South Asian adults living in the United States were more likely to have risk factors for atherosclerotic cardiovascular disease (ASCVD) by the age of 45 compared with white, Black, Chinese and Hispanic adults of the same age, according to new research published in the Journal of the American Heart Association. ASCVD risk factors, when left untreated or poorly managed, can contribute to the earlier development of heart disease, underscoring the importance of timely detection and prevention.
To explore the reasons behind this increased risk, researchers examined health data from approximately 2,700 adults aged 45 to 55 who participated in two large, national studies conducted in the United States. These long-term studies followed diverse populations from different regions of the country: the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). By comparing data across these cohorts, investigators were able to assess how cardiovascular risk factors emerged and progressed across ethnic groups.
The MASALA Study, led by research teams at Northwestern University in Chicago and the University of California, San Francisco, focused specifically on South Asian adults with ancestral roots in Bangladesh, India, Nepal, Pakistan or Sri Lanka. Initial health assessments were conducted between 2010 and 2013, with follow-up examinations taking place from 2016 to 2018. These data were compared with publicly available information from MESA, which enrolled white, Black, Hispanic and Chinese adults beginning in 2000–2002 and continued follow-up visits approximately every two years through 2016–2018.
Researchers evaluated a range of medical conditions known to increase the risk of heart disease, including high blood pressure, prediabetes and type 2 diabetes, as well as abnormal cholesterol and triglyceride levels. Lifestyle factors were also analysed, such as dietary quality, physical activity, tobacco use, alcohol consumption and differences between men and women. Several of these measures align with components of the American Heart Association’s Life’s Essential 8, with diet, exercise and alcohol intake assessed through self-reported information gathered during clinic visits. Alcohol use was defined as consuming at least one alcoholic drink per week.
The findings showed that elevated rates of prediabetes, diabetes and high blood pressure largely drove higher cardiovascular risk among South Asian adults. At age 45, South Asian men had a markedly higher prevalence of prediabetes than men from other ethnic groups, as well as higher rates of high blood pressure and dyslipidaemia. South Asian women also showed nearly double the prevalence of prediabetes compared with women in other population groups. By age 55, both South Asian men and women were at least twice as likely to develop type 2 diabetes as white adults of the same age.
Despite these elevated medical risk factors, South Asian adults demonstrated several favourable lifestyle patterns. They reported the highest diet quality overall, lower levels of alcohol consumption and physical activity levels comparable to those of other groups. These findings suggest that traditional risk factors alone do not fully explain the earlier onset of cardiovascular risk in this population.
The study highlights the need for earlier and more tailored screening and prevention strategies for South Asian adults in the U.S. Identifying cardiovascular risk factors at younger ages may allow for earlier intervention, improved management and a reduced likelihood of developing heart disease later in life. However, the researchers also noted limitations, including reliance on self-reported behaviours and the possibility that results may not be fully generalisable beyond the study populations, which tended to include participants with higher educational and socioeconomic status.
More information: Havisha Pedamallu et al, Prevalence and Trends in Cardiovascular Risk Factors Among Middle‐Aged South Asian Adults Compared With Other Racial and Ethnic Groups in the United States: A Longitudinal Analysis of 2 Cohort Studies, Journal of the American Heart Association. DOI: 10.1161/JAHA.124.041221
Journal information: Journal of the American Heart Association Provided by American Heart Association
