The Brown Heart

Early onset and severe heart disease disproportionately affect South Asian communities worldwide. Heart disease is the leading cause of death among South Asians, but awareness and preventative measures often remain insufficient.

Why do genetic predisposition and specific lifestyle factors put brown hearts at risk at a rate 2 to 4 times higher than other populations? Find out how to take care of your heart health!!

Heart Disease Statistics

  • South Asians account for approximately 25% of the world’s population but carry 60% of the global burden of heart disease.
  • The incidence of heart disease is 2 to 3 times more common in India, and up to 4 times more common in countries like Bangladesh, compared to Caucasian counterparts.
  • Heart disease onset occurs at least 10 years earlier than in Western populations.
  • 50% of heart attacks among South Asians occur in individuals under 50 years old.

Unique Physical and Genetic Factors

  • South Asians have a genetic predisposition to developing heart disease at birth.
  • Indians are uniquely susceptible to putting on visceral fat—the deep fat inside the belly, which is the root cause of many chronic diseases like diabetes and high blood pressure.
  • This phenomenon, called apple-shaped obesity (fat above the waistline), is considered terrible from a cardio-metabolic standpoint.
  • A specific type of lipoprotein called LP little A (Lp(a)) is disproportionately found in South Asians, with some studies showing high levels in over 25% of individuals, serving as an independent risk factor for heart disease.

Dietary Factors (The “Quadruple Threat”)

The Indian vegetarian diet, often mistakenly assumed to protect against heart disease, can carry a similar risk as non-vegetarian diets due to specific structural problems:

  1. High Carbohydrate Content: 60% to 80% of the Indian diet often consists of high-carb sources like white rice and maida.
  2. Trans Fat from Deep Frying: The common practice of deep-frying foods (e.g., samosas, jalebi) produces trans fat, which directly causes inflammation of the heart arteries. For instance, a jalebi can contain 17% trans fat, far exceeding the recommended daily maximum of less than 1%.
  3. Low Protein Intake: There is a relative deficit of protein, especially in vegetarian sources, which prevents muscle building and contributes to higher fat mass.
  4. High Saturated Fat: Traditional cooking often uses oils that are solid at room temperature, such as ghee, coconut oil, and butter, which are high in saturated fat and increase heart disease risk.

Lifestyle Challenges

  • Indians have some of the lowest exercise rates in the world.
  • Stress, Sleep, and Smoking (the “three S’s”) are significant risk factors. Psychosocial stress is the only factor correlating with chromosomal changes causing heart attacks in young people (ages 20 to 35) who had no other risk factors.

It’s also a Woman’s Disease

  • Heart disease is not just a “man’s disease”; the death rate from heart disease in women is 10 times higher than that from breast cancer.
  • The protective benefit of estrogen is “stripped away” if women have conditions like gestational diabetes, obesity, diabetes, or high cholesterol, leading to heart disease rates similar to men, even before menopause.
  • Post-menopause (which can occur as early as 40 to 50), women’s heart disease rates match those of men.
  • Menopause commonly leads to an increase of LDL cholesterol (10 to 60 points) and a weight gain of 10 to 20 pounds, often concentrated around the belly.

Preventative Measures

Preventative efforts are particularly effective because, despite the higher genetic risk, following a healthy lifestyle can reduce the risk to almost the level of those born with a low genetic risk.

Screening and Diagnostic Recommendations

Because of the extraordinarily high incidence of heart disease, South Asians should begin specific screenings earlier than typically recommended in Western communities (around age 35–40):

  • LDL Target: South Asians should aim to keep their LDL cholesterol less than 100 (even if a physician considers 130 “okay” for the general population).
  • Coronary Artery Calcium (CAC) Score: Recommended early on to assess the presence of disease.
  • LP (a) Test: Recommended early on due to the high prevalence of this independent risk factor in the community.

Dietary Changes

Dietary recommendations focus heavily on replacing high-risk traditional habits:

  • Saturated Fat Replacement: Use cooking oils that are liquid at room temperature (e.g., canola oil, avocado oil, vegetable oil, or olive oil). Olive oil is cited as the most heart-healthy oil.
  • Avoid High Saturated Fats: Purely from a cardiac health standpoint, ghee, coconut oil, and butter are not recommended as cooking oils. Ghee consumption should be limited to less than one-half teaspoon per day.
  • Protein Focus: Increase protein intake to a minimum of 50 grams, and ideally 70 to 100 grams daily, to increase muscle mass and lower visceral fat. Vegetarians should focus on sources like dal, tofu, and chana. Protein supplements are acceptable and sometimes recommended to meet these needs.
  • Carbohydrate Reduction: Substitute high-glycemic carbs like white rice with alternatives such as brown rice or quinoa.
  • Avoid Sugary Beverages: Simple sugar drinks (sodas, fruit juices) increase inflammation and should be replaced with whole fruits.
  • Plate & Portion: Structure meals so that approximately half the plate is non-starchy vegetables, a quarter is protein, and a quarter is grains.
  • Frying Safety: If frying is necessary, do not reuse the oil to prevent trans fat formation.

Exercise and Lifestyle Adjustments

  • BMI Goal: South Asians should strive to maintain a lower Body Mass Index (BMI) of less than 23 (compared to 25 for others).
  • Aerobic Exercise: While yoga is beneficial and encouraged, it is not a substitute for aerobic exercise.
  • Strength Training: Simple weight training, even starting light, is important at any age, particularly after 60, to increase muscle mass, lower visceral fat, and prevent falls.
  • Consistent Movement: Any movement is better than none; for example, taking a walk after a meal.
  • Stress Mitigation: Strategies include meditation (5 to 10 minutes daily) to lower cortisol levels, and ensuring eight hours of sleep by cutting off devices in the evening.

Women’s Health Specific Preventive Measures

  • Women must proactively address their heart health.
  • Preventing gestational diabetes is critical, as it is believed to be the starting point (“seed”) of heart disease risk.
  • For women going through early menopause (40 to 50), Hormone Replacement Therapy (HRT) is recommended for 5 to 10 years, provided they discuss it with their doctor and undergo necessary screenings (mammogram, Pap smear).

Meera Kymal, India Currents’ Managing Editor, was in conversation with Dr. Nirmal Joshi and Dr. Renu Joshi, who offered insights on why South Asians across the world are disproportionately affected by severe heart disease. Their new documentary, The Brown Heart, observes heart disease trends within South Asian populations and raises awareness to drive change in how South Asian communities approach heart health.
Watch the full episode here:

YouTube video

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