Heart disease disproportionately affects South Asians (individuals from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), who face a four-fold greater risk of atherosclerotic cardiovascular disease compared to the general population. In fact, the South Asian community experiences a 40 percent higher chance of mortality from heart attacks than the average population, and has a higher mortality rate from ischemic heart and cerebrovascular disease compared to other ethnic groups. Despite representing a quarter of the global population, South Asians account for 60 percent of the world’s heart disease patients.
These disparities are incredibly relevant as the U.S. South Asian community grew 40 percent between 2010 and 2017 and many South Asians have lost loved ones at a young age due to heart disease. Historically, however, there has been little research specifically focused on South Asian health because the Asian community has long been viewed as a monolithic group. South Asian Heritage Month, observed from July to August, makes this an ideal time to highlight the factors contributing to this disparity and promote initiatives to improve South Asian health outcomes.
Why Do South Asians Face this Disparity?
The risk of heart disease among the South Asian community is influenced by a combination of genetic predispositions and lifestyle factors. Diabetes is a major risk factor for heart disease as people with diabetes are 2 to 4 times more likely to have heart disease than those without diabetes. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study examined the determinants of heart disease, and found a higher prevalence of type 2 diabetes in South Asians (23 percent) compared with other populations (18 percent in Black Americans, 17 percent in Latino or Hispanic populations, 13 percent in Chinese Americans and 6 percent in white Americans).
In addition to diabetes, abnormal cholesterol and obesity increase heart disease risk, and South Asians experience elevated rates of all three. South Asians are more likely than other ethnic groups to have low levels of high-density lipoproteins (HDL, also known as “good cholesterol”), high triglyceride levels, and small low-density lipoproteins (LDL), which significantly heighten the risk for heart disease. In the U.S., over 40 percent of South Asian men and over 30 percent of South Asian women have high blood pressure, and South Asians tend to have excess body fat around the abdomen and organs, which increases the risk of heart disease.
Recommendations & Policy Considerations
Destigmatize mental health issues. Mental health is often an integral component of cardiac health, but seeking help is often stigmatized in the South Asian community. This stigma is a barrier to treatment as it can delay diagnosis and mental health treatment, leading to a higher potential for negative cardiovascular health outcomes. The South Asian Mental Health Initiative & Network (SAMHIN) offers a directory of mental health professionals of South Asian origin, which can increase treatment acceptability for South Asian patients. The National Alliance on Mental Illness launched the Chai & Chat initiative to destigmatize mental health by empowering communities to have honest conversations about struggles. We need more resources like these, which connect South Asians with trusted mental health providers and promote open conversations around mental health. For South Asians, it can also be beneficial to utilize traditional cultural practices such as meditation and yoga to relieve stress and anxiety.
Make lifestyle changes. South Asians do not need to completely eliminate traditional South Asian dishes from their diet, which is a crucial component of culture, but rather modify the way these dishes are prepared and consumed. Examples of diet improvements include limiting portion sizes and the consumption of refined grains, eating more fermented foods, using sugar substitutes, and increasing non-starchy vegetable intake. Conveniently, many whole grains, fermented foods like idli and dosa, and non-starchy vegetables like cauliflower, cabbage, and okra are already staples of the South Asian diet. Additionally, increasing physical activity is also important.
Educate health care providers on South Asian health. It is imperative to equip health care providers with educational resources on South Asian health so they can better serve their patients. For example, Cigna offers comprehensive digital resources for providers such as Diabetes Among South Asians and South Asians and Heart Health: Take Control Now. Providers should familiarize themselves with South Asian health, and share recommendations with their South Asian patients. Relatedly, Dr. Sandeep Krishnan, interventional and structural cardiologist, recommends screening young South Asian patients for diabetes and paying attention to borderline Hemoglobin A1C (HbA1c) levels.
Increase attention and research on South Asian health. In 2017, Representative Pramila Jayapal introduced the South Asian Heart Health Awareness and Research Act. This bill amends the Public Health Service Act to allow the Centers for Disease Control and Prevention to fund the promotion of heart disease and type 2 diabetes awareness in South Asian communities. The Rutgers Robert Wood Johnson Medical School established the South Asian Total Health Initiative (SATHI) to bring researchers, health practitioners, and public health experts together in promoting research and education to improve health outcomes for South Asians. Pushing for federal legislation and research programs such as SATHI and the MASALA Study are key to improving heart health for South Asians.
Looking Forward
Implementing more community-based programs such as the South Asian Network’s CHAI: Community Health Action Initiative, which promotes access to health care for South Asians, is also necessary to improve health outcomes and address heart disease in this community. The Memorial Sloan Kettering Cancer Center launched their South Asian Health Initiative (SAHI) to serve the South Asian immigrant population in New York City by providing free screening for high blood pressure, diabetes, and high cholesterol, aiding in health insurance enrollment, and educating about free/low-cost health care. Programs such as these are essential in connecting underserved South Asian communities to necessary services.
The South Asian community is incredibly diverse, encompassing many different languages, religions, and traditions. However, the thread tying us together is our deep-rooted desire to care for our community. This care must include tackling heart disease on both an individual and a systemic level, which demands an unwavering collaborative effort between health care providers, researchers, elected officials, and community organizations.
The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth or of their respective affiliated employers/organizations.