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Welcome to HeartSmart.info!
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, 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 Library and other links on this home page and 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 & HDL subclass distribution 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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Enjoy reading through our valuable information about heart in health and disease to help you to eat wise, live healthy and live longer! Visit us often because we are regularly updating our home page with new heart health information for the benefit of our readers, patients and health care professionals.
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
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! Please click on 'Staff' to see other publications by Dr. Kotha
Three Quick Steps To All You Need to Know About Heart Disease and Prevention
Calculate Your BMI
Calculate Your Heart Disease Risk
Create Your Food Pyramid
Exercise Pyramid
Exercise and Calories
Indian Food Pyramid
Indian Food Nutritional Information
Larger your waist line shorter is your life span!
Indian Americans
and CardioMetabolic Syndrome Brochure
heart movies
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
Heart Disease in Indian Americans
Why Indians should be Concerned?
Because we are in the midst of a Cardiometabolic Epidemic!
High incidence of CardioMetabolic Syndrome with larger waist line(visceral fat), with or without Diabetes and with underlying excess of Insulin (Insulin Resistance), small dense LDL, remnant particles, proinflammatory, procoagulant factors contributes to the very high incidence of heart disease and all cause mortality in Indians.
The NIH program ‘Healthy People 2010’ designated the Asian Indian Immigrant Population in the United States as a “high risk group for heart disease”.
The World Health Report of 2002 projects Cardio Vascular Disease (CVD=heart disease and stroke) to be the largest cause of death and disability in India by 2020.
The World Health Organization estimates that about 60% of the World’s heart disease patients will be Indian by year 2010.
CVD is the largest cause of death in women. Compared to Whites, Blacks and Latinos Indian women suffered the highest all cause mortality and highest cardiovascular mortality in the U.S.
AAPI/RICADIA sponsored first randomized National DIA (Diabetes in Indian Americans) study showed that the prevalence of Metabolic Syndrome and Diabetes in Indian Americans is even higher than that reported by earlier, non-randomized, smaller studies.
Read more ....
Indian Americans
and CardioMetabolic Syndrome Brochure
Larger your waist line shorter is your life span!
Heart Disease- a Global approach for a Global Problem
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.
The IDEA, International Day for Evaluating Abdominal obesity study examined 168,000 patients in 67 countries all around the World and confirmed that abdominal obesity (visceral fat) is convincingly the most important, independent and universal predictor of cardiometabolic risk in men and women of all ages, nationality and ethnicity.
Many studies over the last half century reported higher cardiovascular and all cause mortality in people with Cardio-Metabolic syndrome and its high prevalence in Asian Indians.
The INTERHEART a case-control study( appx 15,000 patients with acute M.I and 15,000 controls) conducted in 52 develoed and developing countries identified nine easily measured and modifiable risk factors (current smoking, high ApoB/ApoA ratio, hypertension, diabetes, truncal obesity, low fruit and vegetable and high fat intake, lack of exrcise, alcohol consumption, and psychosocial factors) that account for over 90% of the risk of acute myocardial infarction in almost every geographic region and every racial/ethnic group worldwide and are consistent in men and women.
The age-adjusted prevalence of CHD in Caucasians is highest in patients with both type 2 diabetes and metabolic syndrome (19.2%), followed by patients with metabolic syndrome but not type 2 diabetes (13.9%). Notably, the prevalence of CHD is no higher in patients with type 2 diabetes but without metabolic syndrome than in individuals who have neither type 2 diabetes nor metabolic syndrome.
The Diabetes in Indian Americans study showed much higher age-adjusted prevalence of Metabolic Syndrome of 26.9% by the original ATP III criteria, 32.7% by the modified ATP III criteria and 38.2% by the IDF criteria.
Diabetes in Indian Americans
Indian Americans
and CardioMetabolic Syndrome Brochure
Larger your waist line shorter is your life span!
Sedentary life style, heart unhealthy cooking and eating habits and lack of exercise and lack of outdoor leisure time activities unmask the risk of heart disease in Indians.
On May 15th 2001, the National Cholesterol Eucation Program(NCEP) of NHLIB issued the revised 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.
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, calcium 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 effective in Primary and Secondary Prevention of CAD as shown by many clinical trials.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.
Endothelial Dysfunction is the hallmark of Atherosclerosis and vulnerable plaque and leads to acute coronary syndromes, premature and sudden cardiac death.
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 transfats, 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.
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 cardiac stress tests; aggressive Primary and secondary Prevention with therapeutic life style changes 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, diabetes and hypertension to goals and to identify disease progression and adverse events promptly, to prevent premature death and 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, children and young adults 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!
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 50,000 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 an 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 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.
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.
RICADIA-Risk Intervention in Coronary Artery Disease in Indian Americans Project
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)
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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
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