Kandula, a primary care physician and researcher at Northwestern University Feinberg School of Medicine who studies heart disease in South Asians, said gender norms may also play a role in exercise habits for some families.

It’s important to ask, Kandula said: “Is it normal for a woman to be doing exercise outside of the home? Are women given the time and the space and the support to do that? Do they have the role models to do that?”

South Asians make up a quarter of the global population and represent millions of people in the United States, but they’re often lumped into an even larger group: Asians. South Asians are also underrepresented in medical research — though that is starting to shift.

Researchers in Boston are working with colleagues at Stanford and Yale to enroll patients in a national study of the genetic factors that make South Asians more likely to develop heart disease. Dr. Pradeep Natarajan, director of preventive cardiology at Massachusetts General Hospital, who is co-leading the study, said there is a lack of good data on South Asians.

“I've always been interested in trying to understand: Why are the South Asians coming to me in clinic at high risk for cardiovascular disease?” said Natarajan, who is also an associate member of the Broad Institute of MIT and Harvard. “We have not had the substantive data sets to really study this. We've now recognized we actually have to create those data sets.”

Natarajan said he’s hopeful this research could lead to new treatments not just for the many South Asian people who might benefit, but for anyone at risk of heart disease.

“We might find actually unique genes … that might be particularly relevant,” he said. “It won't explain all of it, but it'll begin to unpack really critical and important reasons.”