The Iyer Clinic Update

I have been a physician for 41 years and there is one question I ask of people who come to see me. “Why do you go to see a doctor?” Over the years I have received many answers to this question. But the best answer I have ever gotten came from a retired Army Colonel, Joe Bellino. Joe was one of my first patients when I started practice. He was of Italian descent and he would talk non-stop. Joe came to see me because he said that he was getting short of breath. So I examined him, did all the tests, EKG, stress tests, listened to and imaged his lungs. Joe passed every test in flying colors. Finally, I sat down with him and said, “Joe all your tests are perfect.”

“Then why am I short of breath Doc?”, Joe asked.

I paused and hesitated, then I gently suggested,” Maybe Joe, it is because you don’t stop speaking to breathe.”

Joe looked at me seriously for a long moment. Then broke into a smile. “You know doc? You are alright in my book.”

When I asked Joe my question about why he came to see me. He said, “Because you know me doc. You know me in ways that even I don’t know me, and that counts for everything. That is why I come to see you instead of anyone else.”

Joe’s answer reminded me of something my mentor, Dr. Stanley Talpers, once told me. Being a physician is to become a custodian of your patient’s life. You are doing an apprenticeship on his soul. You will know them in the most intimate of ways. Ways even their spouses cannot lay claim to. Indeed, the physician who does not understand this is no physician at all, and the patient who casually changes their physician is executing the most profitless of decisions in their life.

This deep interpersonal relationship I enjoy with my patients is the reason why I choose to divide my time between my Herndon and my Stone Springs office, why I do house calls from time to time even in this day of Nurse-Practitioner-swollen practices, and why my patients can directly reach me via email or cell phone to address their problems. My patients know me and I know them.

If the name of the doctor who is treating you is not Dr. Iyer, then you are not receiving Iyer Clinic care.

… Ravi Iyer, MD

South-Asians in America are nearly twice as likely to die of Heart Disease! Here’s Why!

A study by the Beth Israel Lahey Medical Center in Boston showed that on average, South Asians develop coronary artery disease up to 10 years earlier than the general population. There is a 40% higher chance of death from heart attacks among South Asians than the average population. Stroke related deaths for South Asians are 55% higher.

Here are some very sobering facts.

• South Asians have the highest hospitalization rate for coronary artery disease, four times higher than any other ethnic population.
• South Asians are at higher risk for Type 2 diabetes, up to 6 times more likely to have type 2 diabetes than the general population.
• In South Asians, diabetes and insulin resistance affects up to 20% of the population.
• 25% of heart attacks occur under age 40, and 50% occur under age 50.
• On average, South Asians develop coronary artery disease up to 10 years earlier than the general population.
• There is a 40% higher chance of death from heart attacks among South Asians than the average population.
• Stroke related deaths for South Asians are 55% higher.
• South Asians have a high prevalence of Chronic Kidney Diseases (CKD) and a faster progression of CKD as compared to other ethnic groups.
• According to the World Health Organization (WHO) report, by 2020, South Asians comprise 25% of the world’s population but will suffer over 50% of the world’s cardiovascular deaths.

In America, South Asian s belong to among the most prosperous demographic group. In 2021, the median income for South Asian American households was $120,000, and 72% of individuals over 25 had a graduate degree. The majority of South Asian Americans are tech savvy and work in high-paying skilled jobs, with more than 57% owning their homes.

So while this group is often immensely successful, the high prevalence of cardiovascular and cerebrovascular disease along with the high rates of death below the age of 50 means that a lot of them are being cut down in the prime years of their life before they have the opportunity to reap the rewards of their success in full measure.

What is the reason for this tragic health outcome?

The reasons are 3-fold: 1) Genetics; 2) Diet; 3) Culture

GENETICS

South Asians in America have some of the HIGHEST rates of early cardiac disease! This is due to several findings:

Studies generally indicate that South Asians have smaller coronary arteries compared to Caucasians. Here's a breakdown of the findings:

Diameter differences:

• Left main coronary artery (LMCA):

Caucasians have a larger LMCA (21.2 ± 6.5 mm2) compared to South Asians (16.8 ± 5.4 mm2).

• Proximal LAD luminal diameter:

South Asians have a smaller diameter (1.56 mm/m2) compared to Caucasians (1.72 mm/m2).

• Overall diameter:

Studies have found statistically significant differences in the mean diameter of the LM, LAD, LCx, and RCA in Asian-Indian patients compared to whites.

Other findings:

• South Asians have smaller body surface areas than Caucasians.
• South Asians have higher noncalcified plaque composition, elevated thrombosis, and inflammatory markers.
• South Asians demonstrate more severe CAD compared to Caucasians, with smaller proximal LAD luminal diameters, higher mean percent stenosis per vessel, and more patients with multivessel disease.

The real culprit is injury to the lining of the blood vessel. This is due to mechanical stress (example, High BP), chemical injury (example, high energy radicals and toxic oxidative products present in high carbohydrate and fast food diets or very high circulating blood glucose level in diabetics), or bacterial injury due to recurrent episodes of infectious agents entering the bloodstream (example chronic dental disease resulting in low levels of bacteria entering the bloodstream or systemic inflammatory disease such as psoriasis, inflammatory colitis etc.).

All of this results in significant stress to the blood vessel lining (also called vascular endothelium).

The body responds to this stress by attempting to layer cholesterol over the irritated lining in an effort to soothe the injury. This is analogous to your grandmother applying fat to your burnt hand to soothe the hurt.

Except that successive layers build up over time when the processes producing the injury persist.

Because South-Asian individuals have vessels that are already of smaller diameter to begin with, so it does not take much to produce a critical narrowing and this narrowing occurs in South Asian individuals at normal cholesterol levels

At The Iyer Clinic, we aggressively screen for modifiable risk factors and initiate mitigation efforts even at mild levels of diabetes or mildly elevated cholesterol levels because the South Asian population is at so much higher risk of accelerated early cardio-cerebral disease.

There is nothing more gut-wrenching than trying to find words to console a 40-year-old mother with two preteen kids, why her husband is no longer with them.

NEXT ISSUE: UNDERSTANDING YOUR DIET WITH RELATION TO YOUR HEART

Fall is here and with the last long weekend of summer of Labor Day coming around the corner. It is time to dust out the closet, air out the fall and winter jackets, and get ready for the final 4 months of this year. Here are some simple tips to ensure that you have a wonderful ending to a great 2024.

1) Physicals & Weight Management

Now is a great time to get your physical done. It will allow you to plan your health strategy for the year ahead in ways that are far more likely to achieve measurable outcomes.

Ever since we started our Body for Life Weight and Metabolism program in April 2024, nearly 40 members have enrolled in the program and have lost collectively in excess of 800 pounds of weight in about 3 months! Every one of their metabolic numbers with regard to their cholesterol, diabetes and cardiac risk factors have improved to the level that some of them were able to stop or reduce some of their medications.

Call our office to see if this program would be good for you.

2) Shoot into Health!---- Get your Shots updated. Flu shots will be available in September at the clinic. Regarding COVID boosters, my approach is nuanced. Patients who have major risks are advised to get their COVID boosters when available. For the rest, I advise coming into the clinic and having your antibody levels checked. If the titres are high then you can choose to postpone the shot if you wish.

Shingles shot, Pneumonia, Tdap are recommended for everyone.

3) Get your Screenings: Be sure to get your Mammogram, Bone Density and Cologuard screening done. Walk into our office any day and we will print the orders out for you.

The Iyer Clinic is one of the few primary care centers in Loudoun Medical Group that offers retinal vascular evaluation as part of routine diabetes care. This is because this important screening tool has been so effective in increasing compliance with diabetes control. There are few statements more impactful than showing someone a picture of what diabetes is doing to the blood vessels in their eyes and seeing them realize that the same process is probably occurring in their hearts, kidneys and brain too.

Call us at 703-404-5900 or shoot an email to claudia.cruz@iyerclinic.com to request an appointment.

Wishing you a Happy Fall and the rest of the year leading into the Holidays.

… Ravi R. Iyer, MD

As your doctor and medical team, we are your first line of defense and your best offense against illnesses. Be it something as mild as a common cold or something as serious as a cancer screening, we are committed to providing you with the best medical treatment possible. Internal medicine is the branch of medicine that specializes in the prevention and management/treatment of a wide range of adult diseases. And our clinic at Herndon is equipped with advanced medical equipment and experienced staff to provide you with fast, reliable, and compassionate service. In addition we routinely facilitate and coordinate your care with a wide cadre of specialists who we use when more complex care is needed.

As proud partners of Loudoun Medical Group, we are one group that offers every patient access to a world of infinite possibilities. LMG Ancillary Services are designed to strengthen and streamline patient care, reduce costs and support The Iyer Clinic as they help our patients lead healthier lives. Learn more now!