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South Asians

South Asians. Ashley Marion University of Guelph-Humber Brampton Civic Hospital Cardiac Rehabilitation 0671496. Cardiovascular Disease. Background. Geography location Climate Culture Diet Views on exercise Prevention and awareness Physiological differences.

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South Asians

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  1. South Asians Ashley Marion University of Guelph-Humber Brampton Civic Hospital Cardiac Rehabilitation 0671496 Cardiovascular Disease

  2. Background • Geography • location • Climate • Culture • Diet • Views on exercise • Prevention and awareness • Physiological differences http://www.google.ca/imgres?q=map+of+south+asia&hl=en&sa=X&biw=1280&bih=664&tbm=isch&tbnid=ZetMMCIZNks8iM:&imgrefurl=http://www.southasianconcern.org/south_asians/detail/what_does_south_asian_diaspora_mean/&docid=_DVBn8r4DRN7QM&imgurl=http://www.southasianconcern.org/images/sac_photos/south_asians/south_asia_map.gif&w=420&h=389&ei=eVFwT7TiLNH5ggfbl8xr&zoom=1&iact=hc&vpx=612&vpy=321&dur=1043&hovh=216&hovw=233&tx=112&ty=120&sig=115924055748486242270&page=1&tbnh=132&tbnw=143&start=0&ndsp=20&ved=1t:429,r:10,s:0

  3. What puts South Asians at higher Risk? • INTERHEART case-control study, 52 countries, all ethnic groups, including South Asians • 9 risk factors account for >90% of the population’s noticeable higher risk of MI • smoking, raised apolipoprotein B/apolipoprotein A1 ratio (),hypertension, diabetes mellitus, abdominal obesity, and psychosocial stress

  4. Physiological Differences • Phenotype • Biochemical • Differences in body Characteristics*

  5. Physiological Differences Exp. • Arterial diameter • Altered adipokine activity (leptin, adiponectin) • Inflammation = biomarker of atherosclerosis • Raji et al, • Adiponectin= improves insulin sensitivitygood • Adiponectin levels lower in Asian Indians than in whitesincreased whole body insulin resistance impaired fibrinolysis (process of preventing clots)altered endothelial function • Adipokinesinsulin resistance atherosclerosis

  6. Raji et al

  7. Conditions to take note… • Ischemic Heart Disease • Stroke • Peripheral vascular disease

  8. Stroke • Adiponectin levels lower increased whole body insulin resistance impaired fibrinolysis+ Arterial diameter= Increased number of strokes http://www.cadiresearch.org/?page_id=442

  9. Peripheral vascular disease • What is PVD? • Condition of blood vessels • Leads to narrowing/hardening of arteries • Lower Limbs and feet • Caused by arthrosclerosis • South Asians= increase in atherosclerosis

  10. Ischemic Heart Disease • Aka. Myocardial Ischemia • Heart muscle damage/inefficient • Reduced blood supply to heart • Reduced blood flow=ATHEROSCLEROSIS • Risks • Increases with age • Smokers • Diabetics • HPT

  11. Barriers • What are some of the barriers to working with this population? • Language • Culture and tradition • tradition does not change over-night

  12. Recap • Adipokinesinsulin resistance atherosclerosis • Insulin resistance diminished adiponectin levels

  13. Considerations for Screening/Diagnostics • What do physicians need to consider? • Aware of prevalence of metabolic syndrome and glucose intolerance in South Asians • Screen • waist circumference and waist-hip ratio, rather than BMI. • Assessment of fasting glucose and a complete lipid profile • a strong family history of diabetes, or impaired fasting glucose, an OGTT should be considered

  14. Treatment • no evidence to suggest that treatment targets should differ between ethnic groups. • Exercise* • Diet change • Stress level changes… • Not enough studies with regards to different responses to pharmaceutics

  15. Example Exercise program • Start slowly with aerobics (3 x 30 min with 10 min warm-up and cool down) • Walking, swimming • Cycling for most obese, not as hard on joints • Strength training • Lighter weights higher reps • Continuous • Breath, no max lifts

  16. Barriers to Exercise • Diet • HR? • Beta blockers (HPT) • RPE • Beware starting BP • Strenuous= atherosclerosis • BMI

  17. Work Cited Brookes, Linda (2004). INTERHEART: A Global Case-Control Study of Risk Factors for Acute Myocardial Infarction. Lancet. Retrieved from http://www.medscape.com/viewarticle/489738. Gulshinder, Chattha (2010). Top Ten Risks of the South Asian Diet. Retrieved from http://www.desiblitz.com/content/top-10-risks-of-the-south-asian-diet Gupta, Milan., Singh, Narendra., Verma, Subodh (2006). South Asians and Cardiovascular Risk What Clinicians Should Know. Circulation. 2006; 113: e924-e929. Retrieved from http://circ.ahajournals.org/content/113/25/e924.full#F2 n.a (2012). Peripheral Artery Disease. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm n.a (2012). Stroke In South Asians. Coronary Artery Disease in Asian Indians. Retrieved from http://www.cadiresearch.org/?page_id=442 Patel, Kiran C R (2004).The Epidemic of Coronary Heart Disease in South Asian Populations: Causes and Consequences; First Edition. Retrieved from http://sahf.org.uk/uploads/docs/files/21.pdf Raji A, Gerhard-Herman MD, Warren M, Silverman SG, Raptopoulos V, Mantzoros CS, Simonson DC. Insulin resistance and vascular dysfunction in nondiabetic Asian Indians. J ClinEndocrinolMetab. 2004; 89: 3965–3972. Retrieved from http://jcem.endojournals.org/content/89/8/3965.abstract?ijkey=8fee1377e4f0b42365c1c2632ff1181012bef892&keytype2=tf_ipsecsha.

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