Heart disease and diabetes in South East Asians: a rising epidemic

Jul 20, 2022

6 min read

Updated: 4 days ago

South Asian family sitting on a couch hugging each other

Written by Dr Saneka Chakravarty, MD, FACC. Dr Chakravarty is a board-certified cardiovascular disease specialist focused on personalized preventive cardiovascular care.

Heart disease is one of the leading causes of death worldwide, and people of South Asian descent carry a strikingly higher burden than most other groups. For decades this risk was hidden, because South Asians were lumped together with East Asians, who generally have lower rates of heart disease. Newer research has pulled that risk into focus and understanding it could save your life or the life of someone you love.

Who are "South Asians"?

South Asians are people with ancestry from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka (American Heart Association, Circulation, 2018). This is different from Southeast Asians (such as people from Thailand, Vietnam, Indonesia, or the Philippines), who have a different risk profile. If you have South Asian roots, the information below applies to you.

Why South Asians are at higher risk of heart disease

Large studies consistently show that South Asians develop heart disease more often, and earlier, than white Europeans. In the UK Biobank study of more than 450,000 adults, South Asians had roughly double the risk of heart attack, stroke, or coronary procedures compared with people of European ancestry and standard risk calculators badly underestimated this (Patel et al., Circulation, 2021). Other research points to a 30–100% higher risk of dying from coronary and cardiovascular disease (Iliodromiti et al., Diabetologia, 2023). Because of this, in 2018 the American Heart Association and American College of Cardiology formally listed South Asian ancestry as a "risk-enhancing factor" when making decisions about cholesterol treatment (Abbasi, JAMA, 2026).

The role of "hidden" fat

One of the biggest reasons is where South Asians store fat. Even at a normal weight, South Asians tend to carry more fat around the organs (visceral fat) and inside the liver and muscles, with less protective muscle mass, a pattern sometimes called "thin on the outside, fat on the inside" (Iliodromiti et al., Diabetologia, 2023; Khanna et al., Nature Reviews Cardiology, 2026). This deep fat drives insulin resistance, inflammation, and cholesterol buildup in the arteries, even when the waistline looks normal.

The MASALA study

Much of what we know comes from the MASALA study (Mediators of Atherosclerosis in South Asians Living in America), an ongoing National Institutes of Health–funded study begun in 2010 by researchers at UC San Francisco and Northwestern University. It follows South Asian adults aged 40 to 84 in the United States (Abbasi, JAMA, 2026). MASALA has found that South Asians develop heart-disease risk factors earlier than other groups: by age 45, about 31% of South Asian men and 18% of women already had prediabetes, far more than white participants and high rates of abnormal cholesterol and blood pressure, despite generally healthier diets, low smoking rates, and regular exercise (Abbasi, JAMA, 2026).

Diabetes: a major driver

South Asians develop type 2 diabetes at younger ages and lower body weights than most other populations. In MASALA, diabetes prevalence was about 27%, compared with 6% in white Americans (Hitt et al., Diabetes, 2026). Diabetes appears to raise cardiovascular risk more steeply in South Asians than in white Europeans, and it is a central reason for their excess heart disease (Krishnaraj et al., JACC, 2024).

Heart disease strikes earlier

South Asians tend to have heart attacks about a decade earlier than other groups. In the international INTERHEART study, the median age of a first heart attack was 53 years in South Asians versus about 59 years in people from other regions (American Heart Association, Circulation, 2023). South Asian patients are also more likely to have severe, multi-vessel coronary disease when they present (Krishnaraj et al., JACC, 2024). (Note: some popular claims that "25% of heart attacks happen before 40 and 50% before 50" are not well supported by published data , the reliable message is simply that heart disease comes earlier.)

A different BMI standard

Because South Asians develop diabetes and heart disease at lower body weights, the World Health Organization and the American Diabetes Association recommend lower BMI cutoffs for this population: a BMI of 23 or higher signals overweight (versus 25 for the general population), and 27.5 or higher signals obesity (Bajaj et al., Annals of Internal Medicine, 2024). The ADA recommends screening Asian adults for diabetes starting at a BMI of 23 (Hitt et al., Diabetes, 2026). Newer measures such as the body roundness index and waist-to-height ratio may capture hidden fat better than BMI, though they still need more study in South Asian populations specifically (Khanna et al., Nature Reviews Cardiology, 2026).

Key points to remember

South Asians face substantially higher risk of heart disease and diabetes, often despite a normal body weight.
Use the lower BMI thresholds: 23 for overweight, 27.5 for obesity. Waist size and where you carry fat matter as much as the number on the scale.
Start screening early- talk to your doctor about checking blood pressure, blood sugar, and cholesterol in your 30s, not your 50s.
Standard heart-risk calculators may underestimate your risk, so ask your doctor to factor in your South Asian ancestry.
Lifestyle still matters enormously: a diet rich in vegetables, fruits, legumes, and nuts, regular physical activity, not smoking, and healthy weight all lower risk.

Take action

If you have South Asian ancestry, don't wait for symptoms. Ask your physician about earlier and more thorough screening, and be open about your family history. Awareness is powerful, sharing this information with family and friends can help an entire community protect its heart health.

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Frequently asked questions

Q: I'm at a normal weight. Can I still be at risk?Yes. South Asians can have high levels of "hidden" fat around the organs and in the liver even at a normal BMI, which raises the risk of diabetes and heart disease. Ask about waist measurement and blood tests, not just weight.

Q: At what age should I start screening?Because risk factors appear early, it's reasonable to begin checking blood pressure, blood sugar, and cholesterol in your 30s. Discuss timing with your doctor.

Q: Why is my BMI target lower than my friends'?South Asians develop diabetes and heart disease at lower body weights, so health organizations set overweight at a BMI of 23 and obesity at 27.5 for this group to catch risk earlier.

Q: Does being vegetarian protect me?Not necessarily. Many South Asians eat healthy diets yet still have high rates of prediabetes and cholesterol problems. Diet quality matters, limit refined carbohydrates, fried foods, and sweets, and stay physically active.

Q: Is this risk only for people living in South Asia? No. South Asians living in the US, UK, Canada, and elsewhere carry this elevated risk too, and it can worsen with time spent adopting a Western lifestyle.

This article is for general education and awareness. It is not a substitute for personalized medical advice. Talk with your healthcare provider about your individual risk and screening plan.