South Asian adults in the United States develop risk factors for atherosclerotic cardiovascular disease (ASCVD) by age 45 at higher rates than white, Black, Chinese, or Hispanic adults of the same age, according to a study published in the Journal of the American Heart Association. These findings, based on analysis of data from two long-term health studies, indicate that despite generally healthier lifestyle behaviors, South Asian adults face earlier accumulation of conditions like high blood pressure, prediabetes, and type 2 diabetes that significantly increase heart disease risk.
Researchers analyzed health data for 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). The MASALA Study, based at Northwestern University in Chicago and University of California, San Francisco, collected initial health checkups for South Asian participants between 2010–2013 with follow-up exams in 2016–2018. Participants traced their ancestry to Bangladesh, India, Nepal, Pakistan, or Sri Lanka. Researchers compared this data to publicly available MESA data for white, Black, Hispanic, and Chinese adults, with MESA beginning initial checkups in 2000–2002 and conducting follow-ups through 2016–2018.
The analysis revealed striking disparities. At age 45, South Asian men had nearly eight times higher prevalence of prediabetes (30.7%) compared to white men (3.9%), and significantly higher rates than Chinese (12.6%), Black (10.4%), and Hispanic men (10.5%). South Asian men also showed greater prevalence of high blood pressure (25.5%) compared to white (18.4%), Chinese (6.6%), and Hispanic men (10.1%), and higher rates of dyslipidemia (78.2%) compared to Black men (60.6%). South Asian women displayed similar patterns, with almost two times higher prevalence of prediabetes at age 45 (17.6%) compared to peers in other population groups.
By age 55, both South Asian men and women were at least two times more likely to develop type 2 diabetes compared to white adults of the same age. These differences in heart disease risks between South Asians and other populations were largely driven by prediabetes, diabetes, and high blood pressure. Paradoxically, despite higher rates of these risk factors, South Asian adults demonstrated the best quality diet, lower alcohol use, and comparable exercise habits when measured against other groups.
Senior study author Namratha Kandula, M.D., M.P.H., a professor at Northwestern University's Feinberg School of Medicine 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 advised that South Asian adults maintain healthy lifestyles and undergo earlier screening for blood pressure, glucose/A1c levels, and cholesterol in early adulthood rather than waiting for symptoms to appear.
The study's findings align with a 2023 scientific statement from the American Heart Association that reported South Asian adults face disproportionately high risk for ASCVD. That statement advised specific dietary modifications, such as increasing whole-grain intake, selecting cooking oils lower in saturated fat, and avoiding deep-fried preparation methods, to help mitigate this elevated risk. The American Heart Association provides additional resources through its guidelines, including the Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults and other scientific statements addressing cardiovascular risks in Asian American populations.
Identifying these risk factors early has significant implications for public health strategies targeting South Asian communities in the U.S. Early intervention could reduce the burden of heart disease, which remains a leading cause of death nationwide. The study does have limitations, including reliance on self-reported lifestyle behaviors, potential selection bias toward participants with higher educational and socioeconomic status, and a decade gap between baseline exams in the MASALA and MESA studies. Despite these limitations, the research provides compelling evidence that South Asian adults require earlier and more targeted cardiovascular risk assessment and management approaches.
