Heart and circulatory diseases, along with diabetes, pose a greater threat to individuals of South Asian descent. Dr. Sandy Gupta, a consultant cardiologist at Whipps Cross and Barts Health NHS Trust, sheds light on this persistent concern during a conversation with senior cardiac nurse Christopher Allen.

South Asian Heart Risk

For over half a century, research has indicated that the risk of coronary heart disease (CHD) is significantly higher in first-generation South Asians compared to their white European counterparts in the UK. Despite this knowledge, the issue persists, prompting an exploration into the factors that contribute to this heightened risk.

Defining South Asian Background

When we refer to South Asian background, we encompass individuals from the Indian subcontinent—India, Pakistan, Bangladesh, and Sri Lanka—residing in the UK. Interestingly, within this diverse group, variations in risk exist. The Bangladeshi population faces the highest risk, followed by Pakistanis, Indians, and Sri Lankans. Even within this spectrum, Sri Lankans may carry a higher risk compared to white Caucasians.

Understanding the Increased Risk

The heightened risk is attributed, in part, to body shape and diabetes prevalence. South Asians tend to develop central obesity, primarily around the midsection. This excess fat increases insulin resistance, elevating the risk of type 2 diabetes. Importantly, the criteria for identifying increased risk—such as waist circumference—are lower for South Asians than for white Europeans.

Diabetes not only raises the risk of CHD and heart attacks but is also linked to unfavorable lipid profiles, including high triglyceride levels and low levels of HDL ("good") cholesterol. Alarmingly, South Asians are diagnosed with type 2 diabetes at a younger age and at higher rates than the general population.

The Role of Lifestyle and Genetics

While lifestyle factors contribute, genetics also play a significant role. A school study revealed early markers of insulin resistance in children of South Asian background, underscoring a genetic predisposition. Environmental factors, like a poor diet or smoking, further exacerbate this genetic risk.

Dietary Patterns and Heart Health

Traditional South Asian diets, rich in lentils, vegetables, and oily fish, also feature fried foods, contributing to higher calorie intake and weight gain. Traditional fats, such as ghee, contain saturated fats linked to elevated LDL cholesterol levels. Moreover, a high-salt diet prevalent in South Asian cultures correlates with high blood pressure.

Cultural practices, such as frequent family gatherings, may expose individuals to unhealthy snacks. However, rather than outright bans, a nuanced approach is advocated—recognizing the distinction between "luxury" items and healthy choices, emphasizing mindful portion control and preparation methods.

Physical Activity and Cultural Considerations

Studies indicate that South Asians, especially women, engage in less physical activity. Cultural factors, such as religious beliefs affecting gym attendance, contribute to this trend. Encouraging alternative activities, like walking, group dancing, or single-sex exercise classes, is crucial. It aligns with a broader need for increased physical activity among the general population in the UK.

Additional Factors and Considerations

Many South Asian communities reside in deprived areas, amplifying the risk of CHD. Factors like lower incomes and limited access to healthier foods play a role. Certain communities, such as the Bangladeshi population in east London, face higher death rates and a range of health disparities.

Cigarette and tobacco use, including shisha smoking, are more prevalent in South Asian communities, particularly among the Bangladeshi population. The impact of these behaviors on heart health underscores the need for targeted interventions.

Born in the UK: Is the Risk Mitigated?

Contrary to expectations, evidence indicates that even young South Asians born and raised in the UK carry a higher prevalence of risk factors compared to their white European counterparts. Genetic predisposition, coupled with family influences, shapes lifestyle habits, perpetuating the elevated risk.

A Comprehensive Approach to Heart Health

As we delve into the complexities of heart health in South Asian communities, it is evident that a multifaceted approach is essential. Education, cultural sensitivity, and targeted interventions can contribute to reducing the disproportionate risks faced by individuals of South Asian descent, paving the way for a healthier future.