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Dr. Purushotham Kotha's Health Education / Information home page. Heart Smart is your one stop access to all that you want to know about heart in health and disease. Please click on links on our Home Page and in Patient Education to read about health topics of your interest and RICADIA. Eat wise, Exercise plenty, Live healthy and Live longer!

To learn about metabolic syndrome, heart disease, stroke, silent heart attacks, diabetes, high cholesterol,dyslipidemias, high blood pressure,women and heart disease, preventive care, healthy nutrition, to read a daily blog on Yoga click on Patient Education and customized links in Patient Education. To calculate your risk for heart disease, body mass index and create your own exercise and food pyramid click on 'three quick steps...below.

For specific Info on heart disease in Indians, for Indian foods- guide to health, nutrition & diabetes, for AAPI's consensus recommendations and to read about impaired reverse cholesterol transport in Asian Indians click on Patient Education and Asian Indian Studies. To read about Ghee-the divine golden oil or harbinger of heart disease? and to learn heart healthy nutrition, click on Nutrition.

RICADIA-Risk Intervention in Coronary Artery Disease in Indian Americans Project

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We are interested in constantly updating our home page with new heart health related topics for our readers,patients and health care professionals.

Enjoy reading through our valuable information about heart in health and disease to help you to eat wise, live healthy and live longer!

Please call or e-mail us if you need help in exploring any areas of our web site, and also with your suggestions and comments.


Clinical Trials


For Information on current clinical trials on high cholesterol, Dyslipidemias, Hypertension, Acute Coronary Syndromes,heart attack, Arrythmias, Metabolic Syndrome, Diabetes, Heart Failure, Peripheral Vascular Disease and Stroke please call us at 619 229 1995.

Genetics study in Asian Indians, USC-RICADIA collaboration, please click here

DIA(Diabetes in Indian Asian) study. Please call 619 229 1995.

Early Deaths With Thrombolytic Therapy For Acute Myocardial Infarction in Corticosteroid-Dependant Rheumatoid Arthritis-- Purushotham Kotha, M.D; FACC et al. Clinical Cardiology 21.853-856(1998).-- Primary PTCA should be strongly considered for this high risk group!

Three Quick Steps To All You Need to Know About Heart Disease and Prevention


Calculate Your BMI
Calculate Your Heart Disease Risk
Create Your Exercise and Food Pyramind
Indian Americans and CardioMetabolic Syndrome Brochure
Daily Yoga Blog

Interesting, Informative and Educational Websites:



heart movies
American College of Cardiology
American Heart Association
www.diabetes.org
www.ndep.nih.gov/diabetes/pubs/Power_broch_Eng.pdf
www.chestnet.org
www.acponline.org
Vascular Biology Working Group
www.thefutureforum.com
European Society of Cardiology
American Society of Echocardiography
www.nlm.nih.gov/medlineplus
www.ncbi.nlm.nih.gov/entrez
American Association of Physicians of India
Osmania University Medical Alumni
South Asian Health Foundation of U.K



Heart Disease in Asian Indians




We would like to bring to your attention the very high incidence of heart disease (Coronary Artery Disease=CAD) in Asian Indians (people from subcontinent of India, Pakistan, SriLanka and Bangladesh).

Several epidemiologic studies from India, Singapore, UK and USA over 45 years have observed that Asian Indians have the highest risk of heart disease ( CAD ) off all ethnic groups studied. Women are no exception!

CAD causes angina, heart attack, heart failure, severe cardiac disability, and is the nuber one cause of premature and sudden cardiac death.

Indian Americans and CardioMetabolic Syndrome Brochure

Please see our extensive article detailing RICADIA ( Risk Intervention in Coronary Artery Disease in Indian Americans ) Project Click on the RICADIA link above or click on Patient Education and click on Asain Indian Studies and RICADIA Project to find answers to many questions you have on heart disease. Read about impaired reverse cholesterol transport in Asian Indians by clicking on the link Asian Indian studies in patient education.


Purushotham Kotha M.D., FACC. Chair Person, CAD Committee AAPI; Director, RICADIA project (Non-Profit )
Sunder Mudaliar M.D.(UCSD) President-SAPI 2003 & 2004
Vibha Bhatnagar M.D, M.P.H (UCSD)
Mary McAlister Project Manager





RICADIA Project Letter to Physicians


Heart Disease - Asian Indians and General Population - a Global Approach


Dear Health Care Professional,

As we entered the New Millennium it is time for us to remind ourselves that CAD is still the number one public health problem and that Asian Indians carry very high risk of Coronary Artery Disease among all ethnic groups studied in this World. Women are no exception! Compared to caucasians, African-Americans and Latinos Indian women sufferred the highest all cause mortality and cardiovascular mortality in the United States.

Indian Americans and CardioMetabolic Syndrome Brochure

Several epidemiologic studies have observed a very high incidence of CAD in Asian Indians. CAD is the number one cause of death in all civilized societies.

Asian Indians have a high incidence of metabolic syndrome, prediabetes and diabetes.

Atherogenic Lipoprotein Profile-small dense LDL-C or pattern B, low HDL-C, high Triglycerides, Insulin Resistance and central obesity are quite common in Indians.

Sedentary life style, heart unhealthy cooking and eating habits and lack of exercise and leisure time activities unmask the risk of heart disease in Indians.

More than three hundred genes are implicated in the genesis of CAD. Genes load the gun, and environmental factors (diet, stress, sedentary lifestyle) pull the trigger.

Until recently the NCEP guidelines have focused on high levels cholesterol in high risk individuals only and therefore were unable to identify the other important risk factors for CAD such as low HDL, high non-hdl cholesterol and triglycerides, high Lp{a)and homocysteine, metabolic syndrome, prediabetes and insulin resistance that are commonly present in Asian Indians.

However on May 15th 2001, the National Cholesterol Eucation Program(NCEP) of NHLIB issued the new ATP3 guide lines recognizing the metabolic syndrome as a secondary target after lowering LDL-C to goals and also payig attention to emerging risk factors such as homocysteine, Lp (a), CRP-hs. It has recognized the presence of diabetes as euivalent to established coronary heart disease.

The good news is that there is so much more we can do now than forty five years ago when the high risk of CAD was first identified in Indians living in Singapore.

Research in Lipidology,Coagulation, plaque morphology and Vascular Biology is progressing at the Internet speed and is providing us with effective and powerful pharmcological agents such as lipid lowering drugs, ACE inhibitors,Angiotensin receptor and beta blockers, new classes of oral hypoglycemics and platelet inhibitors and safer thrombolytics and new tools and devices such as drug eluting stents, biventricular pacemakers and defirillators.

Statins have been very effective in Primary Prevention and Secondary Prevention as shown by many clinical trials.

Statins are very effective in reducing the LDL-C burden and to some extent in raising HDL-C and lowering high triglycerides and inhibiting postprandial hypertriglyceridemia.

Endothelial Dysfunction is the hallmark of Atherosclerosis and vulnerable plaque leads to unstable angina, acute coronary syndromes, acute myocardial infarction, premature and sudden cardiac death.

The beneficial effects of statins extend beyond lipid modulation and include prevention of endothelial injury and stabilization of chronic plaque as well as unstable plaque after spontaneous plaque rupture and coronary interventions.

Fibrates and Niacin also have favorable effects on lipid profile. They decrease triglycerides and increase HDL-C.

The new oral agents for Diabetes are effective in improving Insulin resistance and dyslipidemias that are commonly seen in Asian Indians and in the Deadly Dysmetabolic Syndrome X (Hyperinsulinemia, Obesity, Diabetes, Hypertension and Arteriosclerosis) seen in approximately 30% of the Western population.

There has been an explosion of diets in this decade and we are more than ever confused as to what to eat and what to avoid!

Premature and accelerated atherosclerosis, severe three vessel CAD, diffuse coronary involvement, a higher relative rate of myocardial infarction, severe left ventricular dysfunction, all seem to be much more common in Asian Indians although the conventional risk factors such as hypertension, smoking and consumption of red meets are less prevalent in the same population.

It is likely that in the presence of low HDL-C, high triglycerides and insulin resistance, the threshold for the detrimental effects of LDL-C is lowered increasing the susceptibility of Asian Indians to CAD.

In recent years there has been an alarming increase in the number of people who smoke and drink in India. Treating dyslipidemias, diabetes and hypertension to goals is not a priority yet!

Consumption of fast foods, red meats and animal fats and sedentary life style and childhood obesity are all on the rise in India! Consumption of fresh vegetables and fruits is very low in many regions in India.

Several Primary and Secondary Prevention trials have proven the efficacy of Lipid modulating agents in preventing and reducing adverse cardiovascular events( M.I and Stroke) and reducing all cause mortality. We need large scale, randomized, prospective clinical trials in Indian Asians looking at conventional and emerging risk factors and their response to standard treatments, that have proven efficacy in the western population.

Taking an aggressive approach to early detection using blood lipid, Coagulation and metabolic studies in asymptomatic and symptomatic individuals; family screening and pedigree studies; early use of exercise stree tests; aggressive Primary and secondary Prevention with therapeutic life style changes, diet and pharmacological intervention; regular follow up and counseling can all help change the natural course of CAD in Asian Indians and general population afflicted with CAD and prevent premature death and disability, and their socio-economic consequences.

The Lipid ,Coagulation and metabolic studies help us tailor a right diet and right drug to individual patient. One diet and one drug alone is not appropriate for all individuals.

Regular follow-up and counselling will help us to treat metabolic syndrome, dyslipidemias, diabetes and hypertension to goals and to identify disease progression and adverse events promptly, to prevent premature death and permanent cardiac disability.

Dietary habits are established early in life and to educate and help prevent heart disease in children we must act now. BOGALUSA,PDAY,FELIC studies have confirmed the presence of fatty streaks, smooth lesions and early plaques in the coronary arteries and aorta of fetuses and children and their correlation to maternal hypercholesterolemia. Therefore it is never too early to intervene, and infact primordial intervevention may be the most optimal intervention when it comes to truly prevent ahterosclerosis in humans!

The choice is between adapting therapeutic life style changes very early and use medications when necessary to live healthy and live longer or suffer the ravages of advanced atherosclerosis with angina, heart failure, chronic disability, Myocardial Infarction, Stroke, Peripheral arterial disease, premature and sudden cardiac death!

The population of India is over a Billion. Twenty million are living abroad. Two million Indians are living in USA (of these approximately 45,000 are physicians). Incidence of CAD in urban India is as high as it is in the Western World. Heart attack in one or more members of many Indian families has become a regular and accepted adverse event. Even after the diagnosis of CAD has been made optimum treatment is not being delivered promptly. This does not have to be the case anymore. There is no reason to wait any longer to start a global, well-coordinated fight against CAD in Asian Indians.CAD in Indians is reaching epidemic proportions!

To facilitate rapid dissemination of information on CAD to people and health care professionals across the World we created a dedicated Website www.heartsmart.info Please email us at pkotha@heartsmart.info or webmaster@heartsmart.info for any further information.

We would like to encourage more research into basic science, clinical science and public health aspects of heart disease in Asian Indians.

Please e mail, call or fax to inform us of your interest to actively participate in this mission to help our fellow men and women around the world to fight CAD - the number one killer disease.

We need volunteers to propagate our message, dietitians to give us heartwise menus and culinary tips, public health professionals to design effective strategies, to reach, educate and involve our communities and physicians to screen, counsel and treat. For Updates and News Paper articles on heart disease please click on Patient Education.

Thank you for your attention and cooperation to deal with our number one public health problem.

Eat well but Eat Wise; Click on Nutrition in Patient Education.
Walk at least two miles a day, every day of the week;
Learn and strive to handle your stress well and don't let it take control of you.
Sponsor Walkathons, community talks and health screenings!
Remember laughter is the best Medicine, it does not cost and does not need a prescription. Use it ad lib.

Food Pyramid

Sincerely,

Purushotham Kotha.M.D;FACC
Director, RICADIA project (Non-Profit )
RICADIA.ORG
director@ricadia.org
pkotha@heartsmart.info

The RICADIA Project Team


Purushotham Kotha M.D; FACC, Chair Person, CAD Committee AAPI, President, SAPI -2001 & 2002
Sunder Mudaliar M.D (UCSD) President, SAPI- 2003 & 2004
Vibha Bhatnagar M.D, M.P.H (UCSD)
Mary McAlister RICADIA Project manager

Locations

San Diego Office
5555 Reservoir Drive Suite 309
San Diego, CA 92120
(619)229 1995
Fax: (619)229 1109
pkotha@heartsmart.info

Physicians & Staff:
Purushotham Kotha, M.D.
Akther Kotha, M.D.
Mary McAlister, Office Manager