Heightened risks of cardiovascular disease in South Asian populations: causes and consequences

ABSTRACT

Introduction

South Asian individuals comprise almost a quarter of the world’s population and have an excess risk of atherosclerotic cardiovascular disease (ASCVD) compared to other ethnicities. In part, this can be explained by higher prevalence, earlier onset, and suboptimal control of traditional cardiovascular risk factors, such as insulin resistance, metabolic syndrome, and dyslipidaemia. However, there remains a significant residual excess risk associated with South Asian ethnicity after controlling for traditional risk factors.

Areas covered

In this review, we describe the epidemiology of ASCVD in both native and diaspora South Asian populations. We explore how traditional cardiovascular risk factors, novel cardiovascular risk factors, and social determinants of health may contribute to the excess ASCVD risk seen in South Asian populations.

Expert opinion

There should be increased awareness of the relative importance of South Asian ethnicity and related social determinants of health, as risk factors for ASCVD. Systematic screening processes should be tailored to this population, and modifiable risk factors should be treated aggressively. Further research is required to quantify determinants of the excess ASCVD risk seen in South Asian populations and to develop targeted interventions to address these factors.

KEYWORDS:

• Cardiovascular disease
• south asian
• ethnicity
• morbidity
• mortality
• prevention

Article highlights

• Multiple studies from across the world demonstrate South Asian ethnicity as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD).

• In part, the excess ASCVD risk associated with South Asian ethnicity can be attributed to earlier onset and higher prevalence of traditional risk factors, particularly insulin resistance and visceral adiposity.

• A residual risk associated with South Asian ethnicity remains after controlling for a wide range of traditional ASCVD risk factors. This may be attributed to emerging risk factors, such as chronic inflammation, lipid make-up, and genetic factors, as well as social determinants of health.

• The South Asian population may benefit from a targeted screening approach, including acknowledgement of the limitations of current ASCVD risk scores, reduced BMI thresholds for identifying higher cardiometabolic risk, and a low threshold for screening for insulin resistance.

• Social determinants of health should be recognized, and public health messaging and lifestyle interventions should be culturally appropriate.

Declaration of Interest

GYH Lip is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.