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The South Asian enigma: early risk of heart disease

He is a physically active 35-year-old father of two who lives in Oshawa, Ont. He doesn't smoke or drink and is not overweight. And he doesn't appear to have a family history of heart disease.

But earlier this month, Navdeep Singh Bedi underwent double bypass surgery after doctors discovered two of his main arteries were completely blocked and another almost completely blocked.

Mr. Bedi, who came to Canada from India in 1997, was suffering from a particularly aggressive form of heart disease that many would consider uncommon for a man in his 30s.

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Yet, in many ways, Mr. Bedi is a poster model for a potentially deadly health problem that seems to disproportionately affect the South Asian population.

And he wants to warn others like him who may not realize they could be at risk of heart disease.

"I don't want anybody [else]to get that problem," Mr. Bedi said while recovering from surgery at home.

A growing body of evidence suggests that people of South Asian descent - men in particular - face much higher risk of heart problems compared to other populations at earlier ages.

It's a serious problem with significant implications for Canada's growing South Asian population, and requires prompt attention, said Subodh Verma, cardiac surgeon at Toronto's St. Michael's Hospital and Canada Research Chair in Atherosclerosis, who performed Mr. Bedi's procedure.

"Regardless of lifestyle they're at higher risk," Dr. Verma said. "South Asians are at higher risk by virtue of being South Asian."

A major study published in January, 2007, found that South Asians tend to suffer heart attacks at younger ages than other ethnic groups. The study, published in the Journal of the American Medical Association, showed people from countries including India, Pakistan and Sri Lanka suffered heart attacks five to 10 years earlier than those from other parts of the world.

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The researchers said that some lifestyle factors, such as low intake of fruits and vegetables and lack of exercise, could help explain some of the increased risk.

But it also appears that South Asians are more likely to be affected by certain health issues that could make them more vulnerable to heart disease.

For instance, South Asians seem to have a much higher prevalence of diabetes than other populations. In addition, some research suggests South Asian people have less "good" cholesterol than other groups, and that their "bad" cholesterol tends to be small and dense, possibly increasing the threat of blockage, Dr. Verma said.

Dr. Verma also said there is some evidence to suggest that cardiovascular risks among South Asians may increase if they live in a Westernized culture.

But despite these clues, researchers still have no clear understanding why South Asians seem to face greater heart problems, Dr. Verma said. And there's a pressing need to find an answer.

"It is frightening to us as to how many individuals we are seeing at younger and younger ages who require angioplasty, who've had a heart attack, who require bypass surgery in their 40s and their 30s," Dr. Verma said.

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In Mr. Bedi's case, he went to see a physician several times for shortness of breath and other symptoms before heart disease was even suspected. His relatively young age and absence of risk factors meant that doctors didn't immediately recognize the possibility his symptoms were related to his heart.

Now, Mr. Bedi said he wants other South Asians to recognize that they may be at higher risk so they can watch for warning signs. He hasn't been able to work since his surgery, and his recovery will likely take another few months. As a result, his family has little income and is facing major worries over how to pay the bills.

"It's very tough," Mr. Bedi said.

Dr. Verma said he hopes the growing awareness and understanding of the risks faced by South Asians will lead to better screening and ability to catch the disease. While most healthy people in their 30s may not seem like prime candidates for heart disease, Dr. Verma said doctors may want to take a second look, depending on the patient's ethnicity.

"I think being South Asian should immediately trigger for physicians a lower threshold to investigate for heart disease," he said. "I think the field is certainly moving toward that."

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