Ashish Mathur NetIP (Network of Indian Professionals) Interview – Heart Diseases and their Prevention Tools for South Asians
NetIP Spotlight: Live Your Potential is a monthly show featuring experts on trending topics.
“Heart Diseases and their Prevention Tools for South Asians”
Jasbina Ahluwalia interviews Ashish Mathur
Jasbina interviews Ashish Mathur, Co-Founder and ED, South Asian Heart Center at El Camino Hospital.
Ashish Mathur will discuss the following topics:
- The widespread nature of heart attacks and diabetes among Indians
- Which tests are needed to identify and predict the risk of heart diseases
- Why the South Asian Heart Center is encouraging young adults to join the “AIM to Prevent” program
Ashish Mathur is an enterprise software executive with over 25 years of industry experience in developing software products from early phases to successful market introductions.
Mr. Mathur has a winning track record in building and leading customer-focused and results-oriented teams through multiple initial public offerings, mergers and acquisitions. He is the co-founder of Juststudents, Inc. and serves as the Chairman of its Board of Directors. He has served on the Board of Directors at Encover, Inc. and is currently an Advisor on the Board of Directors at Scalable Network Technologies.
Most recently, Ashish served as Executive Vice President of Worldwide Professional Services at Selectica, Inc. from 1997, where as an early member of the Selectica founding management team he helped build a 500-person global software consulting services organization with multiple offices in US and Canada, Europe, Japan and India.
Prior to joining Selectica, Ashish served as Vice President of Worldwide Professional Services for Pure Atria Corporation from 1991 to 1997. He also served as Engagement Manager for European and Japanese Telecommunications Software Projects for Teknekron Communication Systems, Inc. from 1990 to 1991, as Engineering Manager of Network Management and Broadband Products at Network Equipment Technologies and Adaptive Corporation from 1985 to 1990, and as a Software Engineer for ROLM Corporation from 1982 to 1985.
Ashish holds a B.S. in Electrical Engineering from the Indian Institute of Technology and an M.S. in Computer Science from the University of Southern California.
(00:47): Hello everyone. Welcome to NetIP Spotlight Live Your Potential where we invite guest experts to speak on a variety of trending topics that matter to you. I’m Jasbina Ahluwalia, your host. I want to warmly welcome you to our show this evening. I know everyone’s crazy busy these days and I appreciate you investing your valuable time in joining us this evening.
To give you a lay of the land, our guest speaker and I will be discussing his insights for about 20 minutes. After about 20 minutes of discussion between the guest speaker and myself, you will have the opportunity to ask him any question that you may have. With that said, let’s jump in. Today’s guest speaker is Ashish Mathur, Co-Founder and Executive Director of the South Asian Heart Center at El Camino Hospital.
Ashish is passionate about prevention and has made it his mission to raise awareness and educate the South Asian community on the epidemic of heart disease and diabetes. Under his leadership, the Center has been recognized as an Asian hero by the County of Santa Clara and has received special distinction from the U.S. Congress. Developed as a guidance, the South Asian Heart Center’s AIM to Prevent program is a unique offering to help community members determine their chronic disease risk based on advanced assessment, lifestyle-based intervention and coach-based management.
Since its establishment in 2006, the Center has screened 4500 participants, trained 800 physicians and published and presented at both the American College of Cardiology and the American Heart Association. Prior to leading the non-profit efforts of the center, Ashish was an enterprise software executive with over 25 years of industry experience in developing software products from early phases to successful market introductions. Welcome to the show, Ashish.
(2:42): Thank you so much. I’m so excited to be here.
(02:45): It’s exciting to have you on. What really led you to co-found the South Asian Heart Center?
(2:53): It was just a series of coincidences, really. It started when I had my heart attack at the age of 44. It completely came to me as a surprise and shook me up. I was a software executive at that time, and building my career. I had done a lot of startup companies. The stress of all of that took its toll. My genetics played out, and I had a heart attack.
When I did, it really shook me up. I was so scared. I tried everything, every book that’s written on heart disease and all of that. I was really scared about the next one. In that journey in reading all of this material, I found out that South Asians, Indians in particular, have this heightened risk for heart disease. It’s very telling when their parents or immediate family members have had these issues at the younger ages, that you are very likely to have them.
Part of the journey was also to read up about what you can do about it, what additional things you can do to go beyond normal testing that happens in order to look for your risk. For two years after the heart attack, I really spent time focusing on myself, and focusing on what I should do. I found that, as I started making changes, my friends started making changes. They were already cognizant when I went to meet up with them or at parties at their homes.
They would always cook something special for Ashish because of my condition. I felt that if this is having an impact on my friends’ circle, why don’t we take it beyond that and see if the community is really affected and would be open to doing something about it as well.
Luckily for me, I live close to El Camino Hospital, which is here in Mountain View, California. They were looking at this issue in the emergency room and were finding out that one out of five people who showed up in the emergency room with a heart attack was an Indian in a population that was only 3% Indian, so it was a real health disparity that was staring them in the face.
I happened to attend the very first talk on the subject at El Camino Hospital. I felt that if the hospital was interested in doing something, I was ready to plunge in and create the program for them and build it up. That’s what happened in 2006. Five years from when I had my heart attack, I had co-founded the South Asian Heart Center. We brought together a bunch of physicians and people in the community to participate and we created the program that now is helping thousands of Bay Area residents, and also people outside the Bay Area.
(6:30): That is so inspirational. Those numbers you gave out are astounding, when you say the one in five. From what you’re saying, I understand that heart attack and diabetes tend to be widespread among Indians. You had mentioned stress and genetics. What are the reasons for this heightened risk for Indians? What have you discovered about that?
(6:56): It’s kind of the perfect storm of genetics, lifestyle and the environment that puts us at a higher risk. Our medical director at the center always says, “The genes load the gun, but the lifestyle pulls the trigger.” It’s clearly the case with South Asians. It’s truly a combination of fate, chance and choice. The genetics predisposes you to a higher risk. The environment helps and organization has helped accelerate this for a younger population.
The lifestyles that we lead, and predominately two aspects of lifestyle that was found in the inter-heart study, show a significant difference between Indians and others. This was their sedentary lifestyles, and their being vegetarian but not eating vegetables. There is a grain-based vegetarian diet versus a vegetable-based diet. We have focused our energy at looking at lifestyle as a way to address this epidemic and to change the course of this epidemic.
(8:24): For people who are listening to these numbers, is there any test out there that could help them identify or even potentially predict the risk of getting heart disease? Which tests are needed to identify and predict the risk?
(8:44): One statistic that I want to throw out is that 50% of the heart attacks are not explained with traditional testing, the normal lipid panel, and the cholesterol testing that you do. They fail to explain 50% of the heart attacks. That is a very large number. A heart attack is usually the first symptom of something being wrong and very often fatal. In South Asians, you’re twice as likely to die of a heart attack compared to other ethnicities, and twice as likely to have a recurring heart attack if you survive the first one.
All the odds are put against you and I feel it’s a miracle. It’s been 13 years since my heart attack and I’ve continued to live on and be able to successfully ward off another heart attack.
(9:48): That’s so interesting. It really is defying some odds, two times as likely to die from a heart attack and three times as likely to have a heart attack recur if one survives one. Did I hear that right?
(10:02): Exactly. I haven’t even told you about it affecting younger populations. Twenty-five percent of the heart attacks occur in people less than 40 years of age.
(10:18): Less than 40, one in four.
(10:24): It is one in two to adults less than 55 years of age.
(10:31): That is 25%. Okay.
(10:32): Yes. In this country, the average age for the first heart attack is 65 years for men and 70 for women. It’s really a progressive disease in South Asians and occurs much earlier. I often see fathers bringing their young sons or daughters into the ER with heart attacks. It’s very difficult for a parent to witness a heart attack in a young son or daughter. That’s what we get to see all the time.
(11:14): Given these sobering statistics, I would love it if you would share what the AIM to Prevent program is about. Tell us more about that. It sounds very heartening, so tell us a little bit more about that.
(11:31): I’ll start by giving you a statistic, and that is, 80% of heart attacks can actually be prevented through lifestyle changes. This was a very late-breaking story that just came out within the last two months. There have been so many lifestyle studies that have been done and shown to show the positive effect of lifestyle changes, even in older ages. If you start exercising at the age of 45, you’ll see a benefit of that in longevity, production and chronic disease.
That’s the heart and soul of our AIM to Prevent program. Our AIM to Prevent program that we’ve created is a very carefully crafted and unique program for Indians. AIM is an acronym for Assess, Intervene and Manage. It’s been put together for primary prevention. We are really targeting young South Asians, young Indians, to undergo this program early in life starting at the age of 18.
(12:42): You’re starting at 18, wow. Okay.
(12:44): At the age of 18, yes. Normal cholesterol testing in this country is done at the age of 45 and we know that 30% to 40% of heart attacks in Indians would have already occurred by then. It’s moot to really go in for cholesterol testing at the age of 45. We start seeing the genetic markers as early as 18 years of age. Specifically, the really deadly combinations of some lipid proteins, one of them is LPA. In the assess phase, our hope is to take you through three sets of assessments.
One is the advanced laboratory test that includes markers beyond the normal lipid panel. We also do a full assessment of your personal history, your family medical history and your lifestyle habits and history. We are focusing on the areas that could raise your risk of heart disease or diabetes. We also do a brief physical to look at your blood pressure, heart rate and height and weight, giving a BMI, which is a good measure of one of the risks as well.
That’s the assessment phase. We then follow it up with a personalized report. The report is presented to you in the form of an iceberg. It actually shows the tip of the iceberg, which consists of the traditional tests that you get done at your physician’s office. Then underneath the iceberg, underneath the surface, are all of the hidden risks with all of the special markers that we look at for Indians. One marker is LPA. LPA is Lipid Protein A, which is heightened and elevated in South Asians. It is a genetic marker that multiplies the risk.
If you have an elevated LPA because of your genetic history, and you have one health risk factor, then your risk is multiplied seven times. If you have two risk factors, let’s say for example you also have high blood pressure, then your risk is actually 32 times. If you have three risk factors, then your risk is multiplied 122 times. Very often, because we don’t know about the status of LPA, we aren’t able to correlate your risk very easily just through the lipid panel or the cholesterol testing that’s normally done.
LPA is a key marker. When we started with the South Asian Heart Center, there was a lot of controversy around the LPA but now uniformly, everyone is looking at LPA as a marker. There have been several new studies that have been done and have correlated the risk and the more explicative aspect of the risk with LPA. That’s a good marker to check for.
(16:04): With LPA, is the test for that a blood test as well? Is it a specialized blood test?
(16:12): Yes. It’s a blood test. It’s not a swab or a genetic DNA test. It’s just a blood test. You can’t really change your LPA much because it’s genetically determined but then we’ve become very aggressive about looking at all of the other risk factors and bringing them down to normal levels. If your blood pressure is elevated, we really want to first try to bring down your blood pressure. That’s a key thing.
Or, if you are hovering or you have family members who have diabetes, then we have become very aggressive on the lifestyle associated with reducing your risk for diabetes. That’s going to multiply your risk for heart attack. The LPA is one marker. We also look at other genetically driven markers. They are what is called particle sizes and particle numbers.
Every LDL and HDL is actually split up into different sized particles. The size matters. If they are small LDL or bad cholesterol particles, they are more atherogenic. You can understand or envision the interior walls of the arteries being like a sieve. They are porous and let particles through that build the plaque. Then what you’ll see is the smaller particles are more likely to go through than larger particles.
We look at this as a repackaging issue. In order to reduce your risk, we will work on lifestyle that helps you repackage your LDL from small dense particles, to the large buoyant particles, which are less atherogenic. At the same time, HDL which is the good cholesterol, is also is sub-divided into different particles. Again, this is genetically determined. However, you’re able to repackage those. You’re able to get large, buoyant HDL particles to be the predominant ones, which are protective.
In just looking at your HDL number, you may have a good HDL number, but it may not be the kind of particles that are protective. In Indians, we find that. We test for those, and the good news is that there are two lifestyle changes. We are able to repackage them and get them to the right size and number. That’s the genetic aspect that we look for.
We also look for inflammation. Inflammation probably explains the heart attacks that are not explained through just looking at cholesterol. It’s a very important factor, so we pay special emphasis on that and we test that. This test actually can be done and is done by a lot of physicians as well. It’s called the VIP test.
Then we look at markers for diabetes. We look at insulin resistance. We look at your Hemoglobin A1C, your fasting glucose and your fasting insulin. That gives us a good idea of what your metabolic disorders are and whether you are prone or pre-disposed to this metabolism. We’ve found as a matter of fact as we’re looking at the numbers at the center itself, that combination of fasting insulin, fasting glucose and Hemoglobin A1C is actually very telling or CT scans that we see of individuals where we see the plaque buildup.
It becomes very important to test for that. That’s our assessment phase, the “AIM” of the AIM to Prevent. Then we wind up with the “I” part, which is the intervention or the Intervene. In that intervention, we focus on lifestyle. Our focus on lifestyle is what we call Lifestyle MEDS for medication, exercise, diet and sleep. We have expert counselors who will actually go through and look at how you fare.
They look at what your lifestyle habits are, with these four factors and areas, and help you with getting the Lifestyle MEDS incorporated into your lifestyle. For example, I’ll take the exercise and diet, which is the middle part of the MEDS program. Most people can relate to exercise and diet. They understand that if I change my exercise, it’s going to help me, or if I change my diet it’s going to help me.
We have a dietician who will actually counsel you. The difference is that our counselor is South Asian, so if you have a predominantly South Asian diet, an Indian diet can be varied from the North to the South and the East and the West. You don’t want to change your diet radically as you go forward. You want to stay within the confines of the normal diet.
If you are from the South, you’re not going to be changing that very easily. It’s going to be very difficult to get oatmeal into your diet or other things that we know are cardio protective. We try to focus on the things that you eat and try to bring about changes within that. For example, we may ask you to mix a few things up or look at what goes inside your masala dosa. We may mix it up with some more vegetables and things like that.
With baby steps, we try to move you from things that are less cardio protective. In the diet, carbohydrates and greens end up actually causing a lot of havoc for South Asians. Our intent is to get them to more protein-based sources, looking at the healthy fat, and looking at carbohydrates but looking at the complex carbohydrates and ancient grains that you can incorporate to help you with making the change there. Our dietitian can help you with that.
Then our exercise physiologist will work with you on the exercise front. In our fitness consultations, we have introduced phone-based fitness consultation as well so you can understand how you can incorporate strength training, which is very sorely missed by South Asians. They understand cardio. They become weekend warriors and do hikes and those sorts of things, but they do not do the strength training, which is very important to reduce the risk of diabetes and cardiovascular disease. That’s the exercise physiologist. Then we have medication teachers who will orient you on medication.
Starting in December, I’m going to start teaching a rest management class that will incorporate both sleep and meditation as a way to de-stress your life. Those orientations are provided as part of the intervention and recommendations are made. Finally, the “M” phase which is “manage,” is the most important phase to us. It is how you manage the interventions and how you incorporate these lifestyle changes.
The coach is assigned to you to help you with that for one year. They look at the recommendations we make and then help you monitor your progress through these recommendations and motivate you through making these changes.
(24:38): Wow, Ashish. That sounds like an extremely comprehensive approach. If there are listeners who want to get involved and potentially be a part of the AIM to Prevent program, how can they go about doing so?
(24:48): Doing so is very simple. We had planned that by this time we would actually have a link on the website as well so they could just go there, click on it and sign up for the screening. No matter where they are, anywhere in the United States, we will be able to work with them. All of our counseling and coaching is done over the phone and via email. The lab work is done by Quest Diagnostics, which is available in most locations in the United States.
We’ll find a Quest Laboratory close to you and target you there. All you have to do right now to join the program is come up on our website and sign up for the AIM to Prevent program and there’s a bunch of questions you have to answer. It’s just a one-page form. You answer that fully. Then we’ll call you and schedule the appointment.
(25:47): I can completely appreciate the motivation for you starting such a high impact non-profit here. I’m wondering if you might have any guidance to our listeners who likewise have a cause they’re passionate about and they also want to found an institution or non-profit to really address that cause and issue. Is there any guidance you might have based on your personal experiences?
(26:19): Absolutely. I think you already mentioned the word “passion.” I think that is the prerequisite. I gave up my software career for a healthcare career essentially because I made that switch. Many people call me “doctor” just because I’ve co-founded the South Asian Heart Center, but I am not a physician by profession. However, I was passionate.
Let me give a short story on that. I had the heart attack and it had affected me. However, it actually took someone from within the community to come to me and say on my birthday following my heart attack, “We’re so glad you’re still with us.” That’s kind of what shook me up. I said, “Perhaps there is a reason for me to actually still be here.” That was when I started thinking about doing this and getting it going.
The passion is really important, I think. If you have it, that’s 80% of it. You’re already there. The second part of it is that you have to treat that non-profit like you are starting a startup. It’s no different than if you are creating a for-profit startup or a not-for-profit startup. The effort is the same. The thinking is the same. You have to worry about the need. Is there a need for your product or service? You have to be in and about establishing that need if there isn’t one.
We know there is a need for the South Asian Heart Center, but people do not believe the need. Very often, the young people don’t think this is a need for them. We have to convince them of the need and get them going. It takes many sessions, sometimes a year, to convince them to join the program. We’re successful because we’ve been able to be persistent with the message within the community.
That’s the second thing, to treat it like a startup, establish the need. Establish a product or a service that others are not offering. You have to be unique. The product has to be unique and address the problem completely. You mentioned the word “comprehensive.” For us, AIM to Prevent is that product or service that is completely comprehensive. If you are an Indian, you don’t need to do anything else. You just need to do this.
This is because we’ve married the state of the art, looked at everything that we could possibly test and then put it together in a program. It’s a complete program because the management piece of it is there as well. Very often you would say, “I can go to the doctor and get myself tested and they provide good advice on what I need to do about my lifestyle.” However, what they are not able to do is the follow through. Everyone knows you need to do exercise and eat better. How many actually do implement it after they’ve gone to the doctor’s office?
With us, because there’s a coach, you are in some way forced to think about it a lot more and that’s the edge. That’s the difference. That’s the differentiation in our service compared to other things that are out there. I would say that if you take the example of a startup and what startups have to do to succeed, all of the right things in terms of what you have to do to make your non-profit succeed, if there’s a passion, plus treating it like a startup, will get you there.
Treating it like a startup means you have to get funding and financing. We were lucky in that we associated with El Camino Hospital, which provided the seed funding and continues to provide 50% of the funding for our operation. The rest of the 50% we get from the community. We are offering a service to the community so we ask them for donations and have been successful at raising money through donations.
We provide our program and all of our consultations at no charge to individuals. We only have a $49 processing fee. People also have to pay for the lab work. Everything else is covered. We’re able to offer that with the funding model for our center.
(30:58): Wow. That’s amazing. I really appreciate you sharing your inspirational insights with us, Ashish. I’m wondering if there are any last thoughts or a take-home message you’d like to share with our listeners before we give our listeners the opportunity to ask you questions.
(31:16): It’s come out of a lot of research and 18 years of being here. We look at the four lifestyle factors, meditation, exercise, diet and sleep. We have built some small mantras for them. This is good for everyone, although our AIM to Prevent program is very personalized. We look at your risks and what you need to do, how diet is going to affect you and what exercise program you should have. It’s very personalized. These are four mantras that, if anyone wants to take away and implement them, they’ll benefit from it.
On the meditation side, our mantra is to get into a routine of meditation daily. By meditation, I don’t mean listening to music or reading a book. Meditation is the practice of putting everything aside and, at a minimum, sitting with your eyes closed and doing that for at least five minutes. Twenty minutes twice a day is what we recommend. Even if you get to five minutes of quiet time just by yourself, with eyes closed, that’s the start of meditation practice.
The exercise mantra is regular, varied and vigorous. You want to be regular with your exercise, which is more than the weekend. You want to do it on multiple days of the week or preferably seven. You also want to vary your exercise. If you do the same thing over and over again, it is less beneficial to you. It will reach its plateau. You want to vary and give other things for your body to assimilate.
Then the period of aspect of it is vigorous so if you’re able to get to regularity, if you’re able to vary your exercise, then get to being vigorous, don’t start your exercise program by becoming a marathon runner. Start by doing that walk first. When you’re comfortable with that and you’re able to tolerate that, and you’re able to vary your exercise, maybe you’ll add a bicycling day, a swimming day or tennis. Then and only then you become vigorous and get to a point where you’re sweating, you’re out of breath and those sorts of things that accompany exercise.
On the food front and the diet front, the “D” is for “diet.” The mantra is more greens than grains. If that is reflective in the plate in a mindful way that you fill your plate up every time, that 50% of the plate is greens or vegetable. Any color of the vegetable will do. We equate greens to vegetable. Potato is not a vegetable. Then the other half of the plate is filled with your protein source. If you’re a meat eater, you add some meat or fish. You add tofu. You add beans. That’s the protein section of your plate.
Then the remaining quarter is where you actually end up putting your grains. That is the constitution of your plate. You’ve done well to add some more greens and grains. We also have goals around diet, which is two fistfuls of vegetables per day, one fistful of fruit, 12 nuts, almonds or walnuts if you’re not allergic and no sugar drinks. That’s the goal you can set for yourself. Zero sugar drinks is very hard for people who put sugar in their teas or drink a glass of Coke every day. There are so many sugar drinks out there. Those are the goals that we get our participants towards for diet.
Then the fourth is sleep. Sleep is very under-rated. There’s not enough talk about sleep and getting your six to eight hours of sleep per day. It’s very hard for people to achieve it, not in the Silicon Valley with all the pressures of work and personal life. The thing is that it plays a really important role in your heart health and in preventing high blood pressure. With six to eight hours of sleep, we want to help you practice a sleep routine and sleep wellness. Those of the things I leave with.
(36:29): Great. You had mentioned that 80% of heart disease can be prevented through lifestyle changes. That is a very colorful way to leave us with those thoughts. Everyone, here’s your chance to ask Ashish any questions you might have. I have the first question here. Welcome, caller.
(37:01): Thanks so much. We really appreciate your time here. Those are wonderful insights for all the listeners on the call. The question I have for you is, let’s say in the unfortunate situation, you find either yourself or someone around you suffering a heart attack. What are the first steps you can take that would help the person or yourself to get the highest chance of survival?
(37:34): That’s an excellent question. I should have mentioned it myself. This is a training that we provide to everyone here at the Center as well. First is recognizing the symptoms. There are a few things that you can look for. There is obviously the classic symptoms of heart attack, which could be chest pain, pain in the jaw. This is a kind of intolerable pain, pain that doesn’t go away by shifting positions or changing how you’re sitting.
With the pain, you may have nausea. You may feel that you are vomiting. They are typical symptoms in males. In females, you might see other kinds of symptoms, such as exercise-induced things, shoulder pain or headaches. It may be accompanied by some sweating. You might see that the back of the neck is sweating as well. If you recognize those, I think as an Indian, the first thing to do is to call 9-1-1 and not to wait.
Very often, these are the kinds of pain that you have that are unexplained. If you are exercising or walking and you feel chest pain that, when you stop, the chest pain goes away or becomes less, these are exercise-induced kinds of pain. Those are also times you want to call 9-1-1. Very often, people say, “Why should I call 9-1-1? It will pass. It will go away.” I would suggest that it is worthwhile to call.
If you have family history of heart attacks, if you’ve seen that happen to your parents or to your other siblings, then there is really no time to wait. The first thing is to go to emergency and do that. What can you do while you are waiting for 9-1-1 to arrive? Make sure you are rested in the sense that you are not pacing around or doing stuff. There have been a lot of emails that float around that say the best way to stop a heart attack is to drink hot water or to cough. There isn’t really any scientific basis or evidence for that.
What may be happening is that there is a clot developing that’s reducing your blood flow to the heart and that’s causing the heart attack. Your best thing is to make sure that 9-1-1 is there. They have the equipment that’s necessary to provide. You might take aspirin. It helps thin the blood out. People who have had a heart attack normally will be carrying some nitroglycerin with them in tablet form. They’ll have those to tide you by to help you expand the arteries a little bit before 9-1-1 arrives.
(41:18): Thank you.
(41:20): Fantastic. Thank you so much. I appreciate that.
(41:24): Thank you so much, Ashish, for taking our listener’s questions. For those listeners who would like to contact you in the future, what’s the best place for them to do so?
(41:35): The best place is our website, SouthAsianHeartCenter.org. We have a “contact us” form where you can sign up for the screening or ask us any of those questions that you have. That’s the easiest and fastest way to get responses from us.
(42:15): Wonderful. Thank you so much for joining us. In case you joined us late and would like to share this show with people in your life, I would like to remind you that a recording of today’s radio show will be sent out. I appreciate your hanging out with us. Make sure to join us for next month’s show. Take care everyone.
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