Diabetes & Cardiovascular Disease Risk Factors among South Asians Compared to other Ethnic Groups

Dr. Alka Kanaya talked about Diabetes and cardiovascular disease risk factors in multi-ethnic groups comparison studies, at a joint event hosted by  www.eppicglobal.org and  www.bio2devicegroup.org .  Dr. Kanaya is Professor of Medicine, Epidemiology, and Biostatistics at UCSF and a principal investigator in Mediators of Atherosclerosis in South Asians Living in America or MASALA study, for short.  Primary objective of the study was to research and understand the high incidence of diabetes and CHD among people of South Asian origin.

Kanaya first shared information on South Asians (will be referred here as SA) and then discussed the study results in the context of multi ethnic comparison.  Currently there are 3.4 M people from South Asia living in the US.  It is the second fastest growing racial/ ethnic minority in the US.  They constitute 20% of all Asians and 75% of them are foreign born.  Although there is little organized medical data on SAs, overall they have relatively lower body weight (BMI), have more central abdominal obesity, and experience higher rates of diabetes and indicate high risk of early heart disease.

MASALA study began in March, 2010 and constitutes a total sample of 906 people, between the ages of 40 and 84.  People with prior history of any cardiovascular disease, those in active cancer treatments, those planning to move out of the area in the next 5 years, and nursing home residents, were excluded.  Data collected included weight, height, waist, seated BP, Ankle-brachial index (ABI predicts the sevearity of PAD, peripheral artery disease), 2 hour OGTT (oral glucose tolerance test), abdominal CT, and several blood tests and extremely detailed questionnaires regarding family history and information about personal habits like alcohol, smoking, sleep, diet and exercise.

Results from MASALA study were compared to results on almost all similar measures with Whites, Latinos, African-Americans and Chinese populations in ongoing MESA study.  See the websites of MESA (www.mesa.nhlbi.org) and MASALA (www.masalastudy.org) studies to see many interesting details on several patterns that emerged.  Kanaya specifically discussed some patterns among South Asians when compared with other ethnic groups.

When adjusted by sex and age, South Asians had significantly high rates of hypertension.  However, there weren’t major or alarming differences in cholesterol.  One of the reasons could be that South Asians were overall more educated, from higher socio-economic background, and were more likely to be using statins and other cholesterol lowering drugs

Most alarming differences were observed in diabetes and pre-diabetes levels.  Almost 30% of men and almost 15% of South Asian women had Diabetes Mellitus, versus 20% or lower among other groups of men, and 13% or lower among other groups of women.  Nearly 37% of SA men and 29% of SA women had IFG (impaired fasting glucose indicative of pre-diabetes), compared to 20% or less for men and 13% or less for women from other groups.  When adjusted for many indicators including age, sex, cholesterol, triglycerides, hypertension etc., South Asians were significantly more likely to have type 2 diabetes.

When adjusted for age, sex, BMI, and waist and excluding those on diabetes meds, this high incidence of Diabetes Mellitus among South Asians seemed to be associated with higher levels of insulin resistance, lower pancreatic B-cell function, and (as confirmed by abdominal CT data) high amount of body fat around abdominal regions and in the liver.

Mercat de la Boqueria, fruits & vegetables (Photo credit: Wikipedia)

Among lifestyle factors, the high rates of DM (Diabetes Mellitus) among SA was attributed to poor diet with less fruits and vegetables and more Western diet (including pizza, pasta etc.), sweets, refined grains, and consumption of high animal based protein in the diet and low levels of exercise.  Considering that even on a relatively leaner body, South Asians carry more fat, the study concluded that guidelines for BMI should be lower for people of South Asian origin.

The study concluded that 75% of South Asians were overweight or obese using the recommended BMI cut-points in Asians.  Compared to other racial/ ethnic groups, South Asians were from higher socio economic status, had low smoking rates, and low to moderate alcohol use.  They also indicated very low physical activity, higher diabetes prevalence (specially among men), second highest prevalence of high blood pressure, and men have more coronary calcium than other groups.

A yoga class. (Photo credit: Wikipedia)

Some of the recommendations for South Asians from the study were, to know the risk factors, work towards ideal BMI goal (less than 23 kg/m2 for SA), remember waist size matters more than BMI, walk at least 30 minutes a day 5 days a week, avoid a diet high in animal protein and refined carbs, and then something interesting – do Yoga!

Kanaya also shared results from her PRYSMS study that assigned subjects with metabolic syndrome into two groups, one practicing Restorative Yoga (included lot of lying down and relaxing poses) and other, Stretching Exercises.  In 6 months, both groups improved their PA and calorie intake.  Favorable changes in the stretching group included, lowered triglycerides and improved mental health.  Restorative yoga group reduced and sustained weight loss and weight girth loss but not visceral fat area.  Finally, only yoga group indicated reduction of fasting glucose and overall favorable metabolic changes in the yoga group included lowering of fasting insulin, glucose, HbA1c and HDL.

One wonders if very determined focus on material wealth goes with more stress.  In any case, it shows once again that stress relief is a key for improved health.  This was a fascinating talk and was followed by Q&A and animated discussion.

Fiona Ma (Assemblywoman & Campaigner against Hepatitis B) to speak at Health Technology Forum Conference

Hepatitis B Virus (Photo credit: AJC1)

Hepatitis B (HBV) virus is a very common virus worldwide.   Approximately, 1.2 million people in the United States are affected by this virus.  Almost 350 million people worldwide, are living with Hepatitis B.  Many people with Hepatitis B are likely to be infected at birth or in early childhood, and due to lack of immediate attention, have developed a lifelong chronic infection.   Hepatitis B is a contagious liver disease that is commonly spread through blood, semen, or other body fluids.  Most people do not experience symptoms until it is too late.  The virus causes 80% of all liver cancers, if left untreated.  Hepatitis B can be prevented with vaccination.  And with immediate attention and monitoring with nutrition, fluids, and medical supervision, acute Hep B can also be effectively treated.

Fiona Ma, incumbent democratic candidate for State Board of Equalization, a reputed politician and a former member of the San Francisco Board of Supervisors, California State Assembly, is a tireless campaigner and spokesperson for “San Francisco Hepatitis B Free” campaign.  San Francisco has the highest concentration of Hep B in the country.  Ma herself learned that she had Hep B, when she was 22.  She acquired it from her mother, who had acquired it from her mother.  About 1 in every 10 Asian Americans, is infected with the virus.  Ma’s mother had developed liver scars and having caught that early, had it removed.

English: California State Assemblywoman Fiona Ma (Photo credit: Wikipedia)

Fiona Ma will be giving keynote address at Health Technology Innovation Forum annual conference on May, 20 at Parc 55, Wyndham Hotel, SF.  The conference is focused on exploring pathways to sustainable health through various means including “best practices for globally underserved”, through “gamification” and “patient engagement”, and through “building resilient communities for better outcomes”.  Traditionally, this conference is heavily attended by physicians from UCSF, as well as entrepreneurs focused on healthcare breakthroughs.  Please register for the conference at http://www.healthtechnologyforum.com , as my friend, with the discount code “HTF14-FriendOfOrganizer” and send me your first & last name at wd_darshana at hotmail dot com, to get $150 off the price of the ticket.

 

Please note other upcoming events below – dates & deadlines.

1) Register for #TiEcon at link https://www.123signup.com/register?id=dbnfb&ref=4182698  as my guest & enter promo code tievalue to get $100 discount. If you are an entrepreneur, I would say this is the conference, you don’t want to miss.  Check out great agenda, top notch speakers & panelists on #IoT, #bigdata, #cloud, and #Healthcare tracks at http://www.tiecon.org.

3) Feel free to send me an email for any of these events at wd_darshana at hotmail dot com and you can follow my updates on Twitter @DarshanaN.  Also, do check out (in JOBS category on this blog), my job opportunities that include many Quality Engineering jobs in CA and MA and hot Software Embedded Engineer job and more.

Computational Biology Applied to Liver Cells in vitro – High Throughput Screen for Drug Toxicity

Dr. Mike Bowles, previously a founder of Com21 and IBeam Broadcasting (both of which went on to huge IPOs) and currently co-founder of Biomatica, talked about the application of Computational Biology to investigate drug toxicity effects, earlier in drug development process.  It is an understatement to say that drug development is very expensive, often costing billions of dollars and years of research.  The primary challenge is determination of long term drug toxicity side effects.  If we can develop and deploy efficient technologies for early prediction of adverse side effects, then the costs of drug development can be noticeably reduced, said Bowles.

 

However, the toxicity studies often take place relatively late in the process.  During first year of research, the focus is on identifying and validating target molecules from over 5000 compounds.  Toxicity is not studied until much later in the development process.  Liver damage is one of the worst potential side effects of drugs, taken alone or with other medicines.  “We need a paradigm shift”, said Bowles, to include toxicity studies earlier in the development process.  But animal studies are also time consuming and they leave many uncertainties about human risk potential.  Often by the time the animal data is in, too much is invested and it is costly to cancel the compounds.  So there is an incentive to go on, rather than to eliminate compounds with riskier profiles.

 

Biomatica addresses this challenge by replacing liver toxicology studies on live rats with machine learned models of liver damage that can be run on rat (or human) liver cells grown in culture.  They have built models using microarray data from hepatocytes to predict animal and human toxicity.  Toxicity does not occur through just one pathway and it is a diffused problem.  But microarray can encompass all the changes going inside a cell, at any point in time.  Microarray data is collected on rat liver or rat hepatocytes grown in cultures or human hepatocytes grown in cultures and used to find earlier the compounds that should be eliminated.  Testing costs earlier on live rats and on microarrays are similar.  But at following stages they start adding up, in case of live rats.  For instance, for 36 rats, in later stage, while they come to about $20,000 with microarry, with live rats they go as high as $113,400.  The early results are indicating very good prediction accuracy, said Bowles.  The talk generated a lot of interest and was followed by Q&A.

 

Pierre Cassigneul CEO of XDx (www.xdx.com) discussed how AlloMap is poised to change medical practice and revenue stream at www.bio2devicegroup.org

XDx is a molecular diagnostics company with a focus on discovery, development, and commercialization of noninvasive gene expression testing that would translate a patient’s immune system information to clinically actionable information.  The goal is to help in effective monitoring of transplant rejection and autoimmune diseases.

 

After the transplant, the organ recipient’s immune system recognizes a transplanted organ as foreign, and mounts a response to reject it.  Currently, the only standard method to monitor for such rejection is endomyocardial biopsy and then prescribing drugs to suppress the body’s natural immune system response.  There are two significant challenges.  Endomyocardial biopsy is an invasive procedure that requires puncturing the jugular vein and inserting the guide with fluoroscopic or echocardiographic guidance.  The jaws are then opened and a tiny piece of the heart is removed.  This invasive procedure is performed weekly during the first month, with gradually reducing frequency to annually after twelve months.  Besides being painful and an invasive procedure with potential of many complications, this is also an expensive procedure costing up to $4 to $10 thousand per biopsy.  An additional challenge pertains to the determination of the dosage of immunosuppressant drugs.  The correct dosage is determined on the basis of the information derived from the biopsies and this is somewhat of a subjective decision, with high consequences.  The dose cannot be too high or too low as these drugs are powerful drugs with serious side effects, and frequently lead to renal or liver failure, in the long term.

 

AlloMap is XDx flagship product to aid in the identification of the probability of acute cellular rejection for post cardiac transplant patient management.  This is a noninvasive method to monitor immune system activity by measuring gene expressing in a patient’s peripheral blood.  The AlloMap blood test is CLIA certified and reports a score and is therefore a quantitative measure, that takes out the subjectivity from determining the right dose.  The hope is also that the patient can then take the lowest possible dose needed.  XDx has 30-44 thousand test capacity, annually.  Not only is this a highly cost saving method to determine the right dosage, but it is a non-invasive, more humane method that should replace traditional biopsies.

 

Cassigneul shared results from several studies that indicate AlloMap to be as clinically effective as biopsies.  And yet, the company has encountered revenue challenges, payer resisting coverage, hospitals making it more challenging to get the blood drawn and so on.  However, recently Society of Heart Lung Transplant, recommended AlloMap in their clinical guidelines.  This was a huge milestone for XDx and cleared the path for revenue generation.  Now several payers have also recommended AlloMap for coverage.  One hundred out of 140 transplant centers in theUS, have used the test and the company is seeing a steady growth.  The company is working on several tests for monitoring of other transplant organs and also for monitoring several autoimmune diseases like Lupus, Rheumatoid Arthritis and so on.  For Lupus, XDx is working on flare predictor so that sudden flare-ups can be caught prior to irreversible damage to kidneys and other organs.  The talk generated strong interest and was followed by Q&A.