Why do South Asians have a higher risk of cardiovascular disease compared to white Europeans?

Rates of cardiovascular disease (CVD) vary among people from different ethnicities. For example, when compared with Europeans, stroke is more prevalent among people of African ancestry and heart disease is more frequent among South Asians.

But why do South Asians have a higher risk of developing cardiovascular problems and what preventative measures should this community be aware of? We spoke to Dr Joban Sehmi, a top consultant cardiologist in London and Watford, to understand more.

Does a South Asian background affect heart risk?

Accounting for traditional CVD risk factors, South Asians have an approximately two-fold higher risk of CVD than Europeans. It is expected that genetic factors may explain the excess risk, but this has not been conclusively investigated.

What is considered South Asian background?

South Asians are individuals whose ancestry can be linked to the Indian subcontinent - a large area of the world that includes India, Pakistan, Sri Lanka, Nepal and Bangladesh. Collectively, South Asians make up around 25 percent of the world’s population.

Why is the risk of cardiovascular disease higher in the South Asian community than in Europeans?

Diabetes is more prevalent among South Asians than other ethnic groups, and is thought to contribute to their increased risk. South Asians largely develop central obesity, which is fat around the waist. This extra fat increases insulin resistance and therefore contributes to the development of type 2 diabetes. Furthermore, it is likely that genetic and epigenetic factors also play a role.

What factors play a role and does a traditional South East diet contribute to an increased risk?

The primary risk factors for heart disease include:

• Physical inactivity
• Central obesity
• Raised cholesterol
• Family history of CVD
• Diabetes
• Cigarette smoking
• Raised blood pressure 

South Asians have a higher prevalence of diabetes, greater central obesity, strong family history of CVD, similar cholesterol levels, lower levels of physical activity and lower prevalence of cigarette smoking.

In regards to diet, ghee, also known as purified butter, is widely implicated as a risk factor for CVD. However, there is limited evidence that a South Asian diet is any worse than a European one with respect to increased risk of CVD.

Does the increased risk still apply to South Asians born in the UK?

Yes, the increased risk of CVD still applies to first and second generation South Asians residing in the UK.

What preventative advice can you give to the South Asian community?

South Asians need to address modifiable risk factors for CVD. This includes:

• Abstaining from cigarette smoking
• Maintaining a healthy weight (BMI <25kg/m2)
• Avoiding fat deposition around the waist
• Exercising regularly
• Observing a healthy diet

A healthy diet is one that includes fresh fruit and vegetables, legumes, nuts, beans, grains, oily fish and avoiding food products rich in saturated fat and carbohydrates. It is widely agreed that a Mediterranean diet is linked to good health, including a healthier heart.

If you are worried about your cardiovascular disease risk and would like to talk to a specialist, go to Dr Joban Sehmi's Top Doctors profile and and book a consultation with him.