If you ask Rajesh Dash, MD, PhD, assistant professor of cardiovascular medicine why he became a cardiologist, his answer is simple – his family's history of cardiovascular disease. Like all South Asians, Dash's cardiovascular disease risk is alarmingly high. For reasons that remain unknown, South Asians have the highest rate of hospitalization for cardiovascular events in California. More than half of South Asians who suffer heart attacks do so before they reach age fifty. This phenomenon is especially significant here in the Bay Area, where more than 300,000 South Asians live and work.
Ahmad Sheikh, MD, clinical assistant professor of cardiothoracic surgery, has a family history of heart disease similar to Dash's, and a very personal interest in understanding why. As attending physicians at Stanford, both he and Dash have seen firsthand the need to address the high prevalence of heart disease in young South Asians, and have spent the past two years leading an effort to develop a comprehensive program here at Stanford to tackle the problem.
Known as SSATHI, the Stanford South Asian Translational Health Initiative will launch in April of this year, offering integrative clinical care, aggressive risk reduction and treatment of existing disease. SSATHI will simultaneously invest in groundbreaking research into this under-studied epidemic, leveraging the cutting edge technology and unique resources of Stanford Medical Center and the Stanford Cardiovascular Institute.
"Cardiovascular disease is striking a very young population in this ethnic group," says Dash, who is medical and scientific director of SSATHI. "We are seeing patients in their 20s, 30s and 40s who have suffered heart attacks, and/or present with significant coronary disease." The disease that affects this population is also particularly virulent, he says. It typically involves more than one vessel, and within that vessel, the blockage is so substantial that treatment with a stent is nearly impossible.
Care for the lifespan
The program is based in the cardiovascular medicine division, but is a collaborative partnership with cardiac and vascular surgery, with several faculty members in each division committed to treating this unique patient population. Sheikh is surgical and translational innovation director for the program.
SSATHI will initially operate in the Boswell Clinic, but will eventually be based at the Portola Valley Clinic. The program is open to any person of South Asian descent who has concerns about his or her cardiovascular health. SSATHI is particularly interested in reaching the younger population (ages twenty to fifty-five) who may not know they are at risk.
In many South Asian languages, the word "sathi" translates to "companion," and that, says Dash, is what Stanford's program aims to be – a companion to patients, helping them navigate their risk, and preventing further disease through medical and lifestyle management.
That entails closely following patients' cholesterol panels, blood pressure and insulin resistance progression, and offering nutrition, exercise and lifestyle management guidance. To help patients make healthier cultural food choices, SSATHI will employ a South Asian dietician. Patients may also undergo genetic testing and meet with a genetic counselor to understand their individual risk.
Dearth of research
To augment its clinical care, SSATHI is launching an equally robust research effort to uncover the underlying causes of this population's increased risk. "There has been very little done to understand the genetic, biochemical and cultural aspects that make this disease so prevalent and malignant in this population," says Dash.
In addition to receiving clinical care at Stanford, SSATHI patients may participate in a larger research effort by sharing their clinical and genetic information for analysis. Stanford faculty members are preparing protocols to submit to the IRB to study innovations in genetic risk, cardiac fibrosis, vascular reactivity, drug sensitivity and insulin resistance. One such NIH-funded study is already underway, led by Tim Assimes, MD, who is screening patients for insulin resistance and its genetic underpinnings.
"Stanford is the ideal place to do this type of project," says Sheikh. "It has a combination of genetics expertise, Big Data expertise, bio-informatics expertise, as well as medical expertise. And we reside in a community with a very large South Asian population that has access to health care and that is very well connected to a larger South Asian community throughout the world."
Because this disease trend is not limited to South Asians living in the U.S., Dash says SSATHI will soon partner globally with peers in India to study cardiovascular disease in a much larger population. In 2010, cardiovascular disease took over as the number one cause of death in India from infectious diseases. As in the U.S., research efforts internationally have also been lacking.
"We will not only identify people with disease and treat them locally," says Sheikh. "But also bring all that data into a larger framework that will eventually yield therapies and guide us toward prevention. That is our hope."
By Grace Hammerstrom