Cardiovascular disease remains the leading cause of mortality worldwide, but individuals of South Asian descent face a uniquely elevated and often overlooked risk. In this in-depth dialogue, Dr. Afnan Tariq, an interventional cardiologist, and Dr. Gina Siddiqui explore why South Asians face a disproportionately elevated burden of heart disease and what can be done about it. They delve into the biological, cultural, and systemic factors that compound cardiovascular vulnerability in South Asians—highlighting the urgent need for more nuanced risk assessment and earlier intervention strategies. Blending clinical insight, population data, and personal experience, the discussion reframes how we assess, prevent, and manage heart health in this high-risk group.
The numbers are stark:
- South Asians have 30–80% higher risk of coronary artery disease (CAD) compared to other groups.
- Diabetes is nearly twice as common, even in non-obese individuals.
- Many suffer heart attacks at younger ages, and often have multi-vessel disease when they do.
This risk is consistent across regions — whether you're in the U.S., U.K., or South Asia itself — and often cuts across socioeconomic lines. Even "healthy" individuals who eat well and exercise may find themselves affected.
Dr. Tariq outlines several key biological and cultural factors:
1. Smaller Arteries, Bigger Problem. South Asians tend to have smaller coronary arteries. This might seem minor — but because the area of a circle increases with the square of the radius, even a small difference dramatically limits blood flow.
2. Central Obesity. Many South Asians carry more visceral fat around the abdomen, even with a normal BMI. That "small belly" look may be a red flag — this central adiposity is closely linked to insulin resistance and inflammation.
3. Higher Insulin Resistance. Even those without diabetes often show high fasting insulin levels and signs of metabolic syndrome. These aren't typically part of routine screening — but they should be.
4. Stress & Inflammation. Studies show South Asians, especially women, have elevated stress markers and chronic inflammation (measured by CRP). This compounds other risk factors and accelerates arterial damage.
5. Cultural tendencies. There has been less time poured into self-care, delay intervention, and avoidance of discussing symptoms, which has led to an increased gap in preventative care.
Together, these factors create a “perfect storm” for silent cardiovascular progression—often without overt symptoms until a major event like a heart attack.
One recurring theme in the conversation is the need for more engaged, two-way care. Many South Asians assume that seeing a doctor means their bases are covered—but limited visit time, fragmented systems, and outdated risk tools often leave crucial gaps.Dr. Tariq argues that patients must become active participants in their care—tracking their data, asking better questions, and seeking providers who understand their background and risks.
This conversation shed light on the unique cardiovascular risks faced by South Asians and emphasized the importance of personalized, proactive care. From genetic predispositions and metabolic differences to cultural stressors and overlooked biomarkers, it's clear that traditional risk models fall short for this population. However, with the right tools—advanced lab testing, targeted imaging, continuous glucose monitoring, and lifestyle strategies like post-meal walks and stress management—individuals can take meaningful steps to reduce their risk. As Dr. Tariq notes, the future of cardiovascular prevention lies not just in more medicine, but in more personalized, proactive, and culturally aware care.
