Los Angeles has the largest Persian, Armenian, and Middle Eastern population in the world. From Westwood’s Tehrangeles to the large Armenian populations in Glendale, Hollywood, and Pasadena, hundreds of thousands of Angelenos have distinct cultures that influence their lifestyles and beliefs about health. Alongside the benefits of their cultures, there are specific heart disease problems that can be discussed.

Dr. Maria Tehrani is a cardiac specialist at the Ronald Reagan UCLA Medical Center in Westwood, and is attentive to the impacts of family history and lifestyle in patients belonging to Persian, Armenian, and Middle Eastern communities.

Why Heart Disease is the Leading Cause of Death for these Communities

Cardiovascular disease is a significant health problem for Persian, Armenian, and the majority of Middle Eastern communities in the U.S., for a variety of reasons, including:

– Higher rates of Type 2 diabetes and prediabetes at earlier ages and lower body weights

– Higher rates of metabolic syndrome (insulin resistance along with abdominal obesity, hypertension, and high triglycerides)

– A strong family history of early coronary artery disease at 40 and 50 years of age

– Undiagnosed and untreated hypertension

– Cultural stigmas related to health and preventive care, with a greater preference for delayed care-seeking

– Increased consumption of traditional foods and refined carbohydrates

Due to these circumstances, many patients in these communities present for their first serious engagement with the healthcare system after they have already experienced a major adverse cardiac event, many years after the potential for preventive strategies.

The Diet Discussion: What is Safe to Eat and What is Not

Middle Eastern cuisine is naturally heart-friendly in its construction. Persian, Armenian, and other Middle Eastern diets that include olive oil, fresh herbs, legumes, vegetables, fish, yogurt, and whole grains (bulgur, for example) would be foods that cardiologists would approve of. The problem is rarely in the traditional foods themselves. It is in how meals are constructed now, with significant changes in Los Angeles regarding portion sizes and readily available prepared foods.

What works well in the traditional diet:

– Use of olive oil

– Parsley, mint, dill, cilantro

– Lentils, chickpeas, fava beans

– Fresh and grilled fish

– Dishes with yogurt (mast-o-khiar, jajik, labneh)

– Stews like ghormeh sabzi and khoresh

– Walnuts, almonds, pistachios, but in moderation

What tends to drive cardiovascular risk:

– White basmati rice combined with stew, kebab, and tahdig

– Butter and ghee used in rice and baked goods

– Kebabs and stews with fatty lamb and beef

– Frequent baklavah, bamieh, gaz, rahat lokum, and sholeh zard

– Sugar-laden tea throughout the day

– Pickled foods, along with very salty cheeses, that lead to excessive sodium consumption

– (Refined bread (lavash, barbari, sangak in large quantities)

The foods that remind us of our family and heritage should be kept, but there needs to be a balance with smaller servings of rice and bread and larger servings of vegetables and legumes, healthier protein, less butter, and limited sweets and salt.

High Blood Pressure: An Often-Silent Problem

Persian, Armenian, and Middle Eastern patients have an inconsistent prevalence of hypertension and an increased incidence of early heart disease, decades before a heart attack or stroke occurs. Salt consumption is part of the culture. Foods such as pickled vegetables (torshi), salty cheeses (feta, lighvan), olives, and cured meats are part of adjacent households.

Things that actually help:

– Record your blood pressure at home, with home devices or monitors

– When cooking, use less salt or none. Foods like cheese and pickled foods should not be eaten daily.

– Foods like beans, leafy greens and tomatoes can help with hypertension. They have a lot of potassium.

– Caffeine should be avoided.

– Meds should be taken consistently. One of the biggest reasons hypertension isn’t controlled is because people take their medication until they feel better. Then they stop taking it. They should have taken it until the doctor says they can stop.

Diabetes and Prediabetes

Type 2 Diabetes is especially prevalent in these communities and frequently develops with less body weight than the general US population. One of the biggest signs that a person has diabetes is their family history. If a person has a family history of diabetes, their risk for diabetes is noticeably higher, even if the person isn’t feeling sick.

What is important:

– They should have their fasting blood sugar levels tested every year, along with their HbA1c starting in their 30s. If you have a family history of diabetes, they should definitely be tested.

– They should stop drinking sugary tea and juice and eating sweets, especially when these sugary foods are eaten multiple times during the day.

– Meals should have vegetables and proteins as the biggest portions and the smallest amounts should be rice, bread and carbohydrates.

– Movement should be a priority. The aim should be to have at least 30 minutes of movement a day, even if that is just walking.

Cholesterol and Triglycerides

A trend that is especially noticeable for many people in these communities is high triglycerides and low HDL cholesterol. This is a dangerous trend because high cholesterol is one of the biggest risk factors for cardiovascular disease. This is the case even when the total cholesterol levels are okay and not high. Refined carbohydrates, sugar, alcohol and a lack of exercising and a sedentary lifestyle.

Rice and bread reduction, along with an increase in physical activity and weekly intake of fatty fish, is beneficial. For patients with early heart attack family histories, statins could be appropriate and therefore a more considered discussion with your doctor is warranted rather than an automatic avoidance approach.

Stress, Family and CV Health

Family cultural focus, which is one of the positive aspects of these communities, can create a form of sustained anxiety. This can include anything from restraint and support of aging family members, controlling the expectations of older members and running family businesses, which is quite typical in most of the Persian and Armenian sections in LA.

Chronic stress does impact the heart, and can create unhealthy eating, inflammation, interrupted sleep, and high blood pressure. Finding leisure time for family and friends is important and restores your heart.

Practical Steps for LA Patients

– Family history? Get a cardiac assessment in your 30s or 40s.

– Know your numbers: blood pressure, glucose level, HbA1c, cholesterol (LDL, HDL), and triglycerides.

– Hypertension and high cholesterol should be treated earlier, before cardiac events.

– Traditional foods: use less rice, butter, and sugar and add more vegetables.

– Take short walks and be active every day.

– Don’t ignore shortness of breath, fatigue, and/or a pressure-like discomfort in your chest, especially when exerting yourself.

When to See a Cardiac Specialist

If you have a family history of:

– heart attacks before 60, and undergoing surgical treatments or stent placement

– Diabetes

– Long standing high blood pressure

– Recent lab tests showing high triglycerides and low HDL cholesterol

– Chest pains, shortness of breath, or low exercise tolerance

– Previous cardiac events

If you have any of the above and are wanting an opinion on Surgical interventions, please schedule an evaluation. For immediate and emergency concern where severe chest pains occur, along with loss of consciousness or stroke like symptoms, please call 911.

Schedule a Consultation in Westwood

Dr. Maria Tehrani specializes in and supports patients across Los Angeles with thorough cardiac evaluations that honor family history and background.