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Addressing ASCVD Risks in South Asians in the U.S.: A Scientific Statement

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Authors: Volgman AS et al. 

Circulation 2018 May 24

This population’s heightened risk for atherosclerotic cardiovascular disease can be explained by the higher prevalence of risk factors, especially those related to insulin resistance.

Sponsoring Organization: American Heart Association (AHA)

Background and Objective

South Asians (individuals from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) have higher proportional mortality from atherosclerotic cardiovascular disease (ASCVD) than other Asian populations and non-Hispanic whites. This Scientific Statement focuses on the impact of risk factors in this population and makes recommendations for clinical strategies and future research.

Key Points

  • South Asians in the U.S. have higher hospitalization and mortality rates from ASCVD than other racial/ethnic minority groups.
  • Both biologic and nonbiologic factors likely explain this heightened ASCVD risk.
  • Perhaps the most significant risk factors are type 2 diabetes and impaired glucose tolerance, which have excess prevalence in this population.
  • Dyslipidemia is another important risk factor; South Asians more commonly have elevated triglyceride, low HDL cholesterol, and elevated lipoprotein(a) levels.
  • Genetic differences may drive the disparate prevalence of metabolic risk factors and ASCVD in South Asians versus non–South Asian populations.
  • Dietary factors might contribute to ASCVD risk in South Asians, as many have a diet with high percentages of carbohydrates and saturated fats.
  • Because cardiometabolic disorders can develop in South Asians at lower body-mass index (BMI) levels than in other populations, lower BMI cutoffs for overweight status and obesity are recommended.
  • Although several population–specific risk-assessment tools exist in the U.S., none has been derived from or validated in U.S. South Asians. The QRISK2 algorithm — derived and validated in 2.3 million people in England and Wales to determine CVD risk in different ethnic groups — includes South Asian ethnicity as a risk factor. Median scores for South Asians are higher than in other tools.
  • Efficacy and safety of certain therapies (e.g., statins) may differ by ethnicity; thus, clinical trials must include adequate numbers of Asians, including South Asians.
  • Healthcare providers must implement culturally sensitive strategies to better inform South Asians about their cardiovascular risks and effective systems to improve access to healthcare services.

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