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From YouTube: NAPACSL Cardiovascular Disease in AAPI Communities
Description
The National Asian Pacific American Caucus of State Legislators (NAPACSL) is comprised of 168 state legislators from 33 states across the country and is a collective effort to bring in Asian American and Pacific Islander perspectives on policies that affect their communities, including economic development, educational equity and culturally competent services such as health care.
A
A
B
Thank
you
irene.
Let's
get
to
why
we're
here
today,
gaps
in
data
widely
exists
among
asian
pacific
islander
subgroups
when
it
comes
to
cardiovascular
disease.
Nationally,
heart
disease
is
the
leading
cause
of
death.
Nearly
half
of
all
people
in
the
united
states
have
at
least
one
of
three
risk
factors
that
lead
to
cbd.
B
Recent
studies
from
the
american
heart
association
show
that
south
asians
in
the
united
states
are
more
likely
to
die
earlier
from
heart
disease
than
other
racially
or
ethnic
groups.
We
will
hear
from
medical
professionals
on
the
latest
data
and
strategies
to
prevent
and
treat
cardiovascular
disease
and
ways
to
engage
with
state
health
departments.
B
If
you
have
any
questions
for
the
speakers,
please
email
irene
at
irene.com
ncsl.org
joining
us
today
are
dr
stanton
chandling,
dr
kazuma
nakagawa
and
dr
alka
kanaya.
Our
first
speaker
today
is
dr
stanton
chandling.
Dr
chandling
has
been
the
supervisor
of
the
cardiovascular
disease
unit
at
the
minnesota
department
of
health
since
2005..
B
In
this
role
he
advances
the
department's
agenda
to
improve
cardiovascular
health
and
reduce
the
burden
of
heart
disease
and
stroke
across
minnesota.
Dr
chandling
will
share
with
us
ways.
Policymakers
can
work
with
state
health
departments
to
address
cardiovascular
disease.
Dr
shanley,
thank
you
so
much
for
joining
us
today.
The
floor
is
now
yours.
C
C
It's
an
interesting
thing
to
think
about
when,
when
you're
trying
to
promote
health
for
people,
especially
around
particular
chronic
disease
such
as
heart,
disease
and
stroke,
the
key
is
in,
in
my
estimation,
and
based
on
my
experience,
is
to
reach
out
to
your
cardiovascular
health
leadership
at
your
state
health
departments
make
it
a
two-way
conversation,
know
that
it
is
really
the
key
to
getting
information
to
one.
Another
is
knowing
that
you
have
trusted
colleagues
and
professionals
that
can
really
help
you
and
know
that
it's
one-stop
shopping.
C
With
that
in
mind,
if,
indeed,
your
state
has
a
a
voluntary
cardiovascular
health
advisory
alliance,
like
we
do
in
the
state
of
minnesota,
I
would
volunteer
at
two
different
levels.
One
is
to
either
be
a
formal
member
of
that
committee,
or
an
ad
hoc
member
of
that
committee,
whereby
you'll
be
able
to
connect
with
various
colleagues
that
are
really
the
most
knowledgeable
about
this
particular
chronic
disease
and
it'll
be
basically
a
really
good
avenue
for
information
exchange
almost
on
the
fly
and
and
as
you
need
it.
C
If
and
there
should
be,
a
cardiovascular
health
state
plan
hours
in
the
in
the
state
of
minnesota
is
in
development
that
it'll
be
a
2030
state
plan.
We
are
doing
it
in
collaboration
with
diabetes,
which
is
also
something
that
I
would
highly
recommend,
since
these
are
very
complementary.
As
far
as
risk
factors
are
concerned,
if
you
do
forge
ahead
with
a
state
plan,
I
would
highly
recommend
that
you
complement
the
objectives
that
are
laid
out
in
healthy
people,
20
30
the
objectives
for
the
nation
which
has
already
been
published.
C
I
would
underscore
being
aware
of
the
risk
factors
for
cardiovascular
disease,
for
your
population
know
the
values
that
your
population
has
and
how,
together
with
along
with
these
risk
factors,
they
can
lead
to
change
that
each
population
group
has
their
own
values.
It's
laden
in
their
history
in
the
stories
that
they
tell
to
one
another,
how
they
engage
health
overall.
C
The
arenas
in
a
state
plan
are
pretty
straightforward.
They
should
include
prevention,
which
really
includes
things
such
as
education
and
messaging,
acute
treatment,
which
is
actually
the
easiest
of
the
arenas.
Frankly,
because
acute
treatment
is
often
connected
with
standards
of
care
and
guidelines
that
are
already
established,
so
once
somebody
presents
themselves
into
the
er
with
a
potential
heart
attack
or
stroke,
guidelines
and
protocols
are
really
put
into
into
place
on
how
to
treat
that
person
and
then
finally
disease
management
is.
C
C
So
again,
all
of
these
strategies
can
be
laid
out
in
a
state
plan.
If
you,
if
you
so
choose
to
proceed
that
way,
then.
Finally,
I
have
a
couple
of
other
points
here.
Quickly
is
note
the
difference
on
outcomes
there's
everybody
wants
to,
especially
if
there's
money
that's
put
into
an
initiative.
What's
the
outcome
for
it
for
it?
Well,
there
are
quantitative
outcomes
where
we
can
be
real
numbers
driven
or
there
are
qualitative
outcomes.
C
C
If
we
are
strategic
in
addressing
our
ongoing
health
needs,
we
will
be
ahead
of
the
game,
always
as
it
relates
to
the
health
of
of
our
constituents
and
of
the
nation
as
a
whole.
So
with
that
I'll
turn
it
over
and
I'll
be
happy
to
answer
any
questions
that
come
come
this
way
through
email
or
whatever
I'll
be
happy
to
circle.
Back
with
all
of
you.
Thank
you
for
the
opportunity.
It's
been
a
pleasure.
B
Thank
you,
dr
shanling.
Next
up
is
dr
kazuma
nakagawa,
a
neurointensivist
and
vascular
neurologist
at
the
queen's
medical
center
and
associate
professor
of
medicine
for
the
university
of
hawaii
john,
a
burns
school
of
medicine
after
starting
an
academic
career.
As
a
clinician
scientist
at
the
university
of
hawaii
and
the
queen's
medical
center,
he
has
identified
a
new
area
of
research
interests
investigating
the
racial
disparities
in
risk
factors
and
outcomes
in
stroke,
patients
among
native
hawaiians
and
other
pacific
islanders.
D
B
D
D
D
D
It
was
surprising
to
see
that
vietnamese
people
reported
worse
health
twice
as
worse,
compared
to
non-hispanic
whites
and
asians.
Overall
japanese
respondents
had
a
higher
proportion
of
people
who
reported
obese
or
overweight
than
non-hispanic,
whites
and
japanese,
and
koreans
reported
higher
rates
of
diabetes
than
non-hispanic
whites
and
just
general
asian
population.
D
If
you
use
a
traditional
bmi
threshold
of
30
for
the
non-hispanic
whites
african-americans
and
hispanics,
and
use
the
agent-specific
bmi
cut
point
of
27.5
for
agents
and
define
obesity
and
overweight
that
way,
you
can
see
here
that
the
proportion
of
population
with
obesity,
which
is
shown
in
dark,
gray
and
overweight,
shown
in
light
gray,
are
very
similar
compared
to
the
non-agents
or
even
higher,
among
asians,
such
as
filipinos
compared
to
the
non-hispanic.
Whites.
D
D
Some
of
the
research
has
shown
that
25
percent
of
heart
attacks
occur
under
age
40
for
young,
south
asians
and
50
percent
occur
under
age
50..
That's
very
young
overall
south
asians
develop
coronary
artery
disease
up
to
10
years
earlier
than
the
general
population
a
decade
younger,
and
this
theme
is
true
for
other
conditions
as
well.
D
D
Therefore,
it
is
time
to
disaggregate
asian
americans
and
pacific
islanders
from
a
single
ethnic
group
and
look
at
each
ethnic
group
separately
globally.
Over
the
past
two
decades,
deaths
from
cardiovascular
disease
have
been
declining
in
developed
nations,
which
you
can
see
in
the
yellow
and
green
color,
but
have
rapidly
increased
in
the
low
and
middle
income
countries,
most
notably
in
russia,
africa,
south
and
south
east
asian
countries,
where
you
can
see
in
orange
and
red.
D
D
D
Our
group,
also
using
statewide
database,
show
that
filipinos
have
the
highest
rate
about
in-hospital
mortality
after
stroke
when
I
first
came
to
hawaii
in
2010
10
years
ago.
This
was
one
of
the
first
cases
I
saw
a
27
year
old
native
flying
man
with
early
onset
of
hypertension.
We
came
in
with
a
disabling
hemorrhagic
stroke.
You
can
see
in
that
picture
that
the
brightness
the
spot
in
the
brain-
that's
on
the
left
side
was
the
bleeding
that
happened.
D
He
was
27,
we
did
extensive
workup,
but
it
turned
out
to
be
the
traditional
just
high
blood
pressure
that
occurred
early.
That
was
uncontrolled
and
I
was
shocked
to
see
how
young
this
man
was
at
the
time.
I
did
a
literature
search
on
racial
disparities
in
hemorrhagic
stroke,
and
I
was
shocked
to
see
that
there
was
no
single
paper
published
among
about
native
hawaiians.
D
D
So
our
project
was
to
look
at
our
own
data
and
show
that
native
hawaiians
and
pacific
islanders
age
of
onset
when
married
stroke
was
much
younger
again
about
10
years
younger.
You
can
see
in
this
graph
that
the
bell
curve
shape
the
age
distribution
has
shifted
to
the
left
for
the
native
lines
of
ganders,
which
you
see
on
the
black
bar.
D
D
We
have
also
shown
gender
disparities
among
the
asian
populations,
showing
the
higher
burden
within
the
asian
men
compared
to
asian
women,
as
well
as
some
of
the
ethnic
differences
in
the
end
of
life
care.
After
a
severe
stroke,
we
talked
about
hemorrhagic
stroke,
but
for
the
ischemic
strokes
as
well.
We
have
shown
that
ischemic
strokes
are
occurring
about
10
years,
younger
again,
a
decade
difference
between
native
wine
and
the
asians
and
non-hispanic
whites,
and
have
shown
that
they
also.
B
Thank
you,
dr
nakagawa.
Next
up
we
have
dr
alka
kanaya,
a
professor
of
medicine,
epidemiology
and
biostatistics
at
the
university
of
california,
san
francisco,
in
the
division
of
general
internal
medicine.
Doctor
ako
kanaya
is
an
expert
in
type
2,
diabetes
and
cardiovascular
disease
prevention.
She
has
focused
her
research
on
asian
american
health
disparities
over
the
past
decade.
B
E
E
Data
that
we
have
is
from
census
2010,
when
the
total
asian
population
in
the
us,
which
does
not
include
native
hawaiians
or
pacific
islanders.
Just
asian
americans
was
almost
15
million
and
you
can
see
that
the
top
three
asian
subgroups
then
were
chinese,
followed
by
asian,
indian
and
then
filipino.
E
And
then
here
are
the
most
recent
estimates.
We
have
from
2018
we're
awaiting
the
2020
census
data
which
hopefully
will
be
out
soon,
but
the
total
asian
population
in
the
united
states
increased
to
about
18
million
over
eight
years.
That's
20
percent
of
an
increase
since,
since
2010
and
again
the
three
top
you
know,
asian
groups
were
chinese
asian,
indian
and
filipino,
and
you
can
see
the
asian
indians
were
actually
one
of
the
fastest
growing
ethnic
subgroups
in
the
united
states.
E
So
what
do
we
know
about
cardiovascular
disease
outcomes
like
heart
disease
by
different
race,
ethnic
groups
in
the
united
states?
And
as
dr
nakagawa
mentioned,
is
you
know?
We've
often
just
had
very
poor
data
among
asian
american
groups,
because
they're
all
aggregated
together,
but
here
is
a
look
at
some
disaggregated
data
from
the
kaiser
northern
california
area,
where
they
looked
at
the
incidence
of
heart
disease
by
different
subgroups,
and
here
you'll,
see
south
asians
on
the
left.
That
includes
indians,
pakistanis
and
bangladeshis.
E
Primarily
then,
east
asians,
which
includes
chinese,
japanese
and
korean,
are
the
the
three
big
east
asian
groups,
and
then
other
asian
groups
not
well
classified,
are
shown
in
the
third
bar
and
then
you'll
see
the
blacks,
hispanics,
whites
multi-ethnic
and
total.
And
I
just
want
to
make
the
point
that,
following
people
enrolled
in
kaiser
a
very
multi-ethnic
integrated
health
system,
they
followed
people
for
10
years
to
see
who
had
a
heart
attack
and
the
rates
were
highest
among
south
asians,
and
that
was
particularly
true
among
south
asian
men
shown
in
orange.
E
E
So
in
2018,
the
american
heart
association
and
the
american
college
of
cardiology
started
to
you
know,
do
a
more
in-depth
look
at
cardiovascular
risk
factors
in
south
asians
and
they
looking
at
the
all
the
data
that
exists
also
from
the
united
states
as
well
as
other
parts
of
the
world.
They
determined
that
south
asian
ethnicity
really
is
considered
a
high
risk
or
a
risk.
E
So
I'm
going
to
show
you
why
this
was
done
and
some
of
the
data
that
we
have
uncovered
in
our
masala
study.
So
the
aims
of
this
study
that
was
started
about
10
years
ago
was
to
establish
a
prospective
community-based
cohort
of
south
asians
in
the
united
states
to
be
able
to
determine
all
different
kinds
of
factors
that
are
associated
with
atherosclerosis,
and
by
that
I
mean
hardening
of
the
arteries,
so
a
precursor
to
heart
disease.
E
So
we
designed
masala
to
include
south
asians,
who
are
between
age
40
to
84
years
old.
We
received
a
grant
from
the
nih
and
were
able
to
include
900
people,
then,
because
we're
interested
in
looking
at
what
causes
cardiovascular
disease,
we
excluded
those
who
already
had
cardiovascular
disease,
so
people
who
already
had
had
a
stroke
or
a
heart
attack
or
any
kind
of
procedures
on
their
hearts
like
stents
or
surgeries.
E
E
That's
been
going
on
for
now,
almost
20
years,
they
enrolled
a
slightly
older
age
group
45
to
84,
and
we
went
younger
in
masala
starting
at
age
40,
because
we
know
that
south
asians
experience
heart
disease
at
a
younger
age
so
wanted
to
capture
some
of
that
and
they
have
a
much
bigger
study
mesa.
They
included
6
500
people
again
with
the
same
criteria,
no
existing
cardiovascular
disease.
So
we
are
comparing
apples
to
apples
between
these
two
studies.
E
They
have
four
race
ethnic
groups,
so
that
includes
whites,
african
americans,
latinos
and
chinese
americans,
and
they
did
the
study
in
six
sites
with
one
in
new
york
at
columbia
university,
one
in
baltimore,
at
johns
hopkins
one
in
chicago,
where
we
have
our
study
going
at
northwestern
a
site
in
minnesota
site
at
ucla
and
one
in
north
carolina
at
wake
forest
university.
They
started
10
years
before
masala
in
2000
and
they
were
doing
their
fifth
exam
when
we
did
our
first
exam
visit.
E
So
here's
what
we've
accomplished
so
far
in
masala
the
first
exam.
As
I
mentioned,
we
brought
in
906
participants
to
really
classify
them
with
blood
tests.
Glucose
tolerance
tests
doing
a
ct
scan
of
the
heart
to
look
at
the
hardening
of
the
arteries.
I'll
show
you
some
pictures
of
that.
Then
we
got
different
grants
to
look
at
their
social
networks
because
we're
really
interested
in
sociocultural
factors
that
may
you
know,
modify
risk
or
give
people
you
know
higher
or
lower
risk
of
developing
heart
disease.
E
E
84
percent
were
from
india
and
about
five
percent
are
from
pakistan
and
one
percent
from
the
other
south
asian
countries,
and
you
can
see
that
there's
other
diaspora
countries
where
people
were
born
in
parts
of
africa,
fiji
and
other
places
around
the
world.
So
only
two
percent
of
our
study
participants
are
second
generation
immigrants
who
were
born
in
the
united
states.
E
What
about
levels
of
high
blood
pressure?
So,
as
dr
nakagawa
said,
you
know,
high
blood
pressure
is
very
common
in
some
ethnic
groups
and
what
we
found
when
we
compared
the
south
asians
in
masala
in
this
first
bar
in
orange
to
the
other
groups
in
mesa,
was
the
highest
rates
of
hypertension
were
in
african
americans
in
mesa
about
59.
E
The
second
highest
were
in
the
south
asians
and
then
that's
followed
by
latinos
and
whites
and
chinese
americans
had
the
lowest
rates
of
high
blood
pressure
and
again,
we've
normalized
this,
so
that
everybody
is
in
the
same
age
group
45
to
84..
We
dropped
out
the
participants
in
masala
who
were
between
age,
40
and
45.
When
we
do
these
direct
comparisons,
how
about
diabetes?
E
The
rates
of
diabetes
in
south
asians
were
the
highest
and
here
in
the
red
oval,
I'm
showing
you
the
adjusted
prevalence.
That
means
how
many,
how
what
percent
of
people
in
each
group
have
diabetes
after
you
adjust
for
things
like
differences
in
education
and
family
income
and
smoking
alcohol
body
mass
index
exercise
other
factors
that
could
you
know
be
the
reason.
People
are
developing
diabetes
and
we
found
almost
27
percent
of
a
prevalence
in
south
asians
compared
to
six
percent
in
white
16
and
african
americans
14
and
latinos
and
16
in
chinese-americans.
E
E
We
have
also
done
a
look
at
the
newest
data
from
the
u.s
large
representative
study
called
nhanes,
we've
aggregated
data
over
a
five-year
period,
2011
to
2016
and
then
broken
up
the
new
data
that
they
have
been
acquiring
in
asians
into
these
three
or
four
buckets
east
asian,
south
asian,
south,
east
asian
and
other
asian,
and
you
can
see
when
you
aggregate
this
data
for
asian
groups.
They
look
like
they
have
very
you
know
much
lower
rates
of
diabetes,
certainly
higher
than
whites
but
lower
than
hispanic
and
african-american.
E
So
back
to
masala,
comparing
to
mesa,
we
looked
at
all
the
different
behaviors
that
were
you
know,
measured
in
these
two
studies
and
south
asians
and
chinese
had
the
lowest
rates
of
smoking,
and
that's
great,
that's
great
news,
because
these
are
the.
This
is
a
totally
modifiable
risk
factor
we're
not
doing
so
great
in
smoking
rates
in
the
african
american
and
latino
populations
in
the
us,
but
certainly
in
the
immigrant,
south
asian
and
chinese
populations.
The
smoking
rates
are
much
lower
than
what
you
see
in
native.
E
But
exercise
was
the
worst
among
south
asians,
and
this
is
using
a
questionnaire
when
we
asked
people
what
types
of
exercise
they
do
every
week,
how
many
minutes,
how
vigorous
the
activity-
and
we
did
kind
of
a
calculation
to
look
at
how
many
metabolic
equivalents
they
were
spending
on
exercise.
You
can
see
that
the
south
asians
were
dismally
low
compared
to
all
the
other
groups.
These
stars
just
show
levels
of
statistical
significance,
so
that
is
a
very
modifiable
risk
factor
again.
E
There's
a
lot
of
diabetes,
there's
a
lot
of
high
blood
pressure
and
there's
terrible
levels
of
exercise
in
south
asians.
What
about
foods?
Now?
Most
of
you
may
have
sampled,
south
asian
foods
at
restaurants
or
friends,
homes
and
there's
a
big
variety
of
south
asian
foods,
and
so
we
really
wanted
to
be
able
to
capture
that
accurately
in
this
study,
because
food
depends
so
much
on
the
region
of
south
asia
that
you
come
from,
and
family
and
traditions.
E
So
we
asked
about
163
questions
that
were
about
dietary
intake
and
using
all
this
data.
We
looked
at
the
patterns
of
diet
that
emerged
in
our
participants,
and
we
found
three
major
dietary
patterns
and
about
a
third
of
the
population
was
consuming
a
diet
that
was
rich
in
animal
protein
shown
here
on
the
left,
with
different
types
of
animal
protein
and
more
western
foods.
So,
like
your
continental
types
of
foods
like
pizza,
pasta,
burgers,
etc.
E
A
third
of
our
study
population
was
consuming
a
more
traditional
south
asian
diet,
which
includes
a
lot
of
fried
snacks
and
sweets
and
high-fat
dairy
types
of
products
and
then
a
third
we're
consuming
more
of
a
prudent
diet.
That's
fruits,
vegetables,
nuts
and
legumes,
and
this
was
kind
of
random
that
it
was
a
third
a
third.
A
third
is
the
major
dietary
pattern
and
when
we
looked
at
which
of
these
diets
was
associated
with
cardiovascular
risk
factors,
what
we
found
was
the
people
consuming
this
animal
protein,
western
diet
had
higher
weight
and
bigger,
waist
circumference.
E
So
more
obesity
in
this
group
people
in
this
middle
group,
the
fried
snacks,
sweets
and
high
fat
dairy,
had
higher
blood
pressure
and
lower
hdl
cholesterol,
which
is
the
protective
cholesterol.
So
these
are
abnormal
metabolic
factors
in
these
two
groups.
Compared
to
this
third,
prudent
group
and
what's
interesting
about
south
asians,
is
about
40
of
the
people
in
our
study
were
lifelong
vegetarians,
and
you
would
think
that
most
vegetarians
probably
fall
in
this
last
group.
Here,
fruits,
vegetables,
nuts
and
legumes
consuming,
maybe,
but
actually
about
half
of
the
vegetarians
were
in
this
middle
group.
E
E
If
you
look
at
this
diagram,
it
shows
you
the
odds
of
developing
well
of
having
fatty
liver,
which
is
also
a
metabolic
problem
that
exists
in
in
a
lot
of
asian
groups.
People
who
were
consuming
more
of
these
healthy
plant-based
foods
on
the
left
column
here
had
lower
risk
of
having
a
fatty,
liver
and
people
consuming
the
healthy
plant-based
food
had
a
lower
risk
of
developing
diabetes
after
five
years
of
follow-up
and
the
people
consuming
the
unhealthy.
E
The
in
the
red
plant-based
diet
actually
had
a
slightly
higher
risk
of
developing
diabetes,
so
I
think
we
can
say
with
a
little
bit
more
certainty
that
you
know
there's
a
difference
between
the
quality
of
foods
people
eat
when
they're
eating
a
plant-based
diet.
So
we
need
to
be
much
more
specific
in
our
public
health
messaging
about
dietary
changes
and
it
needs
to
be
culturally
adapted
because
people
are
not
going
to
understand.
E
So,
as
dr
nakagawa
mentioned
that
we
know
that
asian
ethnic
groups
in
general
have
low
body
mass
index,
but
there
are
a
lot
of
hidden
fat
stores,
and
that
means
that
the
people
can
put
fat
in
places
where
we
were
not
supposed
to
have
fat
deposited
like
fat
around
the
heart,
pericardial
fat
fat
in
the
muscle
tissue
fat
in
the
liver.
I've
already
showed
you
that
you
know
fatty
liver
can
be
affected
by
the
diet
you
eat
and
then
fat
around
the
organs
of
the
abdomen
called
visceral
adipose
tissue.
E
So
in
masala
we
measured
how
much
fat
there
is
in
these
places
using
ct
scan
technology,
and
what
we
found
was
that
south
asians
store
fat
in
all
of
the
wrong
places,
and
here
again
I'm
comparing
masala
in
yellow
to
the
four
groups
in
mesa
and
in
the
top
left
panel
here,
visceral
fat.
That's
the
fat
around
the
intestines
was
highest
among
the
south
asians
compared
to
the
four
mesa
groups.
E
Fat
in
the
muscle
was
highest
in
the
south
asian
compared
to
the
four
mesa
groups,
and
then
fat
in
the
liver
was
highest
also
in
the
south
asians.
This
is
an
inverse
variable
where
the
attenuation
being
low
means
that
there's
more
fat
in
the
liver-
and
here
this
is
total
lean
mass,
which
is
muscle
mass,
which
is
a
healthy
place
to
have
you
know
more
muscle,
south
asians
have
the
lowest
muscle
mass,
and
this
is
probably
related
to
the
fact
that
they
were
also
having
the
lowest
amounts
of
exercise
compared
to
the
other
groups.
E
This
is
about
a
natural
process.
The
body
is
doing
trying
to
stabilize
the
plaque
and
then
what
happens
is
as
we
age,
the
plaque
can
become
vulnerable
and
it
can
rupture
and
the
process
of
the
rupture
of
the
plaque
can
cause
platelets
in
the
blood.
That's
coursing,
through
this
artery
or
blood
vessel,
to
stick
onto
that
ruptured
plaque
to
cause
a
clot
and
when
the
clot
completely
obstructs
the
blood
flow.
That's
the
heart
attack!
That's
when
there's
a
lot
of
pain
and
there's
parts
of
the
heart
that
don't
get
blood
supply.
E
the
red
and
the
green
lines
track
almost
identically
here
for
the
men
showing
you,
the
amount
of
calcium
in
the
plaques
of
the
arteries
is
about
the
same
for
whites
and
south
asians.
After
the
age
of
60
I
mean
they
basically
are
about
the
same
lines.
There's
no
significant
difference
here,
but
the
three
other
groups,
the
latinos
african
americans
and
chinese
americans,
had
quite
a
bit
lower
calcium
deposits
in
their
heart.
E
Compared
to
these
two
groups
for
the
women,
the
white
women
seem
to
have
somewhat
higher
rates
of
calcium
plaque,
especially
after
the
age
of
65
and
the
south
asian
women
were
somewhat
in
the
middle
compared
to
the
other
groups.
So
this
is
useful
because
this
may
be
another
way
to
determine
who
is
at
higher
risk
it's
how
much
calcium
there
is
in
their
arteries.
E
So
I'm
just
going
to
sum
up
here
with
some
of
the
key
lessons.
We've
learned,
south
asians,
have
higher
prevalence
of
cardio
metabolic
risk
factors,
and
maybe
it's
this
adverse
body
composition,
which
I
showed
you
had.
You
know
more
fat
in
all
the
wrong
places
that
may
be
what's
driving
this
problem.
E
The
cack
burden
and
progression
seems
to
be
greater
among
south
asian
men
than
many
other
ethnic
groups
of
men.
I
didn't
show
you
the
cac
progression
data.
After
five
years,
the
south
asian
men
had
faster
cac
progression,
greater
numbers
of
cac
than
even
the
white
men,
but
there
are
several
modifiable
risk
factors
and
I
think
that's
where
we
really
need
to
get
the
public
health
messaging
right,
and
that
is
that
you
can
do
something.
This
is
not
an
inevitable
thing.
E
You
can,
you
know,
change
your
diet
to
a
more
prudent
dietary
pattern
using
more
healthy
plant-based
foods.
We
know
that
that
can
help
prevent
diabetes,
which
is
one
of
the
big
risk
factors
for
heart
disease
exercise,
exercise
more
because
that
will
help
increase
the
lean
muscle,
mass
and
decrease
some
of
these
abnormal
stores
of
fat
around
the
body.
E
E
I
want
to
thank
everyone
who
has
been
a
part
of
the
masala
study
for
the
past
10
years,
especially
our
study
staff
and
investigators
and
the
funders
that
have
been
primarily
the
national
institutes
of
health.
I'm
happy
to
have
you
communicate
with
me
by
email.
I
do
want
to
show
you
one
new
study
that
we
are
doing
to
really
help
give
the
voices
of
asian,
american
and
pacific
islanders
some
more
weight
and
research
that
we
do.
We
are
working
on
something
called
the
care
registry
and
it's
a
partnership
with
many
universities
of
california.
E
As
long
as
they
can
speak
and
read
english
chinese,
cantonese
korean
or
vietnamese,
they
can
enroll
and
there's
many
topics
of
research
that
they
may
be
contacted
for.
So
I
would
really
encourage
you
to
use
your
networks
to
disseminate
this
information
about
care
registry.
It's
just
a
simple
website
and
I
will
post
some
of
that
information
on
the
webinar
as
well.
So
with
that,
I
thank
you
for
your
attention.