It doesn’t matter where you live in the United States, what your race or ethnicity is, how much money you make or whether you are male or female, your chances of developing cardiovascular disease (CVD) are alarmingly high. CVD is a broad term describing specific conditions such as coronary artery disease, angina, heart failure and arrhythmias.
The Centers for Disease Control and Prevention say heart disease is the leading cause of death in the U.S. and is a major cause of disability. Each year, nearly 700,000 people die of heart disease in the U.S.; about 29 percent of all U.S. deaths.
To understand why CVD is so prevalent, it is important to understand the risk factors. The number one culprit is obesity, which can also lead to diabetes. Physical inactivity, smoking and an unhealthy diet are other major factors.
All in the Family
For Gordon Fung, these statistics and risk factors have profound personal significance. His father died of a massive heart attack at the age of 57, on Fung’s first day of college. Heart disease also claimed the lives of his father’s brothers. “All his brothers – a total of six – passed away from heart attacks and strokes. It was horrendous!” he recalled.
Fung is now a practicing physician and a clinical professor of Medicine at the University of California, San Francisco, School of Medicine. He is also director of Cardiology Services at the UCSF Medical Center at Mt. Zion, Division of Cardiology and the director of the Asian Heart and Vascular Center, which opened in 2006. It is the first in the nation devoted to studying CVD in the Asian population, he said.
Fung’s primary concern is an attitude that exists in Asian culture that “you don’t see a doctor until something hurts.” By then, he said, damage may have occurred that can’t be undone.
“Many times, by the time a patient checks into a hospital, they first need to check with their herbalist or family members. So treatment is delayed,” he said. Fung is a member of the California Council on Multicultural Health, which publishes medical literature in various languages such as Spanish, Korean and Chinese.
Fung, a third generation Chinese-American, has noticed that second and third generation Asian immigrants tend to take better care of their health. “I see more of the second and third generation population coming in for more routine check- ups,” he said. “It’s unheard of in recent immigrants.”
The opposite is true for Hispanics, said Elena Rios, president and CEO of the National Hispanic Medical Association. “The first generation immigrants have better health status,” she explained. “The longer your family stays in the U.S., the worse your health care gets.” Calling it the Hispanic paradox, she said it is most likely due to a lack of home-cooked food, the stress of dealing with a new culture, a new job and an increase in alcohol consumption.
Rios, a physician, is concerned about the lack of awareness of risk factors and behavioral changes that can make a huge difference. According to the National Institutes of Health, nearly two of every three Latinos are overweight or obese and nearly 60 percent of Latinos are physically inactive. Rios said Hispanics are also two and a half times more likely than non-Hispanic whites to have diabetes.
“It’s going to get worse because of the obesity epidemic in the country,” she said. “We’re going to see chronic heart disease in people in their 30s and 40s, rather than their 50s.”
Darren Vicenti agreed with Rios, pointing to the large number of Native Americans and Alaska Natives who are overweight or obese. “We all know diet and exercise play a large role, but no matter how much information we put out, we’re still seeing an increase in diabetes rate in both adults and children.”
Vicenti, the Clinical Director of the Hopi Health Care Center, located on the Hopi Indian reservation in Arizona, is both Hopi and Zuni Indian. The health center is part of the Indian Health Service network which provides health care to Native Americans and Alaska Natives through the U.S. Department of Health and Human Services. “The death or mortality rate has increased significantly over the last 10 to 15 years,” he said. “Obesity, diabetes and CVD all walk hand in hand in Native American and Alaska Native communities. It is a vicious triad.”
These trends are a concern for African-Americans as well. Keith Ferdinand is chief science officer for the Association of Black Cardiologists. “By the time an African-American has reached 65 years of age they probably have hypertension,” he said,
“If it’s not treated, it can lead to a fatal heart attack.”
Smoking is another risk factor high among African-Americans. But Ferdinand is optimistic that may be changing. “We, as a society, need to recognize we have a responsibility to ourselves.”
Attitude Adjustment
Social responsibility is exactly what Darwin Labarthe promotes as a way to improve the health of all Americans. He is the director of the CDC’s Division for Heart Disease and Stroke Prevention. “We have very important questions to ask ourselves as a society, about how much we care and how much we can do to change the conditions in which we live,” he said.
Labarthe said positive changes in lifestyles have been gradual, occurring over the course of decades. While at one time smoking was viewed as acceptable, today it is rejected more than it is accepted. He pointed to the increasing numbers of no-smoking ordinances that have been passed in cities across the country. “Public attitudes are evolving,” he said.
“However, it is generally recognized in the U.S. that health differences between rich and poor have become wider,” he said. “We know there is a large population in the U.S. who lack access to health care.”
It is tradition
Some cultural traditions may also be contributing to poor health. For African-Americans, fried foods are the worst offenders, said Ferdinand. “Historically it was a cheap way to cook low-grade food. These were survival techniques for people. But now we know there are more healthful ways to eat.”
Frybread is a popular food at Native-American gatherings. Yet while Vicenti knows that frybread is not healthy, he does not tell his patients not to eat it. He simply reminds them to limit the amount of frybread they eat at special events and focus on good eating most of the time. “If you really think about it practically, there are 365 days in a year. I would challenge anyone to show me that there are 100 days of special gathering going on each year.” Further, he said, even if there were 100 days when frybread is served, that would mean there are 265 days when Native Americans and Alaska Natives would be able to control their diet.”
Fried food is also a cultural culprit among Hispanic people. Rios said Puerto Ricans love their fried plantains and most Mexicans still use lard in their cooking. Rios said it is important to bake instead of fry and to eat smaller portions.
In Asian populations, white rice is one of the biggest culprits. The glycemic index of white rice suggests it is metabolized as sugar, which may then lead to diabetes.
“Currently we’ve been trying to encourage use of brown rice or wild rice,” said Fung. “It’s been going over very poorly.” He added, among the Hmong people, using salty fish to season food is a cultural practice, as is the use of lard in some Chinese food sauces.
Where is the hope?
Rios said technology offers possible solutions to these complex health issues. “We live in the Information Age and we can share more information to help make people healthier.”
Rios’ group – the National Hispanic Medical Association – offers a bureau with information aimed at middle school kids to teach them about healthy living. Ferdinand leads by example. “I tend to exercise more vigorously on a regular basis,” he said.
Ferdinand also avoids eating red meat. “My primary sources of protein are broiled fish and lean turkey.” He recommends the National Institutes of Health's “Dietary Approaches to Stop Hypertension” or DASH diet.
The Association of Black Cardiologists offers “Super Weekends” where it screens people and provides education on heart care. “We tie these into church-based activities where we encourage ministers to give health-based sermons,” Ferdinand said.
Given the already high rates of CVD, Vicente recommends that everyone learn Cardio Pulmonary Resuscitation or CPR. He said the American Heart Association’s “Hands Only” program is a great resource for folks who don’t want to perform mouth-to-mouth resuscitation. He added, knowing CPR is critical when you live in an area where it takes 30 minutes or more for an emergency crew to reach a victim, as in the case on many remote Indian reservations.
“The other piece of the message is that if we, as a society, do not undertake the changes that are needed, we are in effect, consigning future generations to the same or greater risk,” said Labarthe. “Every citizen should have an equal opportunity to live in healthy conditions.”
Vicenti speaks for his physician colleagues when he said, “No matter what our ethnicities are, we all want to take care of our families; our people.”