I lost my uncle on Tuesday night. It happened around the same time I was teaching a group of health care students about obesity as part of an expert panel. During the panel, I implored the students (a mixture of pharmacy, nursing, OT, PT and medicine) to always treat the patient in front of them and not to follow BMI alone.
I reminded them that risk groups like South Asians and East Asians have cardiometabolic risk at a lower BMI.
My uncle had no symptoms of cardiac disease, up until about a week ago, when he began having some chest pain following exercise. He had recently contracted influenza and developed a terrible cough which had confused his interpretation of the chest pain symptom. He appears to have died from a massive myocardial infarction ( heart attack).
He had a family history of cardiac disease and a “normal” BMI. He was also of South Asian ethnicity.
He was 54 years old.
In between my grief and shock, I have reviewed in my mind how we could have known.
With this in mind, I want to review what we should be monitoring when it comes to cardiometabolic disease. ( I am using the broader definition of cardiometabolic disease, defined as the interface between cardiovascular disease and diabetes).
1) Blood pressure. Hypertension or high blood pressure increases your risk.
2) Family History. This includes history of sudden cardiac death or cardiac disease at a young age. Family history of diabetes.
3) Fasting blood glucose (sugar) to monitor for early signs of diabetes or insulin resistance. (Other tests may be indicated)
4) Ethnic background. Some groups are just at higher risk depending on the disease process.
5) Waist circumference and BMI. Waist circumference is a good indicator of visceral fat which is the most dangerous. Remember, BMI may be in the normal range for South Asians or East Asians. For this group waist circumference is a better indicator.
6) Liver enzymes to indicate NAFLD or non alcoholic fatty liver disease.This disease process shares risk factors with cardiometabolic disease and is a red flag.
7) Fasting cholesterol including HDL, LDL, and triglycerides.
8) Smoking and excessive alcohol consumption.
Look for any symptoms of myocardial infarction, stroke, or diabetes. These are amongst the leading causes of death in the world. Cardiovascular disease is number 1.
Here are the warning signs of stroke.
Here are the symptoms of diabetes.
Here are the symptoms of heart attack or myocardial infarction.
Here is information for women and heart disease.
Please do not ignore any major changes to your health. It is easy to explain away signs and symptoms. It is always better to be evaluated by a health professional. A yearly evaluation is also a prudent step to ensuring that you are aware of what your risk is.
None of this can bring back my uncle but if it helps even one person get the proper evaluation and treatment then disclosing this will have been worth it.
Please share this with your loved ones.