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Atherosclerosis risk elevated among South Asian-Americans
The risk for mortality due to atherosclerosis is higher among South Asian-Americans compared with Americans of East Asian and European descent, according to an American Heart Association scientific statement published in Circulation.
According to the statement written by Annabelle S. Volgman, MD, professor of medicine at Rush Medical College and medical director of Rush Heart Center for Women in Chicago, and colleagues, these statistics are affected by several behavioral factors that may increase risk for atherosclerosis among Americans of South Asian descent, who are one of the fastest-growing ethnic groups in the U.S.
Volgman and colleagues conducted a comprehensive literature review to summarize existing evidence to highlight current knowledge gaps and form recommendations based on their findings.
“Statistics about heart disease and stroke risk among Asians can be deceiving when all people of Asian ethnicity are combined into one group,” Volgman said in a press release. “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.”
According to the researchers, South Asian individuals have:
- greater risk for severe atherosclerosis;
- greater likelihood to have multiple segments of their arteries narrowed by atherosclerosis;
- higher levels of LDL and triglycerides and lower levels of HDL, which cause fatty deposits in artery walls, causing them to narrow;
- higher level of calcium deposits if they are of Indian ancestry and older than 60 years; and
- higher rates of diabetes, which develops in the South Asian population at a much younger age than other populations.
According to Volgman and colleagues, these increased risk factors among South Asian-Americans may be due to diet, which primarily consists of saturated fats from tropical oils, including palm and coconut oil, and refined carbohydrates, such as sugar, white bread and highly processed foods.
The authors recommended that those of South Asian decent join community exercise programs that reduce stress, such as yoga and Bollywood dancing or other culturally specific physical activities, which prior studies have shown to be more successful than other forms of physical activity.
Additionally, the writers offered tips for physicians on how to manage South Asian patients at high risk for atherosclerosis, including to use the AHA/American College of Cardiology-recommended guidelines to calculate atherosclerotic CVD risk, and to consider using the U.K. QRISK2 calculator.
They also suggested using primary and secondary CVD prevention guidelines, and the International Diabetes Federation race-specific cut points for diagnosing metabolic syndrome.
Women with gestational diabetes should be closely followed up by physicians to monitor the development of diabetes, according to Volgman and colleagues.
The authors also called for increased educational effort among physicians by targeting gathering areas in South Asian communities, including temples and cultural and health fairs, to raise awareness.
The writers also stated that physicians must appreciate the increased risk for atherosclerosis among South Asian patients and provide specific recommendations on medications, diet and lifestyle modifications. –by Dave Quaile
Disclosures: The authors and reviewers report no relevant financial disclosures.