Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2021 AHA Scientific Sessions.
Clinical Heart and Vascular Center
South Asians (those from India, Pakistan, Bangladesh, Nepal, Bhutan, Sri Lanka, and the Maldives) represent a rapidly increasing population in the U.S. and have significant cardiometabolic risk. Current AHA/ACC Prevention Guidelines list South Asian ethnicity as a risk-enhancer for consideration of initiation of statin therapy. Given the high cardiometabolic risk in this population, I proposed and moderated a session at #AHA21 focused on the excess risk in South Asians. In this session, we learned several key concepts:
1) Compared to white individuals, South Asians have a twofold increased risk of coronary heart disease. In addition, South Asians manifest clinical coronary disease events 5-7 years earlier. This risk is independent of other risk factors and not fully explained by lifestyle.
2) South Asians also have a marked excess risk of diabetes, upward of 3-4 times the prevalence and incidence seen in white individuals.
3) The cardiometabolic features most associated with this excess risk include significant and premature insulin resistance despite a lack of generalized obesity; excess hepatic, visceral, and muscle fat deposition; and an atherogenic dyslipidemia with elevated triglycerides, low HDL-C, and small, dense LDL particles.
4) In South Asians, similar to other Asians, a BMI>23 signifies overweightness and increased risk for diabetes and cardiovascular disease. This is perhaps the easiest and most underappreciated metric for identifying South Asians at risk.
“Culturally concordant assessments are important in identifying unhealthy dietary behaviors in South Asians.”
5) Many South Asians are vegetarians and appear to have heart-healthy diets compared to the average American diet. However, a significant proportion eat an unhealthy vegetarian diet with fried vegetables, nutrient-poor carbohydrates, and sweets. Culturally concordant assessments are important in identifying unhealthy dietary behaviors in South Asians.
6) A significant proportion of South Asians are sedentary due to types of jobs and cultural antagonism toward exercise. Motivating tools that have been shown to work include digital/tech reminders for South Asian men and gender-specific group exercise classes for South Asian women.
7) Elevated lipoprotein (a) is more common in South Asians than in most other groups, and increased polygenic risk may play a key role in the excess risk in this setting.
At UT Southwestern, I am pursuing research studies to understand the lipid and metabolic determinants of this excess cardiovascular risk in South Asians. I also am establishing a South Asian Center for Cardiometabolic Health to provide culturally specific risk assessment, diet and lifestyle guidance, and advanced biomarker and imaging evaluation to promote cardiometabolic health in this population.
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Rohatgi Lab: utsouthwestern.edu/labs/rohatgi