South Asian adults in the U.S. Are experiencing a disproportionately high rate of cardiovascular risk factors, including prediabetes, diabetes, and hypertension, even when compared to other racial and ethnic groups with similar or less healthy lifestyles. A new study led by Northwestern Medicine researchers reveals that these risks begin to emerge significantly earlier – by their mid-40s – than previously understood.
The research, published today, , in the Journal of the American Heart Association, analyzed data from over 2,700 adults and combined findings from two long-term studies: the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and the Multi-Ethnic Study of Atherosclerosis (MESA). The study focused on individuals with heritage from Bangladesh, India, Pakistan, Nepal, and Sri Lanka.
A Paradox of Health and Risk
What makes these findings particularly striking is that South Asian adults in the study reported healthier lifestyle behaviors than many of their peers. They consumed diets of higher quality, used alcohol less frequently, and engaged in comparable levels of physical activity. Despite these advantages, they exhibited a significantly increased prevalence of cardiometabolic risk factors.
“The mismatch between healthier lifestyle behaviors and clinical risk was surprising,” said Dr. Namratha Kandula, senior author and professor of general internal medicine and epidemiology at Northwestern University Feinberg School of Medicine. “This paradox tells us we’re missing something fundamental to what is driving this elevated risk among South Asians.”
The study identified a critical window in the 40s when risk is already high, but disease is still potentially preventable. Previously, the timeline for increased risk in this population was less defined.
Key Findings: A Closer Look at the Data
The data revealed stark differences in risk factor prevalence at age 45. South Asian men were found to have a prediabetes prevalence of 31%, significantly higher than their white (4%), Black (10%), Hispanic (10%), and Chinese (13%) counterparts. Similarly, 25% of South Asian men had hypertension, compared to 18% of white men, 10% of Hispanic men, and 6% of Chinese men. They also showed higher rates of high cholesterol and/or triglycerides compared to Black men (78% vs. 61%).
South Asian women mirrored this trend, with nearly one in five (about 18%) having prediabetes at age 45 – roughly twice the rate observed in white, Black, Hispanic, and Chinese women. By age 55, both South Asian men and women were at least twice as likely to develop diabetes as white adults.
Unraveling the Underlying Causes
Researchers are exploring potential explanations for this disparity. Dr. Kandula suggests that risk factors may begin to develop well before midlife, potentially influenced by early life nutrition, environmental factors, stressors, and activity patterns experienced during childhood and early adulthood, particularly for those who immigrated to the U.S.
Data from the MASALA study indicate that South Asians tend to have more fat around their organs, even with a normal or low Body Mass Index (BMI). This type of fat distribution, which often begins in childhood, is recognized as a significant risk factor for heart disease.
Globally, South Asians experience a disproportionately high burden of heart disease, accounting for roughly 60% of heart disease patients worldwide despite comprising only about one-quarter of the global population. In the U.S., this population develops atherosclerosis, which can lead to heart attacks, up to a decade earlier than the general population.
A Patient’s Perspective
Chandrika Gopal, 58, of Ohio, shared her experience as a participant in the MASALA study. She emphasized the study’s impact on her understanding of her own heart health as a South Asian woman. After immigrating to North America, Gopal noted the challenges of adapting to different food and routines, and how participation in the study, with regular checkups and guidance from Dr. Kandula, has led her to prioritize exercise, sleep, and a vegan diet.
“It’s so crucial to understand our heart health if we want to grow old gracefully,” Gopal said. “Even if we eat well, we can still be at higher risk. Living in a new country, adapting to different food and routines, it all adds up.”
Implications for Clinical Practice
The study’s findings underscore the need for earlier and more proactive screening for cardiovascular risk factors among South Asian adults. Dr. Kandula recommends that clinicians begin looking for high blood sugar, high blood pressure, and other risk-enhancing factors, such as lipoprotein A, before midlife.
She also stresses the importance of providing culturally appropriate lifestyle counseling to help South Asians adopt healthy eating habits, engage in regular exercise, and minimize tobacco and alcohol consumption.
For individuals of South Asian descent, the message is clear: “Even if you eat well and exercise, you may still be at higher risk for diabetes and high blood pressure at younger ages. Ask your doctor about early screening – and get your blood pressure, fasting glucose (or A1c), cholesterol and lipoprotein (A) checked before middle age because early detection, treatment and control of these risk factors can prevent heart disease.”
