The Statistics of Heart Disease Don’t Look Good
South Asians—defined as a geographic group with individuals from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka—make up 25% of the world’s population. Beyond their population numbers, South Asians significantly contribute to the global community across business, medicine, engineering, art, and more. However, this prominent group is under lethal threat; South Asians are disproportionately affected by heart disease compared to the general population.
Atherosclerotic cardiovascular disease [ASCVD] is the general term for diseases that affect the heart and blood vessels due to arterial plaque buildup. This buildup can block coronary arteries—the blood vessels responsible for delivering oxygen and nutrients to the heart— reducing the amount of oxygen-rich blood the heart receives. Narrowing of the coronary arteries may lead to chest pain, shortness of breath, or even myocardial infarction, also known as a heart attack. ASCVD is the leading cause of death in the US and worldwide. South Asians have higher proportional mortality rates from ASCVD compared to other Asian groups and non-Hispanic whites. More specifically, South Asians living in the US have a fourfold higher risk of ASCVD than the local population.
Coronary artery disease [CAD] is the most common form of atherosclerotic cardiovascular disease caused by blockages in the coronary arteries. This blockage leads to the thickening and stiffness of arterial walls. South Asians are believed to develop coronary artery disease up to ten years earlier than the general population. This early onset can cause the disease to be overlooked or missed in younger patients. The pattern of premature coronary artery disease [PCAD] among both immigrant and non-immigrant South Asian populations leads to incorrect treatments, resulting in significant cardiac damage or even death. Premature development of CAD is an exceedingly critical condition. This severity is reflected in hospitalization data—South Asians have the highest rate of hospitalization in California for coronary artery disease.
Understanding Risk Factors – With Facts
Heart disease is monitored and predicted through risk factors, warning flags for heart disease development. Traditional risk factors include hypertension (high blood pressure against artery walls), diabetes (high blood sugar), dyslipidemia (high levels of LDL—low density lipoprotein—cholesterol, very harmful), smoking, obesity, and family premature cardiovascular disease. Nontraditional risk factors—factors that are harder to recognize—are dysfunctional HDL (high density lipoprotein—cholesterol, required for survival functions, if function is lost causes buildup of excess plaque), elevated lipoprotein (carries cholesterol through the blood), and genetics.
Several specified risk factors disproportionately affect the South Asian community. Rates of tobacco usage are substantially high among this geographic group, with around 14% of women and 47% of men either smoking or chewing the narcotic. Tobacco is a major contributor to heart disease as it damages the lining of blood vessels, which in turn leads to the narrowing of arteries. Arterial stenosis (abnormal narrowing of a bodily passage) ultimately increases the risks of heart attacks and even death. Additionally, an INTERHEART study reported that measures of depression and stress in native South Asians, whether at work or home, were among the highest modifiable risk factors for heart disease. The population-attributable risk associated with psychosocial stress or depression was significantly higher for South Asian women. Although often overlooked, depression and stress are critical risk factors for heart disease that must not be ignored.
South Asian Diet
Recent studies reveal the role of the typical South Asian diet as a key risk factor in decoding heart disease trends. The South Asian diet includes foods like lentils, vegetables, rice, and meat, which all have a high percentage of carbohydrates and saturated fats. Vegetarian diets, in particular, lead to an increase in fat and carbohydrates. These common South Asian foods are causing extreme obesity in the community. In fact, South Asians have the highest rates of truncated obesity in the United States. Obesity and high levels of fat, like cholesterol, in the blood lead to blood vessel blockages and increased levels of strain on the heart. Both of these effects cause the narrowing of coronary arteries and can even lead to heart failure.
Ingredients used in South Asian cooking, like mustard oil and vanaspati ghee (a common cooking fat), are extremely harmful to heart health. Mustard oil can have a downstream effect in the body because it has a large proportion of erucic acid, ultimately increasing the risk of heart disease. Regular consumption of vanaspati ghee causes a spike in harmful LDL cholesterol and obesity. Vanaspati ghee has been banned in several countries as it is a form of trans fat that facilitates clogging of arteries and increases the risk of heart disease.
The Mediators of Atherosclerosis in South Asians Living in America [MASALA] study revealed that South Asian immigrants adopting dietary habits of Western countries by incorporating more fat, alcohol, and red meat into their diets could be potentially harming their heart health even further. These additions worsen the already dangerous South Asian diet by increasing fat and red meat, there is a greater risk of plaque buildup. Additionally, the increase in unhealthy foods and alcohol harms the body beyond that, leading to obesity, which can go on to create a domino effect, ending in heart disease.
Flagged South Asian Risk Factors
Ingesting high levels of fat is especially dangerous to South Asians because these individuals store fat differently than other ethnic groups. Usually, excess carbohydrates and proteins are converted to fat and stored in the liver with other excess fat. However, South Asians have a smaller capacity to store fat under tissue, leading to the majority of fat being stored around the liver, a condition called fatty liver. An overflow of fat in the blood permits fat to surround other abdominal organs and muscles. Heightened levels of these fats are flagged by high levels of lipoprotein (a fat and cholesterol carrier) in the blood. Higher levels of lipoproteins and fats are associated with a greater risk of stroke, diabetes, and heart disease.
How to Move Forward
The way forward is well supported by research. Several clinical trials focus on the genetic and hormonal risk factors behind heart disease in South Asians. Scientists are searching for genetic mutations, heart muscle differences, blood vessel differences, and molecular markers of heart damage to better address South-Asian-specific heart disease. The Mediators of Atherosclerosis in South Asians Living in America [MASALA] and the Stanford South Asian Translational Heart Initiative [SSATHI] offer health assessments and treatment strategies, among other clinical services. The MASALA and SSATHI studies are searching for ways to improve targeted care and knowledge of South Asian specific heart disease. By increasing global information and resources for the South Asian community, the early onset of heart disease can be caught quickly, and effective treatments can be administered to reduce the future danger of severe damage or death.
References
https://pubmed.ncbi.nlm.nih.gov/29794080/
https://pubmed.ncbi.nlm.nih.gov/34924350/
https://pubmed.ncbi.nlm.nih.gov/29374801/
https://www.heart.org/en/news/2023/05/17/why-are-south-asians-dying-of-heart-disease-masala-looks-for-answers
https://stanfordhealthcare.org/medical-clinics/stanford-south-asian-translational-heart-initiative/conditions.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC3215354/
