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M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal

In the early 1980s, Dr. Enas. A. Enas, a cardiologist practicing in Chicago, decided to dedicate his time and effort to unravel the mystery of coronary heart disease (CHD) in Indian Americans. Working with AAPI (American Association of Physicians from India), he established the CADI (Coronary Artery Disease in Indians) research study and started collecting data diligently, first from Indian physicians during the annual meetings and later from non-physicians. Blood samples were analyzed for cholesterol and other lipid components. He published many papers in prestigious peer-reviewed journals and spoke at medical meetings and public forums to share his findings, warn all Asian Indians of this impending epidemic and how to deal with it.

CADI study became the catalyst for similar studies in USA, England, India and other countries wherever Indians had immigrated. In 1995, British Medical Journal wrote an editorial about “Premature coronary deaths in Asian Indians in Britain” and made a strong appeal, “Spend now on prevention or pay later for treatment.” Based on epidemiological studies, the article concluded that immigrant South Asians share a significantly higher mortality from CHD than the indigenous white population. More frightening is that this increased risk also applies to the second-generation Asian Indian immigrants who have adverse risk factor profiles for CHD.

Based on all his research studies and experiences Dr. Enas has recently published a book, “How To Beat The Heart Disease Epidemic Among South Asians” (by Enas A. Enas, MD FACC with Sudesh Kannan, Ph.D. Grace Printing, Chicago, 351 pages, $44.95, listed on

The book is arranged in three parts. Part 1 is devoted to “understanding your situation.” This section is a true eye-opener and tells you the causes of the disease and the alarming statistics. Although chapters 2 and 3 are a bit frightening – An Epidemic in the Indian Subcontinent and Malignant Heart Disease among Young Indians – the next chapters give you reassuring instructions as to how to predict your own risk, ahead of time and how to treat all those risks. Part 2 is a call for action. It gives you helpful suggestions such as ‘how to prevent heart attacks and sudden death, control the risk factors which can be controlled and, for those who already are suffering from a cardiac ailment, how to live with it.” Part 3 discusses modern drugs, devices, nutrition and many other emerging issues.

Dr. Thakor G. Patel, chairman, Public Health Committee of AAPI, had these comments about the book: “Dr. Enas's book titled ‘How to Beat The Heart Disease Epidemic Among South Asians’ is an excellent resource book for all doctors who take care of Asian Indian patients. This is probably the first book of this magnitude with tables and short annotations for quick reference I have seen for a very serious condition that affects us out of proportion. The book highlights treatments of hyperlipidemia in very specific terms and has given levels of Total Cholesterol, LDL, HDL and Triglycerides for our community to strive for. His outlined measures for preventing heart disease and management strategies will help curtail the very high rates of deaths due to coronary artery disease. This book is a must-read for all of us.”

In general, every chapter is thoroughly researched and written with clarity. All technical terms are explained, which make it easy for reading by non-medical personnel as well. Many myths such as "Vegetarian diet may protect the hearts, "Indian women do not share the same high rates of CHD," "Low total cholesterol means you are OK," "If you don't have traditional risk factors like high blood pressure, diabetes or smoking, you are relatively safe," etc. are dispelled. CHD among Indians is properly classified, causal factors are clearly explained and a proper treatment pattern charted out. In other words, this book is a true road map for all South Asian descendants to lead a healthy life. In case you already have the disease, don’t lose heart. Life after heart attack and “reversing the heart disease” are discussed well in chapter 7.

Dr. Michael Davidson, professor of medicine and a world-renowned researcher in preventive cardiology and atherosclerosis, writes in the forward: "A book of this breadth and trenchancy is a 'must-read' for all physicians who treat people from the Indian subcontinent. But it is not a guide for Asian Indians only. It is also for those of us who share these all-too-common genes that predispose some people to premature, malignant heart disease."

This book is the culmination of a quarter century of painstaking research and clinical experience from a practicing cardiologist. The actual case histories of 25-year-old Jagdish who had a heart attack and later died while awaiting cardiac transplantation and 39-year-old Patel whose CHD was so advanced and inoperable by the time he came to the doctor and he died five years later, are truly mind boggling. An experienced clinical cardiologist and a masterful storyteller, Enas has added so much of his own personal insights to support his hypothesis. This has made the book a veritable delight to read.

“I need to create global awareness about this catastrophic epidemic among Indians,” Dr Enas told me when he was writing this book. “CHD in Indians is quite different, it tends to be premature, very severe and robs the life of our brothers and sisters in the prime of their lives. But the important thing to remember is, it is highly predictable, preventable, treatable and even reversible,” he said. Hopefully this impressive, authoritative and thought-provoking book from one of the finest researchers on the subject will convince all Indians that indeed we all are at risk. “Initially, the idea was a hard sell even to the medical community here. But now the idea is catching on,” he added.

"How To Beat The Heart Disease Among South Asians " is a good book for understanding, managing and preventing heart disease and living longer, for Indians. Every person of Indian origin should read and understand the book. Can you afford not to read it?

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

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