South Asian Heart Center FY2012 Annual Report by South Asian Heart Center

South Asian Heart Center

2012 Annual Report

“The South Asian Heart Center made me realize that Indians may have heart disease risk factors that are not caught in the regular testing done during the physicals and routine lipid testing. Understanding my risks and taking concrete steps to reduce the risk factors with South Asian Heart Center’s guidance gave me a sense of control over my health. After talking to the nutrition counselor at the Center, I have started constantly looking for ways to reduce carbs and increase protein in the foods I prepare.

Table of Contents

Message from the Executive Director Fiscal Year Accomplishments Heart Attacks: The Hidden Risks Vision for Program Growth Financial Philanthropic Partners South Asian Heart Center Volunteers Message from the Medical Director

3 4-5 6 7 8 9 10 11

The South Asian Heart Center inspired me to start making healthier nutritional choices which have now become part of the entire family’s diet such as replacing cereals with oatmeal/fruit and proteins for breakfast, switching to brown rice, using 0% or 1% milk, eating a variety of sprouted lentils and increasing consumption of salads and various vegetables. We have also increased the level of physical activity - I look forward to brisk walks with my dog and Zumba classes!” – Neela Jorapur, Participant

South Asian Heart Center

2012 Annual Report

Message from the Executive Director This has been a year of realization for the South Asian Heart Center. Our efforts at motivating the community to healthier and sustained lifestyle change are showing promising results. AIM to Prevent, our unique, integrated, and evidence-based approach to heart health and diabetes prevention, offers comprehensive assessment, therapeutic lifestyle intervention, and personal coach-led management. It is producing concrete outcomes: sustained behavior change such as increased consumption of fruits and vegetables and minutes of weekly physical activity. We are observing a corresponding decrease in risk factors including lower triglycerides levels and improved protective cholesterol ratios. Our participants are clearly healthier and community doctors are paying attention. We are seeing a marked increase in referrals to the Center from local physicians who are now working collaboratively on this lifestyle-integrated evidence-based approach to risk reduction and cardiovascular health. Our first six years of operation have validated the concept and established us as a credible organization. Now we need to work harder to improve our reach within communities, particularly among women and youth, scale the prevention and coaching operations, leverage our brand to network with the wider physician circles and medical establishments, and grow the program’s impact on the epidemic through ongoing research. Overcoming this disproportionate risk due to genetic legacy and lifestyle disorders is going to require the commitment and dedication of our team at the Center, and the support of the community. The endeavors of the Center – the awareness we generate, the health literacy we provide, the lifestyles we transform, the risks we reduce, and the lives we may save – are accomplishments of our committed participants and the high performance team we have assembled, and speaks of the quality of the individuals engaged in our mission. With a capable team of professionals and a superb cadre of volunteers and partners, we forge ahead on the Center’s vision with confidence. We are truly grateful to this team and to all of you who support our critical and lifesaving work. Ashish Mathur Executive Director, South Asian Heart Center

A SHI SH MATHU R

Now we need to work harder to improve our reach within communities, particularly among women and youth, scale the prevention and coaching operations, leverage our brand to network with the wider physician circles and medical establishments, and grow the program’s impact on the epidemic through ongoing research.

South Asian Heart Center

2012 Annual Report

We are meeting our goals

Accomplishments Fiscal Year 2012 Coronary artery disease and diabetes epidemics are among the biggest health threats to the community of South Asians - people who trace their ancestry to India, Pakistan, Sri Lanka, Nepal and Bangladesh in the Indian subcontinent. Seemingly healthy, often vegetarian, non-smoking and non-obese young men and women are suffering heart attacks at an alarming rate, developing traditional risk factors at younger ages, leading less protective sedentary, stressful, and less-nutritious lifestyles, and being predisposed to emerging genetic, inflammatory, and metabolic abnormalities. The South Asian Heart Center was established in response to this crisis. Our mission is to reduce the high incidence of heart disease and diabetes in South Asians through a comprehensive, culturally-appropriate program that raises awareness through education, evaluates risks with advanced screening, and facilitates lifestyle changes with heart health coaching. We fulfill this mission through work in four strategic directions – Outreach, Prevention, Education and Research. The unique AIM to Prevent program that we offer to our participants has been thoughtfully developed to provide a simple, low-cost, sustainable, lifestyle approach to early screening and prevention. 4

“Through its outreach campaign and active counseling, the Center has done an amazing job of driving awareness of the risks of heart disease we face as a community. While I can’t change my DNA, the Center has driven home the fact that I can significantly reduce my risk through active lifestyle management - healthy eating, regular exercise and stress management. Having put this counsel to practice over the last 12 months, I can tell you that the results are amazing, and my family and I have started to enjoy the benefits. I am confident that the Center through its laser focused dedication to the cause will continue to make a significant impact in controlling and reversing the risks in our community.” - Sudip Nag, Participant The South Asian Heart Center has been an ally in identifying and managing the high risk of several of my hyperlipidemia patients, that might otherwise go undetected and untreated. Coronary artery disease is a silent killer and the epidemic of heart disease and its repercussions are for the most part, able to be identified by the Center’s advanced screening, leading to proactive, focused therapy and lifestyle management. - Geeta Krishnapriyan, M.D.

South Asian Heart Center

2012 Annual Report

We are making significant progress on each of our strategic initiatives. Outreach – Engaging the Community and Building Awareness o

We staffed booths, conducted health fairs, and delivered presentations attended by more than 12,000 participants at more than 25 Bay Area corporate, community, and professional organization events. We completed more than 200 screenings for the underserved and uninsured.

Prevention – Enabling Protective Behaviors and Reducing Risk o

We completed advanced screening with 928 unduplicated participants last year; 4,000 participants overall.

Of over 1600 case managed participants, we are observing that twice as many are now engaged in our goal of 150 minutes of weekly physical activity. And thrice the number of participants are consuming four or more servings of vegetables per day.

As a result of this behavior modification, nearly 60% of retested participants have improved their triglyceride levels and 25% have lowered their high cholesterol ratios.

Many at-risk participants for whom we recommended a heart scan, tested positive for coronary calcification confirming heart disease.

We added diabetes risk factor screening to our prevention program. Not only is diabetes a risk factor for heart disease, it is a runaway epidemic as well. We are able to alert a high 10% of our population base of their pre-diabetic conditions.

Education – Partnering with Physicians in a Primary Prevention effort to curb the Epidemics o

We trained 161 physicians on practice methods for early diagnosis, comprehensive evaluation, and lifestyle changes.

The number of physician referrals we receive continues to climb. 300+ physicians actively refer their patients for evaluation at the Center.

Research – Advancing Knowledge on the Epidemic and Effects of Lifestyle Change o

We have published posters and manuscripts in collaboration with UCSF and Stanford on topics ranging from the prevalence of metabolic syndrome, adiposity and insulin resistance, Lp(a) and metabolic syndrome, and our coaching program. We were invited to poster presentations at the American College of Cardiology, American Diabetes Association and American Heart Association conferences.

Our work is garnering significant recognition. We were honored to receive the U.S. Congress Award of Distinction from Congresswoman Anna Eshoo and the 2011 Santa Clara County Asian Heroes Award from Supervisor Liz Kniss. We continue to launch new initiatives. We published the Center’s first collection of healthy recipes, “Cooking from the Heart,” an online eCookbook. We initiated the “Ask the Doctor” column in India West that covers topics of health literacy and medical interest for the community. We created the Nutrition Tip from the South Asian Heart Center radio segment (featured on KLOK 1170 and Radio Zindagi AM 1150). We were also featured on ABC7News Beyond the Headlines, and the Houston Chronicle. 5

Heart Attacks: The Hidden Risks in South Asians South ASiAn hEARt CEntER’S

A IM TO PREvENT PROGRAM Assess Intervene

Traditional Guidelines

Value

NCEP ATP III Goal

120/80

130/85

BMI

25 ; 23*

Metabolic panel Total cholesterol (mg/dL)

170

200 ; 150*

100

<130; <100|<70 w/CAD*

Anthropometrics Blood pressure

Advanced Screening

LDL-C (mg/dL) HDL-C (mg/dL)

Medication

≥40

≥50

Triglycerides (mg/dL)

108

<150

Glucose

112

<100

Value

*South Asian Heart Heart Center Goal

Exercise Diet Rest

Manage

South Asian Hear Heart Center Adva Advanced Screening Screening Reverse Cho Cholestero lesteroll Tr Tra ans nspo porrt HDL 2b (%)

≥20

≥30

TC/HDL ratio

3.5

Disorders of LDL Cholesterol LDL IIIa+b (%)

23.5

<15

<60 w/CAD

<30

LDL IVb (%)

Heart Health Coaching

Apo B (mg/dL)

Genetic Predisposition Lp(a), extended range (mg/dL) Family history of CAD/Diabetes

Inflammation CRP (hs) (mg/dL)

Yes 5.1

530

<350

<25

7.1

5.6

Homocysteine (µmol/L)

8.4

<14

Obesity/waist circumference (in)

Fibrinogen (mass) (mg/dL)

Predisposition to Diabetes Insulin (µU/mL) and Dis-metabolism Hemoglobin A1c (%)

Coronary Artery Artery Disease CT calcium score (%ile)

<36

<32 <75th %ile

Disorders of Lifestyle Sedentary Lifestyle Physical activity (min/day) Malnutrition Malnutr ition Vegetable/fruit intake (servings) Stress Levels Rest while asleep (hrs/night)

Rest while awake (meditation,min/day) Smoking Status Sample advanced screening assessment of a 42 year old South Asian Indian male.

≥30

1–2/1

≥4 / ≥2

6.5

7–8

20 x 2 times

Non

Non-smoker | Quit >2 yrs

Lower-risk

Borderline

At Risk

South Asian Heart Center: Vision for Program Growth Accomplishments to date

• • • •

Delivered 15 physician CME symposiums Educated 850 physicians Received referrals from 300 physicians Developed Therapeutic Lifestyle Changes (TLC) webinar curriculum

• Consented 2000+ participants for study • Processed 1200+ tissue samples for genetic/metabolic risk research • Published/presented 5 papers/posters in collaboration with UCSF, Stanford at AHA, ACC, ADA

ENlARGE SCOPE

Augment AIM to Prevent with diabetes prevention protocol, education and resources. Deliver heart health coaching on mobile platform.

ExPAND NETWORK

Expand the network of physicians collaborating with the Center to address the twin epidemics in their practices. Provide online CME and prevention focused resources for physicians.

ENHANCE IMPACT

Study the impact and efficacy of the Center’s lifestyle approach to sustained behavior change and chronic disease prevention. Publish standards for risk marker evaluation in South Asians.

GlOBAl Gl OBAl COMMUNITY

Research

Screened 4000 participants Coached 1600 participants for full year Improved physical activity, dietary behaviors Lowered lipid profile risk factors

HEAlTHCARE HEAl THCARE PROv IDERS PROv

Education

• • • •

ExTEND ExTEND REACH

Build strategic partnerships with corporate, professional, cultural, and religious organizations. Develop greater penetration with extensive use of social media, mobile, and online presence.

CENTER PARTICIPANTS

Prevention

• Conducted 70+ health-fair, outreach events • Covered in 25+ print and TV stories: Print: WSJ, SJ Mercury News, SF Chronicle Television: CBS, ABC, NBC

Target SOUTH ASIAN ASIAN COMMUNITY

Outreach

Growth Driver

South Asian Heart Center

Financials Fiscal Year 2012 Income Community Benefit South Asian Heart Center Fund Transfers

$190,000 $299,879

ToTal

$489,879

Expenses Personnel Supplies Fees/Purchased Services General and Administrative

$289,289 $15,079 $156,236 $19,257

ToTal direcT expenses Depreciation and Amortization

$479,862 $7,730

ToTal expenses net retained income

$487,592 $2,287

Res ear c

Outreach g/ isin a r nd Fu her Ot

Prevention

Funding Facts • Receive annual matching funds from ECH community benefit to promote local health literacy and screening • Raised $1.5M over five years with 1,000 individual gifts, foundation grants, and corporate sponsorships; $312K in FY2012 • Created the community recognized Scarlet Night brand for annual fundraising gala

Strategic Initiatives Breakdown of Expenses Outreach Prevention Education Research Fundraising/Other

11.2% 63.3% 7.3% 8.3% 9.9%

South Asian Heart Center

2012 Annual Report

South Asian Heart Center Philanthropic Partners President’s Circle $100,000 and above Joy and Dinesh Desai visionaries Circle $25,000-$99,999 Indira Foundation, Connecticut Vibha Apte and Girish Gaitonde Madhu and Navindra Jain Neeraj and Parveen Jain Kalpana and Raj Jaswa Priti and Sanjay Mittal Ann and Kanwal Rehki Datta and Girish Shah Advocates Circle $5,000-$24,999 Nina and R.K. Anand Louanna and Keith Angelo Aparna Balasubramaniam and Manish Balasubramanian Vineeta Bhandari Sabeer Bhatia Sonia and Dr. Puneet K. Chandak Sukanya and K.B. Chandrasekhar Dr. Anu and Murali Chirala Sadhana and Vinod Dham Priya and Murali Dharan Arati and Vishwas Godbole Anuradha and B.V. Jagadeesh Matra Majmundar and Raj Mashruwala Nivedita and Ashish Mathur Dr. Prasanna and Dr. P.K. Menon Linda and Dr. Cèsar Molina Pankaj Patel Sharad Patel Vibha and Jayan Ramankutty Sushama and Shyam Rangole Raj-Ann K. Rekhi Rashmi Sinha and Vikram Sahai Ann and George Samenuk Vijay Chawla and Munjal Shah Rita and Vineet Sharma Sheetal and Dr. Anil Singhal Chandana Reddy-Sinha and Ranjan Sinha Ramesh Sivakolundu

Monal and Vatsal Sonecha Sujatha and Krishnamurthy Suresh Sarah and Prof. Kailath Thomas Jayshree and Vijay Ullal, Sita Foundation Friends Circle $1,500-$4,999 Romina and Kulvinder Ahuja Bridgette and Mehmet Akunal Kalpana Trivadi and Rama Aysola Prameela and Brian Bartholomeusz Karishma and Deepak Chandani Deepali and Amit Chandra Dave David Diana and Arjun Divecha Lalitha Kumar and Kumar Ganapathy Anita and Vasu Ganti Ewa and Atul Garg Wendy and Robert Gittings Regina P. Gupta Rani Roley and Arvind Jaini Pammi and Vijay Kapoor Anjali Joshi and Sanjay Kasturia Maninder Kaur Bharti and Ashok Killer Renu and Gary Kohli Poornima and Arun Kumar Anuradha and Pritpal Mahal Surendra Mandava Nivisha and Manish Mehta Claire and Gene Miner Bina and Natwarlal Motiram Asha Jadeja and Rajeev Motwani Dr. Harish Murthy Smriti Deokule and Sudip Nag Deep Pala Anjali and Prasad Palkar Venkat Panchapakesan Shobhana and Bidyut Parruck Mugdha and Sudhir Pendse Geeta Kalia and Ramani Pichumani Shobha Prabakar Sukanya and Puneet Pushkarna Sudha Kidao and Vivek Raghavan Valya and Ramesh Ragu

Vidhya and Ranganathan Seema and Navin Sahni Anita and Shirish Sathe Cecile S. Currier and Lynn Segal Anuradha and Jay Sethuram Prasad Setty Sunita and Devang Shah Man Mohan Sharma Ritu and Poonam Shrivastava Sanjog Sikand Annamma Spudich Kalpana Prativadi and P.V. Sridhar Vijay Vachani Corporate Sponsors $25,000 – 99,999 El Camino Hospital District Genentech SanDisk Shastha Foods $5,000 – 24,999 Abbott Aetna Foundation AstraZeneca Building Kidz School El Camino Hospital Medical Staff Farmers Insurance Headstrong McAfee Pfizer PNG Jewelers St. Jude Medical Takeda Zojio Technologies $2,500 – 4,999 Biotronic, Inc. Boston Scientific Cardiovascular Associates Medical Group, Inc. Google Matching Gifts Koss Pharmaceuticals Marin General Hospital Medtronic Proactive Foundation Schering Corporation

Includes donations received through June 30, 2012. The South Asian Heart Center is deeply grateful and appreciates the generosity of all who have made gifts in amounts under $1500. While we make every effort to recognize the gifts of our supporters, we apologize for any omissions or errors. Please call 650.940.7242 to confirm your donation or to correct any mistakes in this publication.

South Asian Heart Center volunteers Volunteers are truly the heart of our organization. From fundraisers to lifestyle coaches, assessors, and educators, they propel the lifesaving mission of the South Asian Heart Center, expanding our capacity and reach as we strive towards our vital goals.

Nita Shah

Samika Savanur

Here is what some of them have to say about volunteering for the Center. “I volunteer at the Heart Center as I feel that what we do helps a lot of people. It is especially nice when participants acknowledge our efforts. It has also been beneficial to me personally as the lifestyle changes have impacted my whole family in a positive way.” – Nita Shah, Heart Health Coach for 5 years “My reason for volunteering at the South Asian Heart Center was to gain a better understanding of heart disease and diabetes and their prevalence among South Asians. I first wanted to educate myself about this issue and secondly become a role model for others to lead healthier lifestyles. As a clinical coordinator, I had the opportunity to converse with many individuals about their lifestyles as well as to motivate and empower them to take a stand on their health. The South Asian Heart Center has definitely opened up my eyes and has made me realize the importance of heart health and taking preventative measures. I will continue to spread the South Asian Heart Center’s ideals as well as live by them day in and day out.” - Samika Savanur, Student Intern

Sukanya Sekar

“I have been volunteering at the Center for the past 5 years. It has been absolutely a very satisfying experience to work with the South Asian community to help them lead a healthier lifestyle. The Center has helped educate me about how important regular exercise, a healthy balanced diet, and restful sleep and restful alertness is for a healthy heart.” – Sukanya Sekar, Heart Health Coach for 5 years

South Asian Heart Center

2012 Annual Report

Message from the Medical Director The purpose of this letter is to thank you for creating and sustaining the South Asian Heart Center through your continued support. Arising from an informal conversation between a community conscious hospital administrator and a community physician leader, the South Asian Heart Center has become a center of excellence as it fulfills its mission to decrease the high incidence of coronary artery disease through a comprehensive, culturally-appropriate program incorporating education, advanced screening, lifestyle changes and personalized one to one case management. On this anniversary of the Center we are preparing scientific research papers for presentation at prestigious national scientific conferences demonstrating the effectiveness of our Awareness, Intervention and Management (AIM to Prevent) program. We have demonstrated that our unique, cost-effective model of coaching by non-medical volunteers can significantly improve health promoting behavior accompanied by marked improvements in measurable laboratory parameters without adding expense to our already overburdened health care system. My association with you and the Center has permitted me to marry my interest in Vedic medicine and culture with allopathic western medicine and science. Vedic medicine or Ayurveda places great emphasis on daily and seasonal routines as a way of preventing disease or quelling “danger before it arises.” The South Asian Heart Center’s Therapeutic Lifestyle Changes (TLC) curriculum is the result of this interest. Our TLC program can be considered a science based Vedic approach to health. The Center has permitted me to fulfill my professional aspirations as an educator, physician and scientist. I have had the privilege of collaborating with some of the best minds in medicine and present our work at national medical conferences. This past year I have visited India and taught in China. I have had the pleasure of seeing once-skeptical physicians become active participants in our work. Thank you for supporting the Center on this exceptional journey. The Center’s work has been fulfilling personally, and transformative for the community. Our long term impact depends on your continued investment. Together we can save lives, relieve suffering, and create a healthier future for our children and grandchildren. César R. Molina, MD FACC Medical Director, South Asian Heart Center

Cé SA R MO l IN A , MD

Thank you for supporting the Center on this exceptional journey. The Center’s work has been fulfilling personally, and transformative for the community. Our long term impact depends on your continued investment. Together we can save lives, relieve suffering, and create a healthier future for our children and grandchildren.