As a South Asian cardiologist, this topic is all too familiar, not just professionally, but personally. It’s heartbreaking to see someone in their 30s or 40s, seemingly “healthy”, walk into the ER with a heart attack. These people could be ANY of us or any one of our family or friends. Unfortunately, this isn’t a rare issue. South Asians are up to four times more likely to develop heart disease compared to the general population, and many don’t even realize they’re at risk.

So what’s going on? Why are we, as South Asians, so vulnerable?

There are a few factors to consider here

1. It’s Not Just About Weight or Cholesterol

“Im not overweight” or “my cholesterol honestly isn’t that high!”, I hear this ALL the time. South Asians often develop heart disease at lower body weights and with often “normal” cholesterol numbers. We tend to carry more fat around our abdominal area and around our organs (visceral fat). So even if we may look thin on the outside, there could be a very different story on the inside.

2. Genetic and Metabolic Differences

South Asians are more likely to have insulin resistance (a precursor to diabetes), high triglycerides, low amount of HDL (“good”) cholesterol, and small, dense LDL particles, which are more likely to build plaque in the arteries. We’re also one of the most affected races by elevated lipoprotein(a) levels, a cholesterol particle that increases heart disease risk which isn’t routinely tested for. This combination can dramatically raise our risk without showing up on standard labs unless its being looked for. 

3. Diet and Lifestyle

While traditional South Asian diets are rich in their flavor profile, they can often be high in refined carbohydrates, fried foods, sugar, and oil. Then we add in a sedentary lifestyle with high stress levels, this can be a recipe for disaster…on the inside!

4. Underdiagnosis and Late Screening

It’s easy for many South Asians that are younger (less than 40) to not be offered early screenings for heart disease, especially if they don’t look the part or healthcare professionals are not aware of their elevated risk. Trust me when I say, I’ve seen patients, friends and even family who seemingly appear completely healthy miss critical warning signs because we’re not using the right tools to detect risk in this population. By the time symptoms show up, heart disease may often already be advanced.

So what can you do?

I’m here to tell you, this does NOT have to be our story. We may be genetically predisposed but we can be empowered with the right information to make the best choices for our health. With early screening, informed lifestyle choices, and a culturally aware approach to prevention, we can dramatically CHANGE OUR STORY!As someone who believes deeply in combining medical knowledge with cultural sensitivity, I’m passionate about helping South Asians live longer, healthier lives, without giving up the foods, traditions, or identities that make us who we are. We just need to approach heart health with awareness, intention, and the right support.