**The Quiet Crisis of Cardiovascular Illness in South Asians**

Cardiovascular disease (CVD) remains the foremost cause of death globally, yet its effects are not consistent across all ethnic groups. Specifically, individuals from South Asia – encompassing nations such as Bangladesh, Sri Lanka, Nepal, India, and Pakistan – encounter an increased likelihood of developing coronary artery disease (CAD) at a younger age. Nevertheless, conventional risk assessments frequently overlook ethnic-specific elements, resulting in the underdiagnosis and undertreatment of CVD within this population.

**Grasping the Hazards**

As a cardiologist practicing in New York City, I’ve observed directly how lifestyle, genetics, and cultural obstacles exacerbate the CVD burden within the South Asian community. Several key elements define this quiet crisis:

**Early Development and Genetics:** South Asians are inclined to develop CAD sooner than other demographics, often by 5-10 years, even with normal or slightly elevated LDL levels. The occurrence of insulin resistance, heightened lipoprotein(a), and small dense LDL particles is more common among South Asians, posing a risk even in individuals who seem physically healthy.

**Clinical Tip:** Deploy proactive screening measures. Assess coronary artery calcium (CAC) scores and perform advanced lipid testing on individuals over 30 (males) and 35 (females), regardless of traditional risk profiles.

**Dietary Misconceptions:** Numerous South Asians adhere to vegetarian diets, often perceived as heart-friendly, although these diets may include fried items, high carbohydrates, and unhealthy fats from ghee or reused cooking oil. Such dietary habits can escalate insulin resistance and metabolic syndrome due to their elevated glycemic index.

**Clinical Tip:** Promote culturally aware nutritional consultations. Suggest minor adjustments, such as choosing brown rice instead of white, baking in place of frying, and being mindful of portion sizes.

**The “Thin-Fat” Phenomenon and Central Obesity:** South Asians often have normal BMIs but possess increased abdominal fat and waist measurements. Men from Bangladesh and Pakistan, in particular, are prone to central obesity, which can lead to early-onset diabetes and hypertension that may remain undetected until a cardiac incident occurs.

**Clinical Tip:** Traditional BMI measurements are insufficient. Employ the waist-to-hip ratio and contemplate insulin resistance screening for all individuals over 30.

**Underutilization of Statins and Preventive Treatment:** Early statin treatment can significantly benefit South Asians, who might be more responsive to these drugs. Cultural beliefs, lack of awareness, and language barriers often result in low adherence to statins and antihypertensives.

**Clinical Tip:** Enhance health literacy through the use of interpreters and visual tools. Address concerns with compassion, utilizing a shared decision-making approach rather than a directive one.

**Legal and Mental Stress:** Numerous South Asian immigrants, especially first-generation men, endure chronic stress from job instability, legal hurdles, or financial pressures, all of which contribute to increased CVD risk due to prolonged sympathetic activation. Cultural stigma surrounding mental health intensifies instances of silent ischemia and early heart attacks.

**Clinical Tip:** Assess for stress and mental health issues. Collaborate with culturally knowledgeable primary care providers or therapists. Acknowledge the emotional challenges when South Asian men report unusual chest pain or palpitations.

**Cultural Hurdles to Healthcare Access:** In my practice, I’ve observed that religious fasting, language barriers, and immigration-related fears can discourage individuals from pursuing medical attention. Cultural modesty or limited authority over health decisions often cause women to postpone care.

**Clinical Tip:** Effective outreach and comprehension within this community are vital.

**Conclusion**

Healthcare professionals must recognize that standard risk calculators fall short in evaluating South Asian patients. Treat this population as inherently high-risk. Failing to do so could lead to significant repercussions. To address the existing disparities in preventative care and treatment, collaboration among cardiologists, primary care providers, and nurse practitioners is vital. This comprehension transcends statistics, involving an understanding of the distinct cultural and behavioral elements impacting this vibrant yet vulnerable community.

**Monzur Morshed** is a cardiologist. **Kaysan Morshed** is a medical student.