Heart attack in Bangladeshi – by Dr. Atifur Rahman Zarin

Heart attack in Bangladeshi – by Dr. Atifur Rahman Zarin

Yet another busy Friday. Came home a little late, finished my dinner. My wife was still on Facebook while my children were too busy with the latest trends and games to care. As for me? I was browsing my inbox with my tired fingers unaware of Sohail vai (not his real name), a close friend of mine, who had a heart attack. I tried to ring him with little success. I started to feel anxious. I felt this string within my stomach tighten as the tension built. Am I sweating? My palms felt hot and clampy as I searched for an answer. Through one of my friend’s I came to know that he is well. He returned my call not long after and reassured me that he is fine. He had a ST elevation myocardial infarction (STEMI), a serious form of heart attack when one of the arteries supplying blood to the heart muscle is completely blocked. Sohail vai was fortunate enough to be admitted to the hospital within minutes and had artery opened (primary angioplasty) with a stent in 50 minutes. Hopefully, he had minimum damage to his heart muscles and fully revascularized.

Sohail vai is free from most of the traditional risk factors from heart attack. He doesn’t smoke, he has no history of diabetes or hypertension. To the best of my knowledge he didn’t have high cholesterol. He has no family history of premature coronary artery disease. Sohail vai looks quite fit and healthy. He is not obese and he doesn’t have a bulging abdomen with truncal obesity. He is a conscious man and understand healthy eating and lifestyle. Sohail vai is an example of another successful, highly intellectual typical Bangladeshi Australian who has minimum risk factors of coronary artery disease and yet in a relatively young age he had a massive heart attack. I can still recall the number of friends and relatives I have lost over the last few years from a heart attack, this treacherous thing that ruins the lives of many people prematurely. My mother had heart attack last year when I was thousand miles away as I sat there in agonizing pain. Time passing by, a restless night it felt, without being able to offer any help though my normal day that begins with treating patients who are sufferers of heart attack, though over the years, probably I have saved hundreds if not thousands of lives from fatal heart attack.

How common is heart attack in the Indian subcontinent?

Unfortunately, coronary artery disease (CAD) in the Indian subcontinent is quite prevalent in relatively young age. Usually they don’t get focal coronary (artery supplying blood to the heart) stenosis. They generally have diffuse coronary artery disease which is very difficult to treat.

Compared to the general population in the United States, the prevalence of CAD in Asian Indians is approximately 4 times higher and remains a leading cause of death. The consequences of atherosclerosis in the Asian Indian populations (including in Bangladesh) tend to be more severe and develop earlier in life. While total cholesterol and LDL cholesterol (atherogenic bad cholesterol) levels are similar to whites, HDL (cardio-protective good cholesterol) levels are lower, triglyceride (TG) levels are higher and other lipoproteins such as lipoprotein (a) are also higher. Aggressive statin therapy can significantly lower LDL levels, modestly decrease TG and elevate HDL cholesterol and thereby stabilize atherosclerotic plaques.

I was reflecting over this devastating event. I am probably like many of my friends and relatives from the Indian subcontinent who may not have traditional risk factor for a coronary artery disease yet we are at very high risk of premature heart attack and sudden cardiac death which is in many cases quite preventable by smoking cessation, active healthy lifestyle and diet.

  • Increased physical activity is related to reduced risk of cardiovascular disease and has a beneficial effect on a variety of lipid and lipoprotein variables. Despite the fact that there is a clear beneficial effect on the HDL cholesterol concentration and improvement in triglyceride concentration, exercise training has no significant effect on the total cholesterol or LDL cholesterol concentrations. Low HDL-C is an important risk factor for coronary heart disease, stroke and even small increases in HDL-C may confer substantial benefit.
  • There is a strong and graded relation between number of pack years smoked and risk of myocardial infarction. In a study found that, smokers had HDL-C levels of 15–20% lower than nonsmokers. HDL-C levels returned to normal within 30–60 days after smoking cessation.
  • Limit the amount of saturated fat. Foods that are high in saturated fat include meat pies, sausages, butter, cream, hard cheese, cakes, biscuits and foods that contain coconut or palm oil. Eating foods that are high in unsaturated fat can help to reduce cholesterol levels. Foods high in unsaturated fat include oily fish (such as herring, mackerel, sardine, salmon), avocados, nuts, and olive oil.
  • Lowering salt intake can reduce the risk of a further heart attack and also of other cardiovascular diseases.

That means most of our traditional diet is very attractive for stimulating our taste buds but has tremendous negative consequences in our cardiovascular health. I remember I was making a cup of tea when one of my colleagues (who is a professor of preventive cardiology) joined me in the queue. I offered him a cup of tea with a spoon of sugar. He looked at me, surprised and asked me “Atif, would you take poison even if it is sweet and tasty?” I answered, “No, definitely not”. He said sugar is a poison, a slow acting poison.

Like many other Bangladeshi Australian I like to indulge my favorite dish in a transitional party. My wife enjoys the attention of her new Shari in Facebook, my children loves the company of their friends while I too am exhilarated to see my own friends while indulging traditional food.

Once my wife invited few of my friends. She was very excited and decided to do some more shopping. As if she already hadn’t done enough. She loves the flavor of GHEE in her POLAO, the taste of ready-made PARATA soaked in cheap palm oil like the rest of us. How couldn’t we? She likes the flavor of coconut oil in her newly learned THAI recipe and to put some additional oil and butter to add taste to treat our distinguished guests. I didn’t want to hurt the emotions and excitement of my wife. I didn’t give her a lecture on healthy diet. I didn’t tell her that those indulgence and tradition foods were killing us prematurely as we dived into it. I did not lecture my wife on Mediterranean diet though a number of studies suggested that the Mediterranean diet can modestly lower LDL and triglycerides, as well as raise HDL cholesterol.I did not tell her that diets with low saturated fat reduce cholesterol 5-10%.

But for once, for a change, today I thought I should.

And to all those readers who are embarking this journey with me, I am sorry I could not fulfill the amount of pain and distress I felt on that night or finish writing this story as I have to immediately go to a party. I can taste the mouthwatering traditional food as I write this story but I must go to the party right now. Again.

Dr Atifur Rahman Zarin

Dr Atifur Rahman Zarin

Associate Professor
MBBS FRACP FCANZ
Interventional Cardiologist
GC Heart & Specialist Centre

15 comments

Write a comment
  1. Mohiuddin
    Mohiuddin 3 December, 2017, 01:58

    Nice and helpful. What about mustard oil and soya bean oil.
    Tell the name of some Bangladeshi fish which contain unsaturated fat.

    Reply this comment
    • Atifur Rahman Zerin
      Atifur Rahman Zerin 3 December, 2017, 12:05

      Fish oils contain the omega-3 fatty acids. The oil content in the various species of fish varies widely. The most widely available dietary source of onega-3 fatty acids is found in cold-water oily fish, such as salmon, herring, mackerel, anchovies, and sardines. Fish oil is highly effective in treating hypertriglyceridemia. Unfortunately, there is no known study on most of the common Bangladeshi fish (as far as I know), but generally speaking most of the cold water oily fish is likely to be effective.
      Similarly, most of the vegetable oils (including soya bean oil, not sure about mustard oil) has been recommended for everyday use. Coconut oil is not recommended.

      Reply this comment
  2. Annon
    Annon 3 December, 2017, 04:24

    Thanks for insightful article vai! We need to infuse an openness towards fitness in our Bangladeshi community. If we do it, our kids will follow and hopefully one day staying fit will become a norm in the generation of our grandchildren.

    Reply this comment
  3. Khaled
    Khaled 3 December, 2017, 05:54

    Great writing Zerin Bhai…and very timely too. Thanks for sharing your thoughts.

    Reply this comment
  4. Neela
    Neela 3 December, 2017, 11:33

    Really inspiring.Great writing Zarin Bhai

    Reply this comment
  5. Atifur Rahman Zerin
    Atifur Rahman Zerin 3 December, 2017, 12:06

    Fish oils contain the omega-3 fatty acids. The oil content in the various species of fish varies widely. The most widely available dietary source of onega-3 fatty acids is found in cold-water oily fish, such as salmon, herring, mackerel, anchovies, and sardines. Fish oil is highly effective in treating hypertriglyceridemia. Unfortunately, there is no known study on most of the common Bangladeshi fish (as far as I know), but generally speaking most of the cold water oily fish is likely to be effective.
    Similarly, most of the vegetable oils (including soya bean oil, not sure about mustard oil) has been recommended for everyday use. Coconut oil is not recommended.

    Reply this comment
  6. Zaman
    Zaman 3 December, 2017, 12:41

    Great article Dr Rahman. What could I say!! I have also lost few of my friends in their early age because of heart attack. Like your friend I had to take shelter in your cath lab without having much risk factor. My main risk factor is I am Bangladeshi. I pray for myself and others so that we can develop awareness about healthy diet habit. I am not against of our traditional dawat party. It is fun and wonderful way to drain our exhaustion which we gather over the week but our traditional food habit must be changed. It is clearly suicidal. Let’s say no to any saturated fat and cane sugar and create protected exercise time at least four days a week. We can organise health awareness workshop in our community. Hopefully Sohail bhai’s incidence would be an eye opener for us.

    Reply this comment
  7. Wazid
    Wazid 3 December, 2017, 13:01

    Great writing Zerin. I am a perffect example

    Reply this comment
  8. Yunus
    Yunus 3 December, 2017, 16:11

    Dear Zerin, Thank you so much for your enlightening article and reminding us about our food habits that increase health risks. Hope our community take note of it.

    Reply this comment
  9. Maksud
    Maksud 4 December, 2017, 06:41

    Thank you Zerin bhai for a very informative article. It is a reminder for all of us and we all should take this advice seriously.

    Reply this comment
  10. Selim
    Selim 4 December, 2017, 12:11

    A very appropriate and timely piece from Dr Rahman’s desk. We must be all aware about coronary risk factors which we have plenty of as Bangladeshis (traditional risk factors are HT, Raised LDL/cholesterol, diabetes, smoking, pos FHx of CAD at age<50, truncal obesity/ lack of exercise).To this we must add regular "dawat" of mouth watering recipies. We can't change our gene but certainly can try to mitigate those so we can to tilt the burden of risk away from us. For a start, we can start daily walk and start healthy eating at home and then extend it to the Dawat recipies. I am sure there will be other suggestions but without further ado lets start somewhere sooner rather than later.

    Reply this comment
  11. Shams
    Shams 4 December, 2017, 12:12

    A very appropriate and timely piece from Dr Rahman’s desk. We must be all aware about coronary risk factors which we have plenty of as Bangladeshis (traditional risk factors are HT, Raised LDL/cholesterol, diabetes, smoking, pos FHx of CAD at age<50, truncal obesity/ lack of exercise).To this we must add regular "dawat" of mouth watering recipies. We can't change our gene but certainly can try to mitigate those so we can to tilt the burden of risk away from us. For a start, we can start daily walk and start healthy eating at home and then extend it to the Dawat recipies. I am sure there will be other suggestions but without further ado lets start somewhere sooner rather than later.

    Reply this comment
  12. Faria
    Faria 4 December, 2017, 14:02

    Thanks a lot bhaiya for the informative article, it really enriched our knowledge

    Reply this comment
  13. Mazhar Haque
    Mazhar Haque 5 December, 2017, 12:30

    Thanks a lot for your timely and excellent article. Just being Bangladseshi as a race , is one of the biggest risk factors for Metabolic syndrome. I see cirrhosis of liver with or without diabetes becoming common among Bangladeshis from fatty liver without a single drop of alcohol. Our modern lifestyle with unhealthy dietary habits need to change if we want to save ourselves from drowning. We need to improve our awareness. We need to promote healthy and right portion food in every Dowat we attend either as a host or guest.

    Reply this comment
  14. Golam
    Golam 9 December, 2017, 13:46

    Dear Dr Zarin
    Pls see below a link to an article I wrote a few years back related to fish oil and health benefits. There are also some info related EPA and DHA (percentage of fatty acid composition) of some selected fish from the Bay of Bengal coastal region
    http://www.sydneybashi-bangla.com/Articles/Golam_Kibria__Consumption_%20fish_Alzheimer_sydneybashibangla_sent_7%20feb%202012.pdf

    Reply this comment

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