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One person’s normal = another person’s heart attack?

Much has been written about calculating your BMI (or body mass index, the relationship between your height to your weight) and what it might indicate about your health.

Similarly, the glucose level in your bloodstream and what it says about your risk of diabetes.

What you don’t hear much about, and what I learned yesterday, is how much the meaning of those numbers can vary between people. A healthy BMI for one person might put another person at risk for heart disease.

I was visiting the Stanford South Asian Translational Heart Initiative run by Rajesh Dash, MD, PhD, along with some Biodesign fellows I’ve been following (more about that in a later post). By way of background on the clinic, Dash explained the high risk of heart disease in the South Asian population. (My colleague Becky Bach blogged about that risk last year.)

Dash said one challenge in helping South Asians avoid heart disease comes from the definitions of “overwieight” and “diabetic”. Dash said that South Asians tend to have more fat per body weight, and so might have an acceptable BMI but still have an amount of fat that puts them at risk for heart disease. Similarly, a South Asian person who is pre-diabetic might benefit from diabetes medication.

“We see a lot of glucose levels that are technically normal but still troubling,” he told me. “Their risk of a cardiovascular event is almost as high as for someone who has diabetes.”

For a population that has four times more heart attacks in California than other ethnic groups, it seemed especially troubling that a mere definition might be preventing them from getting appropriate care.

That got me wondering how those numbers apply to other populations. Or to me.

I had my yearly blood work done recently and was pleased to see that everything was "normal". I'm curious if in a decade people like Dash and others might have collected enough data to sway the way our values get reported. A set of numbers that is normal for my gender and ethnicity might trigger additional screening in another person, or be considered better than normal for someone else.

Previously: A ssathi (partner) to thwart heart disease in South Asians and Biodesign program welcomes last class from India

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