Why South Asians Are at Higher Risk for Heart Disease: What You Need to Know

Heart disease can affect anyone, but research has consistently found that people of South Asian heritage have a higher risk of developing coronary artery disease, often at a younger age. South Asian heritage includes people with roots in India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives.

This is important because heart disease does not always look the way people expect. A person may feel well, have a normal body weight, and still develop high blood sugar, high cholesterol, or plaque in the heart arteries.

The good news is that many of the major risks can be identified early and improved.

South Asian Heart Disease Risk: Higher Rates and Earlier Onset

South Asians are not one uniform group. Diet, culture, finances, stress, access to health care, family history, and lifestyle can differ greatly between individuals and communities.

Still, large studies in the United States, United Kingdom, and Canada have found that South Asian adults have a higher rate of atherosclerotic cardiovascular disease. This includes heart attack, stroke, and narrowing of the arteries that supply blood to the heart. In one large UK study, South Asian adults had about twice the risk of a cardiovascular event compared with adults of European ancestry, even after accounting for many common risk factors. 1

In the United States, professional guidelines recognize South Asian ancestry as a factor that can increase cardiovascular risk.

Why South Asians Develop Prediabetes and Type 2 Diabetes Earlier

One major reason for the increased risk is a higher tendency toward insulin resistance. Insulin is a hormone that helps move sugar from the bloodstream into the body’s cells for energy. When the body becomes less responsive to insulin, blood sugar rises over time.

South Asians are more likely to develop prediabetes and type 2 diabetes at younger ages and at lower body weights than many other populations. Diabetes is one of the strongest risk factors for heart disease because elevated blood sugar can damage blood vessels over time.

This means that a person should not assume they are protected simply because they are not visibly overweight. Blood sugar screening is especially important when there is a family history of diabetes, high cholesterol, high blood pressure, or early heart disease.

Belly Fat and Heart Disease Risk in South Asian Adults

Body mass index, or BMI, is commonly used to estimate whether someone is at a healthy weight. However, BMI does not show where fat is stored.

Many South Asians tend to carry more fat around the abdomen and internal organs, sometimes called visceral fat, even at a lower BMI. This type of fat is more strongly linked with insulin resistance, fatty liver disease, high triglycerides, and inflammation.

A waist measurement can sometimes provide useful information that BMI alone misses. Central weight gain deserves attention even when a person’s overall weight seems normal.

South Asian Cholesterol Patterns That Increase Heart Disease Risk

Heart disease risk is not determined by total cholesterol alone. Many South Asians have a pattern that includes:

• High triglycerides

• Low HDL cholesterol, often called “good” cholesterol

• A higher number of small, dense LDL particles that may more easily enter artery walls

• Elevated lipoprotein(a), also called Lp(a), in some individuals

Lp(a) is mostly inherited and can contribute to plaque buildup in the arteries. A recent review found that elevated Lp(a) may be more common among South Asian individuals and may help explain earlier or more aggressive coronary artery disease in some families. 3

A standard cholesterol panel is essential, but some patients may also benefit from a one-time Lp(a) test, particularly if there is a strong family history of early heart attack, stroke, or high cholesterol.

Family History of Early Heart Disease in South Asian Families

When a parent, sibling, or close relative has had a heart attack, stroke, bypass surgery, or stent placement at a young age, that history matters.

Genetics likely play a role in cardiovascular risk, but they are not the whole story. Researchers have not identified one single “South Asian heart disease gene.” Instead, risk probably reflects many small genetic influences combined with metabolic factors, lifestyle, environment, and social stressors. South Asians have also been underrepresented in genetic research, so there is still much to learn. 4

Family history should be viewed as useful information, not a source of fear. It is a reason to screen earlier and take prevention seriously.

South Asian Diet, Exercise, and Lifestyle Habits for Heart Health

Traditional South Asian foods can be very heart healthy. Lentils, beans, vegetables, fruit, yogurt, fish, nuts, and whole grains can all support heart health.

At the same time, modern routines can make healthy habits more difficult. Long work hours, sedentary jobs, stress, limited sleep, restaurant meals, sugary beverages, large portions of refined carbohydrates, fried foods, and tobacco use can all add to risk.

The goal is not to abandon cultural foods. It is to make practical adjustments that fit real life. Examples include:

• Choosing smaller portions of white rice, naan, sweets, and fried snacks

• Building meals around vegetables, beans, lentils, fish, chicken, tofu, or other lean proteins

• Using less ghee, butter, cream, coconut oil, and deep-fried ingredients when possible

• Walking after meals or fitting regular activity into the day

• Avoiding tobacco in all forms

• Limiting alcohol

Regular movement is one of the most effective tools available. It helps improve blood sugar, blood pressure, triglycerides, mood, sleep, and weight around the midsection.

How Stress, Sleep, and Social Factors Affect Heart Disease Risk

Heart disease is not only about food and exercise. Chronic stress, financial strain, caregiving demands, discrimination, immigration-related pressures, depression, limited time for self-care, and difficulty accessing culturally appropriate health information can all affect heart health.

These factors may make it harder to exercise, sleep well, attend appointments, cook at home, or take medications consistently. They deserve to be part of the conversation.

Why Heart Disease Risk Calculators May Underestimate Risk for South Asians

Many common heart disease risk calculators were not developed using enough data from South Asian populations. As a result, a person’s estimated 10-year risk may look lower than their actual risk.

This does not mean that every South Asian adult needs medication or advanced cardiac testing. It does mean that decisions should take the full picture into account, including ancestry, family history, blood pressure, diabetes risk, cholesterol pattern, waist size, and lifestyle.

For selected patients, a coronary artery calcium scan may help clarify whether plaque has already formed in the heart arteries. This is a CT scan that measures calcium in the artery walls. It is not needed for everyone, but it can be helpful when the decision about preventive treatment is uncertain.

Heart Disease Screening and Prevention for South Asian Adults

South Asian heritage is a risk factor, not a destiny. The most important step is to start screening and prevention earlier rather than waiting for symptoms.

A heart-health check should include discussion of:

• Blood pressure

• Cholesterol and triglycerides

• Blood sugar or A1c

• Waist circumference and weight trends

• Exercise, sleep, stress, tobacco, and alcohol use

• Family history of early heart disease

• Whether Lp(a) testing or coronary artery calcium scoring may be appropriate

Heart disease often develops silently over many years. Early attention to blood sugar, blood pressure, cholesterol, activity, nutrition, and family history can make a meaningful difference.

The takeaway is simple: South Asians may face a higher baseline risk of heart disease, but early screening and steady, realistic lifestyle changes can go a long way toward protecting the heart.

Heart Disease Prevention in Mountain View for South Asian Adults

Ready to take a proactive approach to your heart health?

At my primary care clinic in Mountain View, we help patients understand their personal risk for heart disease and create practical prevention plans that fit their health needs, family history, culture, and daily life. We can review your blood pressure, cholesterol, blood sugar, weight distribution, lifestyle, and family history, then discuss appropriate next steps.

Early screening can make a meaningful difference, especially for South Asian adults and families.

To schedule, contact Mountain View Primary Care Medical Clinic.

525 South Drive, Suite 101Mountain View, CA 94040

Phone: 650-254-6665