Reducing South Asian heart attack risk with culturally tailored care
November 30, 2022
Ask any person of South Asian descent about cultural touchstones, and a few common themes are likely to emerge:
- Family is a central focus in our lives.
- Traditions, whether they’re related to food, faith, or fashion, bind us together.
- Many of us have lost loved ones much too soon to the hidden threat of heart disease.
Those with South Asian heritage – India, Pakistan, Nepal, Bangladesh, Bhutan, Maldives, and Sri Lanka – face double the risk of heart attack compared with White individuals. In fact, “South Asian” is the only ethnicity listed by the American Heart Association as a risk factor for heart disease.
Research has shown genetic and lifestyle factors play a key role in driving up the risk of cardiovascular problems among South Asian people, who tend to develop diabetes and high cholesterol 10-20 years sooner than other ethnicities. Both conditions are precursors to heart disease.
Despite having a lower body mass index (BMI), South Asian people can accumulate hidden unhealthy fat deposits in vital organs, which can lead to diabetes and heart disease. Most heart disease risk calculators do not account for South Asian patients' greater risk, and many providers fail to adequately detect and aggressively manage their heart disease risk factors.
UT Southwestern’s South Asian Heart Program is designed to keep patients from falling through the cracks. Our culturally concordant preventive cardiologists at the UTSW Medical Center at Coppell evaluate South Asian patients who are at risk for heart disease or want to maintain their heart health. We have also begun enrolling participants in a clinical study that provides access to a state-of-the-art imaging test to detect plaque in the arteries.
By focusing on patient education, emphasizing heart-health management tools, and pursuing research, we hope to raise awareness of heart disease in the South Asian community and empower them to preserve their families and traditions.
Proactive heart care starts with young adults
If you have a strong family history of diabetes and cardiovascular disease, or if you have lost relatives to heart attacks or strokes in their 40s or 50s, your focus on preventive heart care should begin in your 30s and 40s – or even sooner.
Many South Asian people have a genetic predisposition for higher sugar levels, which can increase the risk of developing diabetes. The traditional South Asian diet, while often vegetarian, can contribute to plaque development in the heart arteries. Many beloved dishes are rich in saturated fats (ghee, butter), sugar, and carbohydrates (lentils, naan).
Certain eating patterns in the South Asian culture, when combined with a typical Western diet, can have a significant impact on the incidence of obesity, diabetes, heart attacks, and strokes. Seeing a preventive cardiologist as a young adult can help prevent such complications. It can also help you model a heart-healthy lifestyle and inspire others in your family and community.
Preventive heart care is less about one specific therapy and more about emphasizing a comprehensive and holistic approach to promoting heart health. As such, we have launched a clinical research project called the South Asian CT Angiogram (SACTA) study.
CT angiogram is a painless imaging exam that can detect plaque in the heart arteries. Plaque is a precursor to heart attack or stroke, and knowing whether you have it can help guide preventive care to reduce your risks. SACTA participants will receive a state-of-the-art CT angiogram, which they can use as a baseline to improve their heart health.
We are enrolling people of South Asian heritage 18 and older in SACTA, with a special interest in those age 30-55. If you’d like to learn more, please send an email to SAHealth@utsouthwestern.edu and we will contact you with details about the study.
Related reading: What we know – and don’t – about South Asians’ heart disease risk
What to expect in the South Asian Heart Program
Our specialists understand the cultural and societal distinctions that affect cardiovascular health for South Asians, and we adjust our recommendations for testing and exams based on these nuances.
For example, Parul Sharma, Ph.D., RDN, LD, CNSC, is a nutrition expert who focuses on helping families create heart-healthy variations of traditional foods. She has prepared South Asian cuisine for most of her life, and has studied it as well, so Dr. Sharma is uniquely qualified to guide families toward recipes that respect our cultures and promote heart health.
All patients in the South Asian Heart Program start with an individual risk assessment, which includes an in-depth conversation with a preventive cardiologist to discuss:
- Family and personal health history
- Cardiovascular symptoms, if any (which may require blood tests or imaging)
- Existing health conditions, such as diabetes, high blood pressure, or high cholesterol
- Sleep habits and disorders, such as obstructive sleep apnea
- Diet and exercise habits
- Depression, anxiety, and stress
Increased flow of stress hormones in the body can disrupt sleep, cause weight gain, and produce inflammation – all of which increase the risk of heart problems.
Whereas a BMI under 25 is generally considered healthy for most cultures, South Asian patients might be considered overweight at a BMI as low as 23 due to body composition and genetics. So, we may recommend testing for diabetes and other heart disease risk factors at a lower BMI or blood sugar level than is recommended by national guidelines, which typically are based on data from non-Asian populations.
Although you might look slender, South Asians tend to carry excess fat around the organs in the abdomen (visceral fat) and in the liver. The MASALA study, the largest cardiometabolic study of South Asian people in the U.S. to date, found that regardless of BMI, having excess visceral fat sharply increases obesity and cardiovascular disease risk.
Our South Asian Heart Program providers are trained in advanced weight management, including options such as culturally concordant nutrition and exercise counseling, safe and effective anti-obesity medication, and referrals for bariatric surgery. We work closely with obesity experts in UTSW’s Weight Wellness Program to identify patients at risk for cardiometabolic diseases.
How to join the program
Whereas some of our patients have been in the U.S. a short while, some have lived here for decades or, like me, were born here. Interestingly, the risk for heart disease among South Asian patients remains elevated regardless of where we live.
You can request an appointment with a specialist in the South Asian Heart Program regardless of your past or current heart health history. There are no prerequisites, such as having had a previous heart attack or already having high cholesterol or diabetes – we want to see patients before problems have a chance to begin. You will also be offered an evaluation by our dietitian, Dr. Sharma, at no added cost.
Preventive care is typically covered by Medicare and insurance; we will work with your insurance carrier to get you the care you need. To make an appointment, ask your UT Southwestern provider for a referral to Cardiology – South Asian Heart Program. New to UTSW? Call 214-645-8000 or request an appointment online (ask for “South Asian Heart Program”).
