QUESTION 1 OBSTRUCTIVE SLEEN APNEA -OSA (Asim Sidiqui)

Is there a correlation between undiagnosed obstructive sleep apnea and adverse cardiac outcomes in South Asians at a rate higher than other ethnicities? Is there any research in this space? Hyperlipedemia seems to be the focus of attention, and perhaps rightly so, but curious aboth OSA as a comorbidity.

ANSWER

1.⁠ ⁠Does OSA contribute to heart disease? Absolutely yes. It is an important risk factor (although associated with several confounders such as high BMI and other co-morbidities)….However direct mechanisms contribute to a high risk of ischemic heart disease among people with OSA: 

a) Each episode of apnea leads to adrenergic hormone release which increases BP and has direct adverse effects on blood vessels (inflammation similar to that caused by inflammatory foods etc)

b) OSA can cause direct disruption in cardiac function by changing normal fluctuations in HR and BP

2.⁠ ⁠Does OSA happen more often in South Asians (unrelated to confounders) is a more open question with conflicting studies from the US and UK, some showing an increased incidence and others refuting such an increased incidence.

QUESTION 2 SUDDEN CARDIAC DEATH IN SOUTH ASIANS (Hiroo Sharma)

I had a question about cardiac arrest attack ( not sure using  rights words). Does the body gives some indication of tiredness or any other symptoms so one can be alert of ??

ANSWER

This is a wonderful Question and an extremely important one. Framed in a simpler way: Are there ANY warning signs of SUDDEN CARDIAC DEATH? Sadly, the answer is no at this time. By it’s very nature SUDDEN implies that there is sudden and unexpected collapse (often from a massive heart attack or a related arrhythmia)…All that being said, ALL South Asians should be hyper-vigilant of the risks of silent cardiac disease and the FIRST steThis is a wonderful Question and an extremely important one. Framed in a simpler way: Are there ANY warning signs of SUDDEN CARDIAC DEATH? Sadly, the answer is no at this time. By it’s very nature SUDDEN implies that there is sudden and unexpected collapse (often from a massive heart attack or a related arrhythmia)…All that being said, ALL South Asians should be hyper-vigilant of the risks of silent cardiac disease and the FIRST step in that direction should be KNOW YOURSELF!!! (BMI, Waist Circ, LDL, Lpa, CAC score etc.)!!!

QUESTION 3 HEART DISEASE AND COVID (from Harsh Sharma)

Sir what is the cause of cardiac arrests in India specially post covid.

ANSWER

Great question Harsh! Researched this extensively during our documentary , including detailed conversations with Dr. Prabhakaran Dorairaj (head of CCDC in India)……Overall the following conclusion: There was a definite increase in cardiac mortality from the direct inflammatory effects of Covid 19. However, the high risk of cardiac pathology in South Asians has a much more complex and nuanced origin (with multiple genetic and environmental life style contributions).

QUESTION 4: BLUE ZONES (from Pankaj Agarwal)

Not sure if this can be included in this discussion, but I am very curious to learn how people in blue zones live so much longer disease free. Is it food, life style?? Can any of their practices be adopted into our south East Asian life?

ANSWER:

Great Q. Detailed convo around this will be beyond the scope of this forum, but VERY thought provoking counter-arguments (and true scientific criticism) about the data from Blue Zones research is worth mentioning.  

https://jheor.org/post/2682-ig-nobel-prize-winning-research-longevity-claims-may-reflect-lousy-birth-and-death-recordkeeping-more-than-accurate-human-lifespans

Related NY Times article

https://www.nytimes.com/2024/10/24/well/live/blue-zones-longevity-aging.html?unlocked_article_code=1.bE8.WDxs.r8MD23XXktSG&smid=url-share

QUESTION 5 :WALNUTS AND HDL (Umesh)

Walnuts can increase HDL?

ANSWER:

OVERALL, 10-12 nuts a day are recommended daily. Studies are mixed, but one study showed a 6.3% increase in HDL using 30 grams walnuts daily (which is 10 whole walnuts). By way of context, if your HDL is 35, this means a 2 point increase in HDL only.

QUESTION 6: CAC SCORE-NEED FOR PRESCRIPTION? (Vini)

 Do we require a referral from our PCP to get a CAC scan done? 

ANSWER:

 Yes in the US. Costs around $100 (most insurances do not cover), In India costs around 3-4 thousand rupees

QUESTION 7: MENOPAUSE AND LDL (Vini)

ANSWER:

Hi Vini , thank you for a great question. This is the story of my life and has been very well addressed in the documentary. There’s clear evidence from multiple studies ( SWAN  and others that there is an increase in LDL and apo Lipo protein B right around peri  menopause, and after menopause. This is attributed to a decrease in estrogen which improves the LDL clearance from the liver. It is also attributed to an average of 10 to 15 pound weight gain primarily visceral around the abdomen, which is associated with high LDL.

QUESTION 8: IMPROVING LDL AND HDL (Jyotsna)

Is it important to focus on LDL rather than HDL ? How to improve HDL ?

ANSWER:

Out of the two big culprits LDL is the better one to focus on because you can easily improve it with medications and diet .Even with aggressive diet control you can improve the LDL by 20 to 30% .HDL is usually low in south Asians and is very hard to increase and only aggressive exercise can increase HDL. Some medications may increase a bit (such as Niacin) but have side effects. Walnuts may increase slightly as well