Why South Asians face higher heart disease risk and how you can reduce it

If you are South Asian, your heart disease risk is roughly twice that of your white peers, and it tends to show up earlier in life. Research from the American Heart Association, the MASALA study, and the UK Biobank all point the same way. The good news is that once you understand your main driving factors better, there is a lot you can do to reduce your risk.

• South Asians have about 2 times the heart disease risk of people of European ancestry, even after accounting for lifestyle and standard risk factors.
• Heart disease tends to show up about 10 years earlier. Among young South Asians, 1 in 4 heart attacks happen before age 40 and about half before age 50.
• At age 45, South Asian men are about 8 times more likely to have prediabetes than their white peers, and South Asian women about 3 times more likely.

How high is our risk?

The clearest number comes from a UK Biobank research study, which followed more than 8,000 South Asian adults and nearly 450,000 European adults for about 11 years. We South Asians were roughly 2 times as likely to have a heart attack, stroke, or related event. Even after adjusting for blood pressure, diabetes, cholesterol, smoking, body weight, and exercise, the extra risk did not disappear.

Stanford Health Care, which runs a dedicated South Asian heart program, reports that South Asians have the highest rate of hospitalization for coronary artery disease of any ethnic group in California, and a roughly 40% higher chance of dying from a heart attack than the average American.

Heart disease shows up earlier

Age matters as much as absolute risk. South Asians develop coronary artery disease around 10 years earlier on average than the general population. Among young South Asians who have heart attacks, roughly 1 in 4 happen before age 40 and about 1 in 2 before age 50. That is a generation earlier than most prevention conversations start.

The risk factors themselves also appear earlier. The 2026 MASALA study found that high blood pressure, elevated cholesterol, and prediabetes all tend to surface by the mid-40s in South Asian adults. At age 45, South Asian men were nearly 8 times more likely to have prediabetes than white peers, and South Asian women around 3 times more likely, despite often eating better and drinking less.

What drives higher risk in South Asians?

The 2018 American Heart Association scientific statement led by Dr. Annabelle Volgman and the 2021 National Lipid Association statement by Dr. Dinesh Kalra both point to a mix of biology and body composition rather than a single cause. A few patterns stand out.

• More belly fat at lower body weights. South Asians tend to carry fat around the organs rather than under the skin, which fuels insulin resistance and prediabetes even at a normal BMI.
• Earlier and more aggressive diabetes. Insulin resistance shows up in the 30s and 40s, often before obvious weight gain.
• Higher Lp(a), a genetically inherited really bad cholesterol particle. About 1 in 4 South Asians have elevated Lp(a), which independently raises heart attack and stroke risk.
• Different plaque types in heart arteries. Soft plaque is more risky and causes heart attacks, and imaging studies show that South Asians tend to have more soft plaque.

The plaque itself behaves differently

A 2017 CT angiogram study and a 2022 article both found that South Asians carry a larger share of non-calcified plaque, along with more vulnerable plaque features, compared with white patients with similar risk profiles. That matters because soft plaque is harder to see on a standard calcium score, and it is the kind most likely to rupture and cause a heart attack.

A standard calcium score picks up the hardened, older plaque. A coronary CT angiogram sees the full picture, including the soft plaque that tends to matter more for younger South Asian adults. For this group specifically, that difference can be meaningful.

Why standard risk calculators underestimate you

Most doctors in the US use a 10-year risk calculator to assess your cardiovascular disease risk. The problem is these calculators were built mostly on white and Black US populations and they do not adjust for South Asian genetics. A Kaiser Permanente analysis found that among South Asians flagged as low risk by the calculator, the real heart event rate was more than 2 times what was predicted. In the UK Biobank data, the standard calculator predicted almost identical risk for South Asians and Europeans, even though South Asians actually had double the risk.

What you can do

There is a lot we can do to keep our hearts healthy. The goal is to start earlier and be more proactive.

• Start testing in your 30s, not your 50s. Get a blood test for cholesterol and blood sugar (HbA1c) and keep track of your blood pressure and belly fat.
• Ask for an Lp(a) test once in your life. It is genetic, so it does not change much, but at higher levels it can be a major risk factor on its own. Testing it even once tells you if you need to watch your other numbers more carefully.

• Watch waist, not just weight. A good simple measure is your waist-to-height ratio (see table below). The rule of thumb from the British Heart Foundation: keep your waist to less than half your height.
• Consider a heart scan earlier. A calcium score can find calcified plaque, and a CT angiogram can reveal both calcified and soft plaque, which gives you years to reverse or stabilize it.
• Talk to your doctor about your family history. A parent or sibling with early heart disease roughly doubles your own risk again.

The bottom line

We are not gifted heart-health wise as South Asians, but there is so much we can do to protect ourselves and our loved ones from heart disease. Staying healthy, earlier blood tests, a one-time Lp(a) check, lowering your cholesterol, and getting a heart scan earlier can help you live a long life with a healthy heart.

If you want a quick starting point, our heart age calculator gives you a simple read on where you stand today, and our Lp(a) deep dive explains why that single test matters so much for this population. One caveat: our heart age calculator is based on US risk scores, so it may underestimate your heart age if you are South Asian. Treat the number as a floor, not a ceiling.