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Why South Asians Have Higher Risk of Heart Disease

Thursday, June 02, 2022 1:56 PM

At 52 years old, Rajesh Hatkar was the picture of health. He was trim, clocked 10,000 steps a day, ate small heathy meals and his cholesterol levels were only slightly elevated.

But there was one thing Hatkar could not change when it came to his health—his ethnicity.

Rajesh Hatkar

Rajesh Hatkar

So when he experienced another bout of severe acid reflux earlier this year, NorthShore Cardiologist Arman Qamar, MD, who researches the role ethnicity plays in heart health, ordered a full workup of his heart. Tests revealed that two arteries were blocked, requiring stents to open blood flow.

“I didn’t know how prevalent it was, from an ethnicity perspective,” said Hatkar, of Buffalo Grove, who was born in India. “After my experience I started sharing it out with friends and family, spreading awareness.”

People of South Asian descent – those from Bangladesh, India, Nepal, Pakistan and Sri Lanka – have a higher risk of developing and dying from heart disease than any other ethnic group. They have a much greater chance of having a heart attack before age 50, Dr. Qamar said.

Researchers are learning more about why rates of heart disease are so high in this group. One study found that South Asians tend to develop high blood pressure, high triglycerides, abnormal cholesterol and Type 2 diabetes at lower body weights than other groups.

Although South Asians have lower obesity rates, they tend to have higher levels of visceral and hepatic fat. In other words, they are more likely to store fat deep in their abdomens, wrapped around organs or in their liver, instead of just beneath the skin, known as subcutaneous fat.

Here, Dr. Qamar answers questions about the link between South Asians and heart disease:

We know that South Asians are at higher risk for heart disease. Is it more about behavioral risk factors in their countries or origin or genetics or both?

It’s both. In recent years, industrialization in India has increased access to unhealthy fast foods and sedentary lifestyles. Additionally, epidemiologic genetic studies have shown that South Asians are at an increased risk of early heart disease.

Has the screening or treatment for heart disease in South Asians different than the general population? Are they screened at earlier ages? Anything else different?

Unfortunately, the focus on primary prevention is very suboptimal in India. Most patients only go to physicians when they have developed heart disease. The reason for this is twofold. First, most patients have to pay out of pocket for primary care in India; thus, patients don’t want to see a physician until they have suffered from heart disease. Second, there are no guidelines for prevention of heart disease in India.

What can South Asians do to lower their risk of heart disease?

A healthy lifestyle and diet is very important. They need to add more green leafy vegetables, olive oil and nuts into their diet. They should do cardiac exercise at least 30 minutes three times a week. Particular attention should be placed on prevention of central obesity. Early screening with blood work for lipid panel and detection of diabetes should be encouraged. I recommend all to keep their bad (LDL) cholesterol less than 100 and triglycerides below 150 if they have no history of heart disease. Furthermore, polygenic risk score testing should be done in patients with family history of heart disease.

NorthShore’s Global Effort to Lower Suffering from Heart Disease

In a collaborative research effort, co-led by Dr. Qamar, NorthShore has created a registry of patients who suffered a severe heart attack at two major hospitals in Delhi, India. The registry has now enrolled more than 3,000 patients with extensive data including genomics and biomarkers.

The results of their research may be used to improve upon 2018 guidelines issued by the American College of Cardiology and American Health Association. Even though those guidelines accounted for the South Asian risk factor, more can be done, Dr. Arman said.

Additional blood tests that detect protein markers for cholesterol and heart attack risk, for example, could help guide treatment for this group, Dr. Arman said.

Dr. Arman’s team is currently reporting on their results, and have published their initial findings in the National Lipid Association. The team is also working with the government in India to make atorvastatin, a statin medication, available for free across all government operated pharmacies in India.