South Asian adults in the United States develop risk factors for heart disease significantly earlier than their white, Chinese, and Hispanic counterparts, often by their mid-40s, according to a new study published in the Journal of the American Heart Association. This increased risk occurs despite generally healthier lifestyle choices, including better diet quality, lower alcohol consumption, and comparable exercise levels.
The research, embargoed until , analyzed data from 2,700 adults aged 45-55, drawing from two long-running national studies: the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). Researchers compared health data from South Asian individuals – those tracing their ancestry to Bangladesh, India, Nepal, Pakistan, or Sri Lanka – with data from white, Black, Chinese, and Hispanic adults.
The study focused on identifying risk factors for atherosclerotic cardiovascular disease (ASCVD), which involves the buildup of plaque within the arteries and can lead to heart attack and stroke. These risk factors include high blood pressure, prediabetes, and type 2 diabetes. Early identification and management of these factors are crucial to preventing the progression to full-blown heart disease.
Earlier Onset of Prediabetes and Diabetes
The findings revealed a stark disparity in the prevalence of prediabetes among South Asian men. At age 45, South Asian men were nearly eight times more likely to have prediabetes (30.7%) compared to white men (3.9%), and significantly more likely than Chinese (12.6%), Black (10.4%), and Hispanic (10.5%) men. South Asian women also showed a significantly higher prevalence of prediabetes (17.6%) at age 45 compared to white women (5.7%), Chinese women (8.2%), Black women (9.0%), and Hispanic women (5.1%).
This trend continued into older age. By age 55, both South Asian men and women were at least two times more likely to develop type 2 diabetes compared to their white counterparts. South Asian men also exhibited a significantly higher prevalence of high blood pressure (25.5%) compared to white (18.4%), Chinese (6.6%) and Hispanic men (10.1%), as well as higher rates of dyslipidemia (high cholesterol and/or triglycerides) compared to Black men (78.2% vs. 60.6%).
Healthy Lifestyles Don’t Fully Protect
What’s particularly noteworthy is that these increased risks were observed despite South Asian adults demonstrating healthier lifestyle behaviors. The study found they maintained a higher quality diet, consumed less alcohol, and engaged in comparable levels of physical activity compared to other groups. This suggests that factors beyond lifestyle are at play.
“The earlier accumulation of health conditions that increase the chance of heart disease among U.S. South Asian adults signals the need for earlier screening, tailored prevention and prompt risk-factor management,” said Dr. Namratha Kandula, a professor of medicine at Northwestern University’s Feinberg School of Medicine and a co-founder of the MASALA study.
Understanding the Underlying Factors
While the exact reasons for this increased susceptibility remain under investigation, research suggests several potential contributing factors. One key area is body fat distribution. South Asians tend to store more visceral fat – fat around the organs – even when appearing thin, which releases harmful chemicals that damage blood vessels. Metabolic issues, such as higher rates of diabetes and insulin resistance, also play a significant role. The Mayo Clinic notes that South Asians can develop diabetes with a body mass index (BMI) as low as 23, while other populations typically develop it at a BMI of 25 or higher.
The American Heart Association published a scientific statement in 2023 highlighting the disproportionately high risk of ASCVD among South Asian adults and recommending dietary modifications, such as increasing whole-grain intake and choosing cooking oils lower in saturated fat.
Implications for Prevention and Screening
These findings underscore the importance of proactive health management for individuals of South Asian descent. The study authors recommend earlier and more frequent screening for heart disease risk factors, beginning in early adulthood, rather than waiting for symptoms to appear. This includes regular checks of blood pressure, glucose/A1c levels, and cholesterol.
Healthcare providers should also move beyond a “one-size-fits-all” approach to cardiovascular risk assessment and develop culturally tailored prevention programs. Further research is needed to fully understand the genetic, metabolic, and environmental factors driving this disparity, which could lead to more accurate risk prediction models and targeted therapies.
It’s important to note that the study had some limitations. The data relied on self-reported behaviors, which can be subject to inaccuracies. The participants in both the MASALA and MESA studies tended to have higher educational and socioeconomic status, potentially limiting the generalizability of the findings. There was also a decade-long gap between the initial baseline exams of the two studies.
