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Symptoms of HEART DISEASE in overweight INDIAN POPULATION.

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Hello Doctor,

Hi there,

I'm a 34 year old male, half Indian (South Asian), half Caucasian, who's been working to get healthier. I'm in good health generally, though I am overweight/obese (5'11' and <235 lbs...pants size is 40) and working to slim down and get in better shape, though success has been mixed. I'm also pre-hypertensive but working with my doctor on reducing that along with the weight to try to avoid full blown hypertension. My dad (also Indian) died of a heart attack in his early fifties; my mom (Caucasian) is 67 and doing well. I don't smoke, do drink (but try to keep it in moderation the majority of the time), and have a varied diet, including lots of fruits and veggies. I also take several supplements including a good multivitamin, high dose B Vitamins, extra Vitamin D (based on blood tests), ~2g fish OIL, aged garlic extract, CoQ10, phytosterols, hawthorn, hibiscus, and small amounts of several other compounds such as resveratrol, quercetin, ashwaghanda, reishi/cordycep mushroom, cayenne, etc. I had several questions related to my heritage and heart disease risk.

1.) I recently read that Indians/South Asians have a much higher risk of heart disease than most other races (some say three-fold or higher). Is this true? What effect does mixed (Indian/Caucasian) ethnicity have?

2.) Are there any medical tests more warranted for Indians than other races? For example, I've read things like insulin sensitivity and lipoprotein(a) can be different. Would these, or other tests you might suggest, be worth having based on my genetics?

3.) I do exercise regularly and generally feel good. In an Indian population, are there usually warning signs if you have heart disease (such as erection difficulties, pain when exercising, inability to catch breath, etc.), or is it often silent with heart attack as the first symptom and very little warning preceding it?

4.) A recent study confuses me - please see - it seemed to indicate aged garlic extract + CoQ10 slowed or reduced atherosclerosis. But it also said that OxPL/apoB and Lp (a) increased significantly. I thought these were bad, but their finding seemed to indicate all benefit, not risk. Thoughts?

5.) Are there any other steps I can take to prevent heart or stroke problems in my future aside from said supplements, exercise, and trying to keep a healthy diet? I guess some of what I read worries me that because of my father's history and some of my genetic predispositions, heart disease is inevitable or I could already have a large degree without knowing it (as I've always been heavy, even as a child).



Category: Cardiologist

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Category: Cardiologist
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Thank you for your query at
1. The global mixed ethnic south asian caucasian population is very small in number. No large scale studies have analysed this subgroup separately. It is difficult to predict genetics. Overall the risk for such a population would be definitely less than indian population. But there is no large scale data to confirm these assumptions
2. The screening guidelines remain same for Caucasian and indians. Only that the cut ofd lmits for indians for the definition of metabolic syndrome are much stricter for indians than western population. Otherwise screening for hypertension dyslipidemia and diabetes remains the same. Crp and lpa are not strongly recommended. Furthermore these tests are only to ascertain your risk. On account of your family history overweight and pre hypertension you are already in the moderate risk group. So the idea is that you should be aware of your risk and take precautions. You should undergo a fastng lipid profile blood glucose tests. If you have deranged parameters then you move up the ladder of riak into high risk group and then maybe we could get a hs crp. Right now it is not needed
3. Symptoms of coronary artery disease are not much different amongst the two populations except that more young people are affected amongst indian population
4.The study shows overall reduction in calcium score and other parameters as well. Whether the lpa effect matters will only be evident from a mortality morbidity study. Still the results are quitw impressive and you could take those extracts
5. Carry on your exercise atleast 45 min a day and more if you wish to loose weight. Cut down calories by 15 to 20 percent for weoght loss. Include sprouts green leafy vegetables and salads in diet both during linch n dinner. Fruits aftwr meals both times. Avoid smoking alcohol packed salted foods dairy and bakery products meat and poultry. You may have fish and egg white. Have almonds and walnuts daily.
Dr Vivek Mahajan

Patient replied :

A few other questions I forgot to ask: You mention the cutoff for metabolic syndrome is different for people of indian descent. Is this something my doctor would likely be aware of, or something I should discuss? Could I have a metabolic syndrome that is "missed" simply because those cutoffs are different? You mention symptoms of coronary artery disease are similar among the two populations. To clarify my initial question, are there generally some symptoms (things like ED, angina, breathlessness) that tend to act as a warning that a major event might happen without changes/treatment, or do many people just have a heart attack without prior warnings. Also, an additional question. I'm trying a product called PeptACE with 1.5g/day of bonito fish protein (85% peptides) to see if it affects my blood pressure. Are you familiar with this and is there any known risk from this supplement? Thanks again for your advice!


Metabolic syndrome is a combination of high BP ( hypertension ), hyper cholesterolemia, and hyperglycemia.
When three of them are present together, the patient is at increased risk of CAD/ Stroke.
But if you can maintain the values within normal range then there is no increased risk.
No matter what the population is, a BP under 140/90 mm of Hg is always desirable. Sugar levels can be checked once in 6 months, and regarding cholesterol i need to see your lipid profile ( especially LDL and TG values ), based on which i can assess what you need to do here.
Now regarding populations, yes the values may vary in indian population and western, however the BP values i mentioned are accepted as global standards. So try to keep it under 140/90 with adequate exercise and diet. Also symptoms of CAD, will be breathlessness, chest pain, edema, fatigue, e.t.c and erectile dysfunction comes later, but due to indirect causes.
I advise you to walk regularly at least 45 minutes- 1 hour everyday. Brisk walking will help you lose weight, feel healthier and keep your BP and sugar levels within normal range.
Also regarding PeptAce, studies claim it is a good supplement to keep bp levels under control, though more research needs to be done. There is no harm in trying it.
Feel free to dicuss further,

Patient replied :

Thanks for the detailed and helpful reply!
I don't believe I yet have metabolic syndrome based on my tests, but unfortunately I don't have access to my lipid records at this time; I will discuss this at my next doctor appointment (but as far as I'm aware my numbers weren't especially bad). Good to know about the CAD symptoms; so far, no specific worries there.
I do have a treadmill/incline trainer that I try to use 5 times a week (usually 30 minutes) and do other exercises and stretches 3 days a week. I also try to work in walking in my everyday life anyway I can, and will continue to look for ways to increase that a bit.
I'll give PeptAce a try. I also plan on taking garlic and am considering nattokinase.
Thanks again for your help!

Thank you for your appreciation.
If you continue exercising, and be on a good diet ( healthy low fat low salt ), then it is highly unlikely you will develop metabolic syndrome.
And walking is the best exercise any given day.
Let me know when you have your lipid values.

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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