The Silent Risk: Heart Disease in the South Asian Community
Dr. Milind J. Kothari & Amruta Potdar
Heart disease doesn’t always come with a warning—and for many in the South Asian community, the first sign may be the only sign. Cardiovascular disease (CVD), a group of conditions that affect the heart and blood vessels, is the leading cause of death worldwide. Among South Asians, the risk is high and often underrecognized. According to the American Heart Association, 13% of Indian American men have coronary artery disease, which is higher than any other Asian population in the US. Additionally, the average age of first heart attack in South Asians globally is around 53 years of age, compared to 59 years of age in Western European or Middle Eastern populations. (Kwan)
Cardiovascular disease includes a range of problems, from heart attacks and strokes to conditions like heart failure and irregular heart rhythms. The most common underlying process is atherosclerosis, where fatty deposits known as plaque buildup inside the arteries. This narrows the arteries and limits blood flow to critical organs like the heart and brain. A complete blockage in a blood vessel can lead to serious and potentially life-threatening complications.
The Burden in South Asians
“Heart disease affects people of South Asian descent more often and at a much younger age compared to other populations.” On average, South Asians develop heart disease about ten years earlier than Western populations. What’s even more concerning is how rapidly the disease can progress, sometimes without any symptoms until a major event like a heart attack occurs.
The reasons for this difference are complex and not yet fully understood. Part of it may be linked to dietary habits. In addition, many South Asian immigrants tend to delay routine medical screenings, either due to lack of time, access, or awareness. This allows risk factors like high blood pressure, diabetes, and cholesterol to go unnoticed for years. Research also shows that South Asians tend to store fat differently from other ethnic groups. Even at a “normal” weight, many carry excess fat around the abdomen and internal organs, especially the liver—a pattern that is particularly harmful to heart health.
Understanding Risk Factors
Risk factors for heart disease are generally divided into two categories: those that you cannot control and those that you can.
Unchangeable risk factors include age, sex, family history, and ethnicity. While we can’t change these, these factors are still important to recognize. Being of South Asian descent alone is a risk factor that increases your chances of developing heart disease.
On the other hand, there are many modifiable risk factors. These include high blood pressure, high cholesterol, diabetes, smoking, excessive alcohol intake, poor diet, being overweight, and lack of physical activity. The good news is that managing these factors effectively can significantly lower your risk of heart disease—even if you have a family history.
Recognizing the Symptoms
Not all heart conditions come with chest pain. While classic symptoms of a heart attack include chest pressure, shortness of breath, and pain spreading to the arm or jaw, many people—especially women—experience atypical symptoms. These may include indigestion, nausea, dizziness, stomach pain, or even just fatigue. Because these symptoms can seem like a simple indigestion issue, they are sometimes misinterpreted or dismissed.
In addition to symptoms related to the heart itself, problems with circulation in the limbs can also signal cardiovascular disease. If you experience symptoms in your legs such as pain when walking, swelling, or skin changes with redness or coolness, you should seek medical attention.
| Common Foods/Diets | Healthier Substitute | Why It’s Better |
|---|---|---|
| Ghee or butter | Olive oil or avocado oil | Lower in saturated fat; better for cholesterol levels |
| Refined white flour (maida) | Whole wheat roti or millet roti | More fiber, helps with blood sugar control |
| Deep-fried snacks | Roasted chickpeas, baked or air-fried snacks | Lower fat and calories |
| White rice | Brown rice, quinoa, or cauliflower rice | More fiber, helps with blood sugar control |
| Whole milk | Milk with lower fat content (2%, skim, unsweetened almond milk) | Reduces sugar and saturated fat intake |
| Low protein intake | Tofu, lentils, beans, paneer (in moderation) | More natural sources of protein, less sodium and additives |
| Low vegetable intake | Add leafy greens and colorful vegetables to every meal | Increases fiber, vitamins, and minerals |
| Vegetarian diet | Include lentils, soy, dairy, nuts, seeds, eggs | Ensures protein, vitamin B12, iron, and omega-3 intake |
How Heart Disease is Diagnosed
Early detection can save lives. “Doctors use a variety of tests to assess heart and vascular health. A simple blood test can reveal your cholesterol levels and blood sugar, both of which are crucial indicators of cardiovascular risk.” In some cases, your physician may recommend measuring apolipoprotein A levels, which can provide a more accurate assessment of heart disease risk in patients with normal cholesterol levels. In addition to blood tests, various other techniques can be used to assess and diagnose heart disease, described below:
As mentioned above, cardiac catheterization is used to view the arteries of the heart directly. In cases of severe blockage, a stent can be placed to re-open the blood vessel and keep blood flowing to the heart muscle. Below is a picture of a blocked artery (red) that is reopened after stent placement during cardiac catheterization (green).
Case Example: A 60-year-old man who had a history of hypertension and a family history of heart disease. The patient was completely asymptomatic. The primary care physician suggested a calcium CT score and it came back showing moderate risk. After additional testing was performed, a cardiac catheterization was recommended to accurately determine extent of cardiac disease.
The figures above illustrate the coronary angiogram that was obtained during cardiac catheterization. The figure on the left shows a significant blockage of one of the vessels (red circle/arrow). The figure on the right is the same vessel after coronary stenting (green circle/arrow)
Prevention: Start Early, Live Strong
The most powerful weapon against heart disease is prevention. This begins with regular visits to your primary care doctor, ideally starting by age 18 and becoming more frequent as you approach your 40s and beyond. At these visits, your doctor can monitor your blood pressure, order blood tests, and help you manage any emerging risk factors.
A key area of focus is physical activity. The Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes per week of moderate aerobic activity, such as brisk walking, or 75 minutes of vigorous activity, such as running or cycling. In addition, strength training exercises should be performed at least twice a week.
Diet plays an equally important role. South Asian diets are often heavy in carbohydrates and fats, which can increase triglyceride levels and insulin resistance. Making simple changes—as seen in the table below—can make a major difference.
“If you smoke or use tobacco products, quitting is one of the best decisions you can make for your heart.” There are many resources available to help, including medication, counseling, and support groups. Similarly, if you consume alcohol regularly, talk to your doctor about safe limits and whether a reduction might benefit your overall health.
What to Ask Your Doctor
Next time you see your doctor, come prepared with questions:
- What is my risk of heart disease based on my personal and family history?
- How often should I check my blood pressure and cholesterol?
- Should I be taking medications like statins or aspirin?
- Would a heart scan (such as a calcium score) benefit me?
- Am I at a healthy weight for my age and height?
- How can I distinguish between heartburn and heart-related symptoms?
- What kind of diet should I follow to protect my heart?
- Are there programs or professionals who can help me quit smoking or lose weight?
- Am I due for any vaccines or cancer screenings?
Final Thoughts
Heart disease isn’t just a concern in Western countries—it’s a serious issue for our South Asian community as well. In fact, we face a higher risk than many other groups. But the good news is, with better awareness and simple preventive steps, we can make a big difference. By understanding your risk, staying informed, and making small, healthy changes to your daily routine, you can take control of your heart health and live a longer, stronger life.
Talk to your doctor about your heart health. It’s one of the most important things you can do for yourself—and for your family.
About the Author
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Dr. Kothari
Ms. Potdar
