HEART surgeon Professor Jaspal Kooner has given a time for an interview at Hammersmith Hospital but at the appointed hour he is waiting by the lift to say he will first have to rush into theatre to deal with an urgent operation. It is just as well for the patient, a 61-year-old Asian man who is suffering from breathlessness, that he is in the hands of one of the most highly regarded cardiologists in the country.
Kooner, who was born in Kenya and came to Britain in 1968 at the age of 12, has done some 20,000 heart operations over the past 20 years and trained 200 cardiologists. At 63, the man who was voted “doctor of the year” for the whole of the UK as far back as 2004 and named by Tatler as one of Britain’s top doctors in 2013, now holds a number of senior posts: consultant cardiologist, Imperial College Healthcare NHS Trust, Hammersmith Hospital Campus; professor of clinical cardiology, National Heart & Lung Institute, Imperial College London; and consultant cardiologist, London North West Healthcare NHS Trust, Ealing Hospital Campus.
“Asians are at two-fold higher risk of cardiovascular disease, three-fold higher risk of diabetes and fivefold higher risk of kidney failure,” says Kooner.
Actually, the patient he is operating on is a typical example of the health hazards facing the Asian community. It seems even if Asians don’t smoke or drink, eat sensibly and exercise adequately, the dice is still loaded against them. And most don’t observe the basic rules.Take, for example, this particular individual who is having a stent inserted in a blood vessel 90 per cent blocked with fatty plaque – “a bit like having lime scale deposits inside a pipe”.The man is question, informs Kooner, “has Type 2 diabetes, is obese, is a nonsmoker, is physically not very active and has a family history of early onset heart disease. He is an executive, with office based work; he runs a medium business of his own.
He often goes home late, and does not have the time to exercise. So these are what we call risk factors.“He is vegetarian. Sometimes people feel that vegetarian diets protect us against heart disease, but vegetarian diets may not protect you if you negate the vegetarianism by excessive consumption of fats, oils, starches and refined sugars. And these will lead to increased weight, increased risk of diabetes, which will lead to increased risk of cardiovascular disease.
“He first presented himself to me four months ago – he was showing symptoms of breathlessness while walking. This we suspected was due to angina, and we saw signs of reduced blood supply to the heart muscle. After early tests such as cardiograms and MRI scan, we were able to link that with a narrowing of the coronary artery. This required treatment with the placement of a stent.
“In his case, we were able to assess the internal diameter and area of the (blocked) artery to enable accurate assessment of the extent of disease so we could size the stent up appropriately.”The good news is that “we treated the tight area in his coronary artery – now that has relived his symptoms”. But the bad news is that the operation “does not necessarily reduce his future risk (of a stroke) because what we have done is treat a small segment of one artery. What we have to understand is that the underlying problem because of the build up of this fatty material in the arteries, which we call plaque sclerosis, is not fixed or localised in one area. And the disease itself is not limited just to the large calibre vessels – the disease is much more diffuse.
“If you look closely at his coronary arteries, you will have seen areas of irregularity in some of the other territories which sometimes can just be glossed over. And they shouldn’t be. But you can’t replace everything.“The risk of heart attacks occurring in the arteries is much higher in areas of narrowing which are smaller – say, less than 50 per cent – simply because the population of plaques (in those vessels) is much higher.“In his case the internal area (of the blocked artery) should have been 15-16 sq mm. In his case, it was reduced to just short of 2 sq mm.
The purpose of the assessment that we did was not to demonstrate that it was nearly blocked – that is pretty obvious on the initial angiogram – the purpose here was to size it internally for the diameter of the stent. When we are putting the stent in, we are able to expand the stent to an appropriate diameter so it fits in like a hand in glove rather than a stent floating somewhere in the middle.
”To extrapolate from one case to the wider problems of the community, Kooner is director of a biobank that will study the heart and other health problems of 250,000 Asians, of whom 100,000 are in the UK and the remainder in India, Pakistan, Bangladesh and Sri Lanka.The study will try and find out why Asians are more prone to cardiovascular disease, diabetes and kidney failure.
“Cardiovascular disease is still a mystery,” admits Kooner. “For diabetes, last year we were able to identify that obesity carries 200 genetic markers of which five end up predisposing one to higher risk of diabetes, particularly among Asians. We calculate that approximately 30 per cent of the excess risk of diabetes among Asians is attributable to these five genetic markers.
”He explains: “They are a bit like switches which sit on top of DNA. Obviously, the future is to home in on these targets to understand more about the biology and develop partnerships where one can actually look towards identifying potential targets that can be used either to predict disease better or to develop drugs that can help prevent diseases.
“Meanwhile the advice to people to retain a healthy lifestyle remains central, particularly for conditions such as obesity and diabetes. Werecommend good care of diet where you are reducing the intake, particularly among Asians, of starches, refined sugars and saturated fats, and increasing physical activity to at least 40 minutes of moderate to high levels of exercise per day.
”What sort of exercise would he recommend?“When people are not used to exercise we would encourage them to do exercises that are more natural for them. For people who don’t exercise one of the very easy things that people can do is walk.
