South Asians are more likely to die of heart disease, such as heart attacks and strokes caused by atherosclerosis—the disease process that narrows arteries—than East Asians and non-Hispanic whites living in the United States, according to a new scientific statement from the American Heart Association published in its journal Circulation.

The statement provides an overview of the behaviors that influence the risk factors for heart disease and stroke among South Asians living in the United States based on a review of existing scientific research.

“Statistics about heart disease and stroke risk among Asians can be deceiving when all people of Asian ethnicity are combined into one group. Overall, Asians are at a lower risk for heart disease and stroke compared to people of European ancestry. But when you look at South Asians—both immigrants and people of South Asian ancestry born in the United States—their risk for heart disease and stroke is higher than people from East Asia and people of European ancestry,” said Annabelle S. Volgman, MD, chair of the statement’s writing group and professor of medicine at Rush Medical College and medical director of the Rush Heart Center for Women in Chicago, Illinois.

More than 3.4 million people who identify themselves as South Asians live in the United States, and about 80% come from India. Others come from Bangladesh, Bhutan, the Maldives, Nepal, Pakistan, and Sri Lanka. This group includes both immigrants and people of South Asian ancestry who were born in America, according to the United States Census.

Compared to people of European ancestry, South Asian Americans:

•have a greater risk of having severe atherosclerosis;
•are more likely to have multiple segments of their arteries narrowed by atherosclerosis;
•have higher levels of artery-clogging LDL cholesterol and triglycerides and lower levels of HDL (good) cholesterol, which predispose the arteries to develop fatty deposits in artery walls that cause them to narrow;
•have a higher level of calcium deposits, a marker for atherosclerosis, if they are of Indian ancestry and over age 60;
•are more likely to have diabetes, which is believed to accelerate atherosclerosis; and
•develop diabetes at a younger age.

The statement also focuses on behavioral factors that may increase the risk of developing atherosclerosis among South Asian Americans and suggests ways that they can be changed to improve health.

Volgman notes that diet is a key factor—many South Asians, even if they are vegetarians, eat a lot of saturated fats from tropical oils—such as palm and coconut oil—and refined carbohydrates—such as sugar, white bread, and highly processed foods.

Ongoing studies are looking into improving diet quality among South Asians by reintroducing traditional whole grains, which were once a mainstay of diet in the region, in addition to suggesting replacing ghee (butter with all the water removed) with monounsaturated oils, such as olive, corn, or other oils.

South Asian Americans also engage in less physical activity than other minority group members, according to the statement. “As health-care providers, we need to do a better job of helping our South Asian patients understand the importance of exercise, because many don’t realize how important it is to their health,” said Volgman. A recent study found that only 49% of South Asian Americans believed that exercise was important in preventing heart disease.