RISK FACTORS IN THE FILIPINO POPULATION. Colman Ryan MD FACC.

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1 RISK FACTORS IN THE FILIPINO POPULATION. Colman Ryan MD FACC. 1

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3 Health Status: United States vs. 29 Other OECD Countries Health Status Measure U.S.A. U.S. rank in OECD (30) Infant Mortality (deaths in first year of life/1000 live births/2002) Best rank of OECD All races Iceland (2.7) Whites only Maternal Mortality 2001 (deaths per 100,000 births) All races Iceland (0) Whites only Health Status: United States vs. 29 Other OECD Countries (2) Health Status Measure U.S.A. U.S. Rank in OECD (30) Life Expectancy from birth (y) Best Rank of OECD All Women Japan (85.3) White women All men Sweden (78.4) White men Life expectancy from age 65/-2004* All women, years Japan (23) White women, years All men, years Iceland (18.1) White men, years * Data missing for six (6) countries Determinants of Health Proportions (Premature Mortality) Behavioral Causes of Annual Deaths in the United States, 2000 Genetic predisposition Behavioral patterns Environmental exposures Social circumstances Health care Genetic 30% Behavior 40% Source: McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April Social 15% Environment 5% Health care 10% Sexual Alcohol Motor Guns Drug Obesity/ Smoking Behavior Vehicle Induced Inactivity Source: Mokdad et al, JAMA 2004;291: Mokdad et al; JAMA. 2005; 293:293 * 435 * Also suffer from mental illness and/or substance abuse 3

4 I love this Doctor Q: Doctor, I've heard that cardiovascular exercise can prolong life. Is this true? A: Your heart is only good for so many beats, and that's it... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap. Q: Should I cut down on meat and eat more fruits and vegetables? A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products. Q: Should I reduce my alcohol intake? A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up! 4

5 Cardiovascular Risk Factors in ASIANS Northern California - Klatsky, 1991 Smoking (Male) Increased Cholesterol Chinese Japanese Filipino Other Asian Diabetes Westernization of the Filipino Population in Rome, Italy - Obesity, Diabetes and Hypertension - Gentilucci, males 240 females 12.9 years in Rome BMI>25 Kg/m % Diabetes 13.1% Hypertension 34.3% 75% are unaware of Diabetes or Hypertension Overweight ALARMING Results High BP (>140/90) Metabolic Syndrome in Filipinos - Morales D, et al Diabetes/VASC Research March 2008 Low HDL in 60.2% Men, 80.9% Women abdominal obesity 17.7% Men, 35% Women Hypertension in 33.3% of both Metabolic Syndrome in 18.6% Cardiovascular Risks Among Asian Americans Results from a National Survey - Ye J, 2009 Multiple logistic regression vs. whites Hypertension Diabetes Obesity Binge Drinking Chinese Filipino Other Asians

6 Phases of Epidemiologic Transition - Gaziano 1. Pestilence & Famine Average life expectancy ~ 30 years 2. Receding pandemics 3. Cardiovascular disease & cancer Mostly man-made disease - smoking - decrease activity - increase consumption of animal products 4. Decline in deaths from cardiovascular disease 5. Obesity and Diabetes - Most Americans are overweight and one third are obese Common Conditions Associated With Obesity Coronary Artery Disease Stroke Hypertension Hyperlipidemia Diabetes Joint Disease Cancer Sleep Apnea Accidents Asthma 6

7 Filipinos in California and Hawaii 2000 Southern California 480,000 Bay Area 312,000 San Mateo County 32,000 Oahu 275, ,000/year (23% of population) 7

8 I love this Doctor Q: How can I calculate my body/fat ratio? A: Well, if you have a body and you have fat, your ratio is one to one. If you have two bodies, your ratio is two to one, etc. Q: What are some of the advantages of participating in a regular exercise program? A: Can't think of a single one, sorry. My philosophy is: No Pain...Good! 8

9 Q: Aren't fried foods bad for you? A: YOU'RE NOT LISTENING!!!... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you? Q: Will sit-ups help prevent me from getting a little soft around the middle? A: Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach. Q: Is chocolate bad for me? A: Are you crazy? HELLO Cocoa beans! Another vegetable!!! It's the best feel-good food around! Q: Is swimming good for your figure? A: If swimming is good for your figure, explain whales to me. Q: Is getting in-shape important for my lifestyle? A: Hey! 'Round' is a shape! CLUSTERING OF RISK FACTORS IS ASSOCIATED WITH POORER LATE OUTCOMES IN DIFFERENT ETHNIC GROUPS PRESENTING FOR TREATMENT OF CORONARY ARTERY DISEASE Colman Ryan, M.D., F.A.C.A. Richard E. Shaw, M.A., Ph.D., F.A.C.A. Felix Millhouse, M.D. Alex Zapolanski. M.D. Maureen Cavanaugh, R.N. San Francisco Heart Institute Seton Medical Center Daly City, California, USA 9

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11 Risk Factors Year Filipino Hispanic Caucasian Obesity Hypertension Diabetes Smoking Hyperlipidemia Between 1994 and 2008 RISK FACTORS FOR HEART ATTACK AND STROKE FILIPINOS Colman Ryan, MD Risk Factors Year Filipino Obesity Hypertension Diabetes Smoking Between 1994 and 2008 RISK FACTORS FOR HEART ATTACK AND STROKE - HISPANICS Colman Ryan, MD Risk Factors Year Hispanics Between 1994 and 2008 RISK FACTORS FOR HEART ATTACK AND STROKE - CAUCASIANS Colman Ryan, MD Risk Factors Year Caucasians Obesity Obesity Hypertension Hypertension Diabetes Diabetes Smoking Smoking

12 Between 1994 and 2008 RISK FACTORS FOR HEART ATTACK AND STROKE ASIANS Colman Ryan, MD Risk Factors Year Asians Obesity Hypertension Diabetes Smoking What we can do in the Bay Area 1. Educate Schools Churches Homes Shopping Centers 2. Subjects Diet Fast Foods Exercise Avoidance Example 47 12

13 I love this Doctor Well, I hope this has cleared up any misconceptions you may have had about food and diets. And remember: 'Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - body thoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride' AND... For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting nutritional studies. 1. The Japanese eat very little fat And suffer fewer heart attacks than Americans. 2. The Mexicans eat a lot of fat and suffer fewer heart attacks than Americans. 3. The Chinese drink very little red wine and suffer fewer heart attacks than Americans. 4. The Italians drink a lot of red wine and suffer fewer heart attacks than Americans. 5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than Americans. 13

14 CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you. Bibliography 1. Morales D, Purizalen Fe, et al Metabolic Syndrome in the Philippine general population: Prevalence of Risk for Atherothrombotic Cardiovascular Disease and Diabetes Mellitus. Diabetes & Vascular Research. 2008;5: Ye J, Rust G, et al Cardiovascular Risk Factors Among Asian Americans: Results from a National Survey. Annals of Epidemiology. 2009;19: Klatsky A; Tekawal Health Problems and Hospitalizations Among Asian-American Ethnic Groups. Ethnicity & Disease. 2005;15: Gentilucci UV, Picardi A, et al Westernization of the Filipino Population Resident in Rome: Obesity, Diabetes & Hypertension. Diabetes/Metabolism Research and Review. 2008;24: Ryan C, et al Coronary Heart Disease in Filipino and Filipino American patients Prevalence of Risk Factors and outcomes of treatment. Journal of Invasive Cardiology. 2000;12: Ryan C, et al The Role of Ethnicity in Outcomes After Coronary Artery Intervention: How Important Are Clusters of Risk Factors? Journal of the American College of Angiology. September/October 2003;Vol I;3: