There's a sort of a history in South Asian demographics
that you have a higher predisposition for heart disease.
Given that genetic predisposition,
I just wanted to explore what was out there
in terms of being able to do any tests
or diagnostics and just see where I was at.
My first visit to the Advanced Lipid Clinic
was with Dr. Kalra,
and my subsequent visits have also been with him.
And he was great in answering all my questions,
in terms of diagnostics that were available,
about the fear that I had,
or the concerns that I had about my predisposition.
Sameer came to us with a question, which was that,
"How can I prevent my risk of having a heart attack
in the next 10 years?"
He was very concerned that he had high cholesterol
and that he had a family history.
He was able to give me some sort of texture
of the various considerations and put together a game plan.
Took a careful family history
and examined him.
Thankfully, he did not have any of the genetic syndromes
that we are aware of.
Then we did calcium coronary scanning,
which is a quick scan, CAT scan of the chest and heart
to make sure that there's no calcium
in the coronary arteries.
If young people have calcium,
that means they already have build up of plaque,
and that tells us that we need to be very aggressive
in treating these kinds of patients.
There are definitely people who either because of their diet
or their genetic background
can have higher cholesterol levels.
So we know that folks who are obese,
who eat a lot of saturated fats, unhealthy foods,
processed foods, including carbohydrates,
those folks will have higher cholesterol numbers.
But there's also others who belong to certain ethnic groups,
such as French Canadians or Ashkenazi Jews,
or even South Asians who have a constellation of factors
that lead to metabolic syndrome with high blood pressure,
abnormal lipid profiles.
These populations are predisposed to get coronary disease
and vascular disease at an earlier age.
This is where the Lipid Clinic specializes in these areas.
So the most common one, of the genetic ones,
i.e., this is a disease that you're born with
because you got an abnormal set of genes from your parents,
those are familial hypercholesterolemia.
There's two kinds of familial hypercholesterolemia:
You can have two abnormal genes,
or you can have one normal gene and one abnormal gene.
And so the manifestations depend upon how high your LDL is.
The genetic tests are done by our geneticist
and we have genetic counselors.
It's not just a matter of sending off a blood sample
or the swab;
it's also the issues surrounding being tested
and knowing what an abnormal genetic test means.
So we will definitely check these people
for the genetic panel of tests
that can pick up one of these 25 or so disorders.
So these days we are focusing a lot on plant-based diets
and eating lean proteins and meats,
such as fish or poultry without the skin.
We got his cholesterol down with diet, exercise
and lifestyle improvement.
And his coronary calcium score was zero,
which really tells us that he has a good prognosis
over the next 10 years or more.
When people come to us
and they're concerned about high cholesterol,
first of all, we'll seek out
if there is a reversible cause for it.
But for the vast majority of people
who have higher cholesterol numbers,
it's because of diet, sedentary status that creeps in
as they get into middle age.
So we'll address those first.
So we talk about setting them up with a dietitian,
putting them into an exercise program
so that they can lower their cholesterol
by non-medication-related ways.
And if it still doesn't come to goal, where we want it,
then we'll have a discussion about calculators
that can tell us what your 10-year risk is
of having a heart attack.
And if that risk is still unacceptable to the patient
and we'll discuss with them
and we'll put them on medications.
Dr. Kalra was very patient,
especially with someone like me.
I do a lot of research and I get pretty detail oriented
and I look into things
and I tend to come with a laundry list of questions.
And so he was...
he could kind of tell that, I think,
after a few of my questions,
then he kind of dug in with me and I appreciated that.
And we were able to reassure him
with the testing we did
that he was truly at low risk
and we'll monitor him for progression of any blockages
in his coronaries.
So it really empowers the patient
to be able to control what's going to happen down the road.
Given everything going on,
it does give me a sense of, you know,
that I have a clean bill of health cardiovascularly,
which is great.
And yeah, I mean, having that backdrop
with everything that's going on is comforting.