Sudden but Certain: Genetic health concerns in Asian Indians

Kewalnain Sachdev turned 51 only two days before his first heart attack.

He survived the ordeal, and a couple weeks of recuperation gave Renu Sachdev and their family hope for his recovery.

On the evening of Jan. 12, 2003, Mr. Sachdev’s health suddenly declined, and he could no longer breathe. He was admitted into the hospital with his second heart attack. Like the first time, the situation began to mellow.

“I went home the following morning after my husband’s condition was clear, but then later it felt like my heart sank,” Mrs. Sachdev said. “The phone rang. The doctors said come immediately to the hospital. So I went, and his bed was empty. He was gone.”

The Sachdev family through the years. The most recent portrait was right before Kewalnain Sachdev passed away. (Courtesy of Renu Sachdev)
The Sachdev family through the years. The most recent portrait was right before Kewalnain Sachdev passed away. (Courtesy of Renu Sachdev)

Cardiovascular disease remains the leading cause of death in the United States, and specific ethnic communities suffer the most from the disease. According to the Center for Disease Control, heart disease is also the number one killer of Asian Indians. For people like Mr. Sachdev, cardiovascular-related issues come swiftly without much warning but leaves families with more awareness of their own heightened risks.

“He was a very thorough gentleman,” Mrs. Sachdev said. “He didn’t smoke, drink and eat any non-vegetarian food. He was very healthy, had no high cholesterol and used to exercise regularly.”

As a physical therapist with much knowledge on health and exercise, Mrs. Sachdev was glad her husband stuck to good habits. Although a healthy diet and exercise play a role in reducing the risk of heart disease, the genetics of Asian Indians increases the risk.

“Studies have shown for Asian Indians that 20 to 30 percent is genetic and the rest depends on diet,” said Dr. Arabinda Behura, an internist at Geisinger Lewistown Hospital. “Majority of the South and Southeast Asian countries are sedentary and eat junk. It’s harder for Asian Indians to tackle this when they’re already on the backside from that genetic standpoint.”

There is a common misconception that Indian food is extremely healthy because it has healthy ingredients like curry leaves and turmeric. In reality, Behura said, most Indian food is fried and filled with sugar, negating much of the positive effects of the herbs and spices.

Behura said Asian Indians tend to have a lower threshold of bad cholesterol.

Dr. Navin Nanda, a cardiologist and professor of medicine and cardiovascular disease at the University of Alabama at Birmingham, cited a study, “Increased Prevalence of Smaller and Denser LDL Particles in Asian Indians,” published in the Journal of the American Heart Association, which showed a comparison between 39 Asian Indians and 39 caucasians, equal in gender and age: “A higher prevalence of increased low-density lipoprotein particles, some [proteins that help blood clot formation] and increased platelet activation in Asian Indians compared to whites may be playing a role in the higher prevalence of coronary artery disease in this ethnic group."

Cardiovascular disease has many different subcategories that affect different structures of the cardiovascular system.

“Coronary artery disease is three to five times more common in Asian Indians as compared to other ethnic groups,” Nanda said. CAD, one of several kinds of heart diseases, is the hardening of arteries that send oxygenated blood throughout the body.

Mr. Sachdev’s heart attack dealt with failing arteries that required stents to allow blood to flow. According to Medtronic, a medical technology and equipment company, stents have been used for over a decade for CAD patients, which is much less invasive and easier for plaque removal.

As early as 1967 in Mumbai, India, Nanda studied myocardial infarction, also known as a heart attack, in young adults ranging from 18 to 40 years old. His research debunked the commonly known idea that only older adults were susceptible to heart attacks.

“It tends to occur at an earlier age and it is not uncommon to see Indian patients presenting with acute myocardial infarction in their twenties and thirties,” Nanda said.

Though not as young as Nanda’s patients, according to the CDC’s 2011 research on American life expectancy, Mr. Sachdev is considered young because the average lifespan in the U.S. is 80 years old.

Since genetics is an area people cannot yet control, healthy diets and exercise are the only effective ways to reduce the risks of cardiovascular disease. The Sachdevs were largely vegetarian and a fairly active family, so most of their lifestyle has not changed. Mrs. Sachdev said her biggest change was cooking with less oil, and they almost completely got rid of sugar in their diet.

She said making the effort to be healthy could help people live longer, even with the genetic risk. “It’s better to control whatever you can, and be secure with the rest that you can’t,” Mrs. Sachdev said.

Just like controlling diet and exercise habits, people can also seek help for concerns that they have. Behura and Nanda both said cardiovascular disease is much higher in urban, metropolitan areas in India. Various health problems, as well as heart disease, in big cities are also seen in the U.S., but the plus side of living in the city is access to health care. Clinics and non-governmental organizations in India are working toward educating people similarly to efforts done here.

Even with the best access to health care, sometimes a symptoms can still go unreported.

Mrs. Sachdev said the most plausible reason as to why her husband had a sudden onset of heart issues was due to workplace stress. He was a pharmaceutical chemical engineer at Baxter Medical, and he rarely talked about the "bad days" he had at work. She advocates to people with possible concern of their own risks to see a doctor when signs occur, and also seek help for mental stress. She said support and knowledge are key to understanding the disease, and being connected is more important than ever.

Both India and Asian Indians residing in the U.S. are joining the fast-paced, globalized lifestyle of the modern world. Mrs. Sachdev and families like hers, though affected negatively by the disease, have slowed down and realized the importance of health in an increasingly mobile generation.

Behura said this could be a tough realization, but an important one: “This is the society that we live in, and there’s no time, more stress and we try to go with an easier lifestyle. But when it comes to the heart, you have to spend more time."