I am a first-generation, South-Asian American. Like many other South Asians, I have a family history of cardiovascular disease. When I was ten-years old, my grandfather woke up with up with chest discomfort and burning, a pain he attributed to reflux. My grandmother, being the smart woman she is, told my dad, a cardiologist – who helped my grandfather get assessed and ultimately receive stents for severe coronary artery disease. Now, my father and I are being managed for risk factors of cardiovascular disease.
Though my story is not at all unique, its commonality brings light to a troubling fact: South Asians, both in their native country and abroad, carry an undue burden of cardiovascular disease. So much so, that being South Asian is the only ethnicity identified by the American Heart Association as a “risk-enhancing” factor for cardiovascular disease. In the United States, the death rate for ischemic heart disease is on the rise for both men and women [5]. This burden notably persists amongst all age groups. Unfortunately, not only do more South Asians have prevalent cardiovascular disease then age/sex matched White adults, they also have a greater burden of cardiovascular disease, as evidenced by multivessel involvement and obstructive coronary artery disease compared to other groups [1].
South Asians are more likely to develop cardiovascular disease risk factors such as diabetes (by two to three-fold), hyperlipidemia, central adiposity, and hypertension [3,5]. The development of these risk factors often occurs at a younger age in part due to behavioral factors such as inadequate physical activity and unhealthy dietary patterns, but also from a genetic predisposition [2]. Despite my father taking multiple measures to reduce his cardiovascular risk such as cutting out fried foods and rice and carbohydrate-based meals which are so ingrained in our culture; he was still found to have coronary calcium (a marker of subclinical coronary atherosclerosis) and is now started on more aggressive lipid lowering therapies. I also found myself also falling prey to poor genetics with findings of high cholesterol at the age of thirty. With my dad and I both in the medical field - we are lucky to be able to recognize concerning symptoms in our family and know when we should be screened and how to manage our risk factors. Others are not so lucky.
While these statistics are troubling, what is more striking is the historical lack of awareness and screening for cardiovascular disease amongst South Asians, particularly immigrants [4]. With proper screening and management of risk factors, the burden of cardiovascular disease in South Asians can be reduced [2]. The foundation of change starts with education: education about cardiovascular disease burden, risk factors, and management strategies and education that includes both subspecialist and general clinicians as well as the public. Through my training, I have been fortunate to work in a variety of communities from downtown Baltimore, Maryland to Eldoret, Kenya. One common thread I have noticed is the need for improved outreach to underrepresented groups who often lack understanding or access to basic preventive health care. Often, we see them in the hospital when it is too late.
Participating in education forums for South Asian groups in North Carolina, I have seen the power in bringing together a community, allowing the space for learning and questions, and the empowerment that comes to individuals who participate. Although these are initial steps, they lay the groundwork for innovation and progress in addressing the significant burden of cardiovascular disease among South Asians. As I advance in my career, I aim to integrate these grassroots principles to foster principles of preventive cardiovascular disease care.
CRediT authorship contribution statement
Aarti Thakkar: Writing – original draft.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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