Tuesday, December 1, 2015

The Heart Disease Conundrum - The New York Times

South Asians today account for more than half of the world's cardiac patients. Heart disease is the leading cause of death in India, Pakistan and Bangladesh, and rates have risen over the past several decades. South Asian immigrants to the United States, like me, develop earlier and more malignant heart disease and have higher death rates than any other major ethnic group in this country.

The reasons for this have not been determined. Traditional cardiac risk models, developed by studying mostly white Americans, don't fully apply to ethnic communities. This is a knowledge gap that must be filled in the coming years. Fortunately, there is a model for doing so: research performed in a small town in Massachusetts over the past seven decades. Known as the Framingham Heart Study, it is perhaps the most influential investigation in the history of modern medicine.

The Framingham Heart Study is a big reason we have achieved a relatively mature understanding of heart disease in the United States — at least for a large segment of our population. It established the traditional risk factors, such as high blood pressure, diabetes and cigarette smoking, for coronary heart disease. Framingham also spearheaded the study of chronic noninfectious diseases in this country, and indeed introduced many doctors to the very idea of preventive medicine.

The impetus for Framingham was clear. In the 1940s, cardiovascular disease was the main cause of mortality in the United States, accounting for nearly half of all deaths. Knowledge of coronary risk factors was spare. As Dr. Thomas Wang and colleagues wrote in the journal Lancet last year, "Prevention and treatment were so poorly understood that most Americans accepted early death from heart disease as unavoidable."

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