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

Updated: Aug 8

25 percent of the world's population carry the burden of 60 percent of the world's heart disease. The high incidence of heart disease in the South East Asians presents a major public health crisis and warrants a discussion.

The threats to our cardiovascular health have been largely unknown, until recently. This is because, we were clubbed together with other East Asians with much lower risk of heart diseases.

The MASALA study (Mediators of Atherosclerosis in South Asians Living in America) is being conducted on more than a 1000 South Asian women and men aged 40-84 years as we speak. The study is funded by the National Heart, Lung, and Blood Institute.

One of the first clues to explain increased risk of heart disease was provided by the MASALA study.

South Asians were found to have more fat in the abdominal area, the liver and around the heart. Even though South Asians typically have low BMI, even normal waist circumference at times, this accumulation of fat around internal organs causes different types of inflammation and activates certain biological pathways that contribute to cholesterol plaque formation in blood vessels.

South East Asians have been noted to have smaller than usual blood vessels supplying the heart, which may explain more vulnerability to blockages.

South Asians are more likely to require a bypass surgery than other ethnicities.

25% of heart attacks occur under age 40 for young South Asians, and 50% occur under age 50. This is not too different from mainstream population however, with 20% heart attacks happening before 40 nowadays across all ethnicities.

However, South Asians develop coronary artery disease up to 10 years earlier than the general population, on average.

There is a 40% higher chance of dying from heart attacks among South Asians than the average population.

The greatest risk factor in South Asians is twofold higher rates of type 2 diabetes compared to their Caucasian counterparts.

As a result of these findings, the American Diabetes Association and the World Health Organization have recommended lowering the BMI cutoffs for defining overweight and obesity in South Asians to increase the identification of cardiometabolic risk in this population.

The WHO recommends using 23 kg/m2 and 27.5 kg/m2 for overweight and obesity, respectively.

Key takeaways:

South East Asians are more prone to heart disease and diabetes despite normal or near normal body weight.

Ideal BMI for south East Asians is 23( 25 for rest of the world). Sorry folks 😔. This is to allow more aggressive screening and treatment of risk factors.

Earlier screening for heart disease and diabetes should be considered in South East Asians ( in early 30s). There should be lower threshold of treating risk factors.

Frank discussion with your healthcare team may sometimes be necessary, as more often than not your healthcare team may not be aware of the situation in this sub population.

More research is needed going forward from here, there is also need for increased awareness. Not everyone has the same risk and there may be one or more specific triggers in this sub population that is yet to be identified.

South East Asians mean people with Indian, Pakistani, Bangladeshi, Nepalese, Bhutanese, SriLankan or Malaysian descent.

Some of this data is derived from first generation of south East Asians in United States, but likely has widespread applicability.

Do you have friends or family members affected by early onset heart disease?

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