South Asians and heart disease

What do we mean by the term ‘South Asian’?

The term South Asian is used to describe a person whose ancestors came from the countries of the Indian subcontinent, including India, Pakistan, Bangladesh and Sri Lanka. Most middle-aged and elderly British South Asians migrated to the UK as young adults. South Asians represent the largest
ethnic-minority group in the UK. Although these people are often classed as one group, they are in fact made up of many different communities.
South Asians in the UK are a group made up of people of different religions, languages and customs.
The needs of an individual person should not be lost through stereotyping their ethnic group, religion or culture.

Are South Asians more likely to suffer from coronary heart disease?

In the 1950s and early 1960s, people began to realise that South Asians were at a higher risk of coronary heart disease after they had moved to western cities. The rates of coronary heart disease are high in Hindu, Sikh and Muslim communities in Britain.
The increased risk of coronary heart disease is particularly significant for young male South Asians.
The death rate from coronary heart disease is 40% higher than the national average in South Asian men, and 51% higher in South Asian women.
South Asians are 50% more likely to die prematurely (before the age of 75) from coronary heart disease than the general population.

Why are South Asians at greater risk of coronary heart disease?

If we knew why South Asians were at risk from coronary heart disease it would help us develop plans to prevent the disease.

Despite lots of research, the reason for the increased risk of coronary heart disease is not clear. However, it is generally agreed that there are several factors that seem to be associated with an increased risk of having heart disease. These are known as risk factors.

The main risk factors for heart disease, such as smoking, high blood pressure and blood lipids (fats), should be monitored, recorded and addressed in the South Asian population. Those people with significant factors that they could change (for example, through diet and exercise) need to have care plans to help them manage and reduce the risk factor.
Risk factors for coronary heart disease (smoking, high blood pressure, being overweight and lack of exercise ) are relevant the South Asian population.
Some groups of South Asians have fewer traditional risk factors, but still have a high rate of heart disease. The levels of cigarette smoking, blood pressure and cholesterol are not raised in all South Asian groups. For example, smoking rates tend to be low in Indians, but they still have a high rate of heart disease. This fact has led people to think that there might be other risk factors that are particularly relevant to South Asians.

There may be risk factors that are particularly significant for South Asian people. These include the following.

High numbers of people with diabetes (being diabetic makes you more likely to develop coronary heart disease). Diabetes is up to six times more common in South Asians.
High numbers of people who need a higher than usual amount of insulin to maintain a normal blood sugar (this is known as insulin resistance).
Abnormalities of lipids in the blood.
Inflammation in the coronary arteries.
Not enough physical activity.
Carrying more body fat around the waist than on the hips or limbs (this is known as central obesity).
The stress of trying to fit into the British culture and the possible effects of racism.
Socio- economic reasons – poor housing, unemployment and so on.

It is possible that South Asians are more at risk of coronary heart disease, perhaps because of genetic factors or because of a rapid change in risk factors after moving to the UK.
It is also possible that a higher percentage of South Asians are likely to die from coronary heart disease because there are fewer causes of death in middle-aged South Asians.

Which South Asians are most at risk of coronary heart disease?

Particular groups of South Asians are at a higher risk of developing heart disease. These people need to be identified and given support, information and treatment. These people include the following.

Those who have had a heart attack or have been diagnosed with angina or acute coronary syndrome.
Those who have a mother, father, brother or sister who had a heart attack before the age of 75 or has been diagnosed with angina or acute coronary syndrome.
Those who have a number of the risk factors for coronary heart disease, even if they do not have any symptoms of heart disease.

Those who are at higher risk of coronary heart disease need to have regular medical
check-ups.Those at higher risk of heart disease need to be given the information and support they need to make sure they have a healthy lifestyle. Some people may need this information in different languages or from someone who speaks their first language.

How can South Asians help prevent coronary heart disease?

The main things that South Asians can do to help prevent coronary heart disease are as follows.

Stop smoking and chewing tobacco or paan. Stopping smoking is the most important thing a smoker can do to avoid a heart attack. Within five years of giving up smoking, the risk of a heart attack will reduce to almost that of a smoker.
Be involved in regular, moderate physical activity. Those who are not active or are unfit have almost twice the risk of dying from coronary heart disease. At least 30 minutes of physical activity a day, five days a week, will reduce the risk of heart disease and heart attack, and has general health benefits.
Avoid being overweight.
Reduce the amount of saturated fats in the diet. For example, by choosing lean cuts of meat, removing the skin from chicken, cutting down the amount of fat used in cooking and using alternatives to ghee.
Increasing the amount of fruit and vegetables eaten. Five portions a day is recommended.
Replacing starchy foods such as ordinary rice and chappatis with versions that have a lower glycaemic (GI ) index, such as basmati rice. (The glycemic index measures how fast and how much a food raises blood glucose levels, and how much by.). Glucose is a sugar that is formed and stored inside the body and also comes from the foods we eat, such as basmati rice, parboiled rice.
Eating wholegrain cereals rather than refined cereals.
Decreasing the amount of sugary food eaten. Providing healthier options such as fruit for dessert.
Eating smaller meals throughout the day rather than three large meals.
Symptoms

What are the symptoms of coronary heart disease in South Asians?

Typical symptoms include a heaviness or tightness across the chest, shortness of breath, sweating, feeling sick and vomiting. The discomfort may go down the arm, up the neck or round the back. Elderly people and those who are diabetic may not experience any chest discomfort. They may just feel weak and unwell, be short of breath, feel sick and be sweating.

Some South Asians may have difficulty describing their symptoms in English, which can make diagnosis more difficult for nurses and doctors who do not speak the same language.
If you get any of the symptoms above you should see your GP as soon as possible. It may help you to take someone with you to help translate for you and the GP.
Recovery and cardiac rehabilitation

What do I need to know about recovering from an acute coronary event such as acute coronary syndrome or a heart attack?

If a member of your family has had a heart attack, it may be tempting to want to protect them from knowing about their heart attack or having to think about their heart problem. Because of this, families sometimes put family members off taking part in cardiac rehabilitation activities. A(a structured programme of education and activities , designed to reduce future heart risks)., consisting of education and activity guided toward lifestyle modification, increasing functional capabilities, and peer support. However, this could limit the amount of support and information they receive and not give them the opportunity to exercise in a safe, controlled environment.

Activity

After a heart attack you need to return to your previous activities gradually. About four to six weeks after a heart attack you should be getting back to how you were before. However, there will be good days and bad days.

Most patients can climb the stairs in the first days back home and there is no need to bring your bed downstairs. Friends and family may try to do everything for you and to treat you as if you are an invalid. This is not necessary and you should try to do a bit more each day.

You may get lots of visitors coming to see you. However, you need to give yourself time for rest and perhaps stagger when people come to visit. It can be stressful worrying about keeping the house tidy and preparing food for guests. If you normally look after your grandchildren, try to get help from other family members.
Changes in your lifestyle
It is important for you to know what a healthy lifestyle is and how to go about making the right changes. You also need to have the skills, motivation and confidence to change your behaviour. Having the support of both health-care professionals and your family is important when you are trying to change your lifestyle.

The desire to make changes in your lifestyle is likely to be influenced by what you think caused the attack and why it happened. This may influence the lifestyle changes you choose to make. Talking through your thoughts and feelings about recovery may help.

Physical activity

Some communities do not have easy access to safe, pleasant open spaces, footpaths or cycleways, or affordable leisure facilities. It will be helpful for you to find out about local sports groups and clubs that offer the type of activity that suits you.

How much exercise should I do?

A healthy level of exercise is 30 minutes or more of an activity that makes you a little bit short of breath, but during which you are still able to hold a conversation. You should do this at least five days a week.

The 30 minutes of activity can be all in one go or broken down into several shorter bursts of activity of 10 minutes or so. Exercise such as walking, cycling or swimming is particularly good. Building regular activity into your daily life (for example, walking rather than driving, cleaning the car, going up the stairs rather than taking the lift), makes it more likely that you do not see exercise as a chore and that you make time for exercise. A useful website you could visit for more information is www.whi.org.uk.

The heart is a muscle and will benefit from regular moderate exercise. Moderate exercise and taking part in daily activities will not damage the heart.

Smoking

Smoking just three to six cigarettes a day doubles the risk of having a heart attack. If you smoke, stopping is not easy and you will need support and information to help you.

How can I get help to stop smoking?

There are national services to help South Asians stop smoking. The British Heart Foundation (BHF) have been funding Asian Quitline since 1997. This service offers counselling and support, over the phone, to those who want to stop smoking. This service is offered in five different Asian
languages – Bengali/ Sylheti, Gujarati, Hindi, Punjabi and Urdu. All the professionally trained male and female counsellors are fluent in one of these languages, and in English. Free information sheets and leaflets in all five Asian languages are also available and are sent to all callers who would like more information.

The phone numbers for Asian Quitline are as follows.

Bengali – 0800 00 22 44
Gujarati – 0800 00 22 55
Hindi – 0800 00 22 66
Punjabi – 0800 00 22 77
Urdu – 0800 00 22 88

Asian Quitline also works with community groups and places of worship, and in training professionals to offer programmes in the community.

There is also the NHS Asian Tobacco Helpline which provides confidential and free advice on how to give up smoking cigarettes, 'bidi' or the hookah as well as chewing tobacco. The phone numbers are as follows.

Urdu – 0800 169 0 881
Punjabi – 0800 169 0 882
Hindi – 0800 169 0 883
Gujarati – 0800 169 0 884
Bengali – 0800 169 0 885

Diet

A healthy diet is important to keep at a healthy weight and to lower cholesterol levels. The diet recommendations for people with coronary heart disease are the same as for anyone who wants to reduce their risk of heart disease. A healthy diet should be followed by the whole family, not just you. Eating is often a family event and mealtimes need to remain sociable and enjoyable. If you are a woman who has had a heart attack you will need some help with cooking for the first few weeks, and help with the weekly shopping for a month or so. After that you should be able to return to the level of activity you had before their heart attack.

How can I make sure I am eating a healthy diet?

The following are guidelines for healthy eating.
Reduce the amount of saturated fats in your diet. For example, choose lean cuts of meat, remove the skin from chicken, and cut down on the amount of fat you use in cooking.
Increase the amount of fruit and vegetables you eat – five portions a day is recommended.
Replace starchy foods such as ordinary rice and chappatis with versions that have a lower glycaemic index (GI), such as basmati rice and parboiled rice. Low GI foods are broken down more slowly by the body and so raise the blood sugar levels gradually. Low GI foods are also useful in losing weight as they make you feel full for longer so you are not so tempted to snack between meals. Several supermarkets now label their food using the GI index, which makes shopping more straightforward.
Eat wholegrain cereals rather than refined cereals.
Reduce the amount of sugary food you eat. Provide healthier options such as fruit for dessert
Eat smaller meals throughout the day rather than three large meals.

What about my weight?

Being overweight puts you more at risk from heart disease.

In the early days after a heart attack, when you cannot be as active as normal, it may be tempting to sit at home and eat comforting food, which is usually fattening! It is also easy to put on weight if you are giving up smoking. If you wear loose fitting clothes you may not notice that you are putting on weight.

Putting on weight is worse for you if you put the weight on around your abdomen. This is known as central obesity.

What if I am diabetic?

It is important that your blood sugar levels are well controlled if you have coronary heart disease. This will increase your life expectancy, improve your quality of life and reduce the risk of complications following a heart attack.
Diabetes UK produce a number of free information leaflets in the main South Asian languages. These aim to help people manage their diabetes and lead a full active life. Audio tapes and a video are also available. The fact sheets are free and you can order them from the Diabetes UK website at www.diabetes.org.uk.

Diabetes UK also provide a diabetes helpline. This has trained counsellors who can provide information on aspects of living with diabetes. There is a translation service available.
You can get advice and support to help you with a healthy diet from a dietician who can discuss your diet with you in your preferred language. Ask the cardiac rehabilitation team or your GP about this.