Circulation June 19, 2018, Volume 137, Issue 25
Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD).
South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized.
A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population
Cardiovascular Disease & Cancer Risk Among South Asians: Impact of Sociocultural Influences on Lifestyle and Behavior. Journal of Immigrant Minor Health: May 2017
A complete literature review revealed cultural beliefs, societal obligations, and gender roles within the South Asian community to be indirect contributors to the health of South Asian immigrants (SAIs). Health professionals need to increase their work with SAI communities to change less beneficial cultural elements such as misconceptions about health and exercise, and lack of communication when using alternative medicines. Community engaged efforts and continuing medical education are both needed to improve the health of the South Asian immigrant population in a culturally appropriate manner.
South Asians (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan) are at a disproportionately higher risk of stroke and heart disease due to their cardiometabolic profile. Despite evidence for a strong association between diabetes and stroke, and growing stroke risk in this ethnic minority-notwithstanding reports of higher stroke mortality irrespective of country of residence-the explanation for the excess risk of stroke remains unknown.
Study explored the effects of cardiac rehabilitation (CR) on South Asian (SA) compared with European Canadians with coronary artery disease (CAD). Overall, referral rates to CR remains low but attendance appears higher in SA patients. Among those who attended CR, there is a strong association with improved survival irrespective of ethnic status. In SA patients with CAD, attendance and completion of CR should be strongly endorsed because of its incremental benefit.
Acculturation and Subclinical Atherosclerosis among U.S. South Asians: Findings from the MASALA study. Journal of Clin and Exp. Research in Cardiology 2014 Jun 23: 1 (1) : 102.
A landmark study following south Asians living in San Francisco and Chicago to investigate reasons for higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors. Study on going.
Kandula et al. "The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factor in communituy setting: Design & methods." Contemp Clin Trials 2013 Sep 21;36(2):479-487
Reseachers at Northwestern University have developed a pilot study to investigate the efficacy of a community based intervention program for South Asians. Patients with at least one CVD risk factor will be randomized to lifestyle intervention vs control. Results will provide important data on lifestyle interventions as a tool to reduce CVD in South Asians.
Coronary artery disease in South Asian immigrants living in New York City: angiographic findings and risk factor burdens. Ethnicity & Disease 2013 Summer;23(3):292-5.
Our colleagues at Mt. Sinai reviewed cardiac risk factors and angiograms of 520 South Asians and 219 Caucasians consecutively referred with stable angina pectoris or acute coronary syndrome. Found South Asians were younger, have significantly higher rates of 3-vessel disease, as well as higher rates of DM, hypertension, obesity and dyslipidemia than Caucasians. Aggreed with current literature and recommended aggressive screening, prevention and treatment in this population.
Mehta et al. "Obesity & Dyslipidemia in South Asians." Nutrients. July 16, 2013 ;5(7):2708-33
A review paper addressing obesity and dyslipidemia as emerging public health challenges in South Asian countries. Findings include the prevalence of obesity is more in urban areas than rural, and women are more affected than men. Higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome). Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition.