South Asian adults in the United States begin accumulating risk factors for heart disease significantly earlier than their peers from other ethnic backgrounds, according to a new study published in the Journal of the American Heart Association. The analysis of data from two long-term health studies found that by age 45, South Asian adults showed markedly higher prevalence of conditions like prediabetes and high blood pressure compared to white, Black, Chinese, and Hispanic adults of the same age, despite reporting healthier lifestyle behaviors overall.
The research examined health data from 2,700 adults aged 45–55 from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). These studies tracked diverse populations across different U.S. regions, with MASALA focusing specifically on adults tracing ancestry to Bangladesh, India, Nepal, Pakistan, or Sri Lanka. Researchers compared this data to publicly available MESA information for other ethnic groups.
Key findings revealed stark disparities. At age 45, South Asian men had a 30.7% prevalence of prediabetes—nearly eight times higher than their white peers (3.9%) and significantly exceeding rates among Chinese (12.6%), Black (10.4%), and Hispanic (10.5%) men. South Asian women showed similar patterns, with 17.6% having prediabetes at age 45, approximately three times the rate of white women (5.7%). By age 55, both South Asian men and women were at least twice as likely to develop type 2 diabetes compared to white adults of the same age.
High blood pressure also appeared earlier and more frequently among South Asians. South Asian men had a 25.5% prevalence at age 45, compared to 18.4% in white men, 6.6% in Chinese men, and 10.1% in Hispanic men. Additionally, 78.2% of South Asian men had dyslipidemia (high cholesterol and/or triglycerides) compared to 60.6% of Black men. These cardiovascular risk factors are critical because they contribute to atherosclerotic cardiovascular disease (ASCVD), where plaque builds up in arteries, potentially leading to heart attacks and strokes if unmanaged.
Notably, these elevated risks persisted despite South Asian adults reporting the best diet quality, lower alcohol use, and comparable physical activity levels to other groups. Lifestyle measures were assessed using components from the American Heart Association's Life’s Essential 8, with alcohol use defined as consuming one or more drinks weekly. This paradox underscores that factors beyond conventional lifestyle behaviors—possibly genetic, metabolic, or environmental—drive the earlier onset of risk in this population.
Senior study author Dr. Namratha Kandula, a professor at Northwestern University and co-founder of the MASALA study, emphasized the implications. "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," she said. She recommends that South Asian adults maintain healthy lifestyles but also undergo earlier screening for blood pressure, glucose/A1c levels, and cholesterol in early adulthood rather than waiting for symptoms.
This research aligns with a 2023 scientific statement from the American Heart Association, which reported that South Asian adults face disproportionately high ASCVD risk. That statement advised specific dietary modifications, such as increasing whole-grain intake and selecting cooking oils lower in saturated fat, to help mitigate risk. The current study's long-term data illustrate how cardiovascular risk factors manifest earlier among South Asians, highlighting an urgent public health concern. Identifying these risks early can lead to targeted prevention and treatment, potentially reducing heart disease incidence in this growing demographic.
The study has limitations, including reliance on self-reported lifestyle data, which can be inaccurate, and participant groups with generally higher educational and socioeconomic status, potentially limiting generalizability. Additionally, there was a decade gap between baseline exams for MASALA (2010–2013) and MESA (2000–2002). Despite these constraints, the findings carry significant weight for clinical practice and community health initiatives. They suggest that current screening guidelines may be inadequate for South Asian adults, who might benefit from proactive assessments in their 30s or early 40s. As cardiovascular disease remains a leading cause of death globally, these insights are crucial for developing equitable, evidence-based approaches to heart health across diverse populations.
