South Asian Adults in U.S. Develop Heart Disease Risk Factors Earlier Than Other Groups

South Asian adults in the United States were more likely to have risk factors for atherosclerotic cardiovascular disease by age 45 when compared to white, Black, Chinese or Hispanic adults in the same age group, according to a study published in the Journal of the American Heart Association. These ASCVD risk factors can lead to earlier heart disease if they are not treated and managed. To understand why, researchers analyzed health data for 2,700 adults, ages 45–55 from two national studies in the U.S. The health data examined were from two long-term studies that followed a diverse group of adults from different regions in the U.S.: the Mediators of Atherosclerosis in South Asians Living in America Study, and the Multi-Ethnic Study of Atherosclerosis.

The analysis examined health conditions that raise heart disease risk - such as high blood pressure, prediabetes and type 2 diabetes - as well as lifestyle behaviors, including diet, tobacco, alcohol use, physical activity and sex differences. The lifestyle measures collected during office visits, several components that are part of the American Heart Association's Life’s Essential 8, included determining diet quality, physical activity and alcohol consumption based on self-reported information. Alcohol use was defined as drinking one or more alcoholic drinks per week.

Key findings from the study revealed that the difference in heart disease risks between South Asians and other populations was largely driven by prediabetes, diabetes and high blood pressure. South Asian men had a higher prevalence of prediabetes at age 45 when compared to peers in other ethnic groups. South Asian men had a significantly greater prevalence of high blood pressure compared to white, Chinese and Hispanic men, and a significantly greater prevalence of high cholesterol and/or triglycerides compared to Black men. Similarly, South Asian women had almost two times higher prevalence of prediabetes at age 45 compared to peers in other population groups. At age 55, both South Asian men and women were at least two times more likely to develop type 2 diabetes when compared to white adults at the same age.

Despite having higher rates of heart disease risk factors, South Asian adults also had the best quality diet, lower use of alcohol and comparable exercise habits. Senior study author Namratha Kandula, M.D., M.P.H., a professor of medicine in internal medicine and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago and a co-founder of the MASALA study, said, "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."

A 2023 scientific statement from the American Heart Association likewise reported that South Asian adults face disproportionately high risk for ASCVD caused by the buildup of plaque within the arteries. To mitigate this, it advises some dietary modifications - such as increasing whole‑grain intake, selecting cooking oils lower in saturated fat and avoiding deep‑fried preparation methods - to help reduce this elevated risk. The long-term data analyzed in this study illustrate how health factors that contribute to cardiovascular disease, like high blood pressure; elevated levels of cholesterol and/or triglycerides; and prediabetes, appeared earlier among South Asian adults when compared to peers in other population groups. Identifying risk factors early can lead to early prevention and treatment strategies for South Asian adults in the U.S. and reduce their risk for heart disease.

The study has several limitations including the use of self-reported behaviors can be inaccurate because individuals may forget details or give answers they think may sound more desirable. Also, both the MASALA and MESA studies relied on participants following up, and these individuals were most often participants with higher educational and socioeconomic status. In addition, there may be limited generalizability beyond the populations studied in MASALA and MESA. Lastly, the MASALA and MESA had a gap of a decade between initial baseline exams - the MASALA baseline exam was initially conducted in 2010-2013, while the initial baseline exam for participants in MESA took place between 2000 and 2002. Additional resources include the American Heart Association's guideline for the prevention, detection, evaluation and management of high blood pressure in adults available at https://www.ahajournals.org/doi/10.1161/HYP.0000000000000086 and their scientific statement on culture, diet, economic factors and more affecting CVD risk among Asian Americans at https://www.ahajournals.org/doi/10.1161/CIR.0000000000001135.