People from South Asia—India, Pakistan, Bangladesh, Nepal, Bhutan, Maldives and Sri Lanka—have a four times greater risk of heart disease than the general population and have a much greater chance of having a heart attack before age 50.

Heart attacks strike South Asian men and women at younger ages and the attacks are more deadly compared to any other ethnic group. Almost one in three in this group will die from heart disease before age 65.

In India, cardiovascular disease remains the No. 1 cause of death. One study found that South Asians developed heart disease 10 years earlier than other groups.

Why these heart attacks occur is only partially answered with traditional risk factor assessment. South Asians tend to be smokers, and the typical South Asian diet tends to be high in sugar, refined grains, and fatty foods.

An alarmingly high number of South Asians appear to be insulin resistant, a pre-diabetic condition in which the body does not process insulin efficiently. Insulin-resistant patients have similar rates of cardiovascular events as those with full-blown diabetes.

Body mass index (BMI) in South Asians often falls into a thin-fat syndrome: People may have an acceptable BMI, but they also carry more of their weight in their abdomen and that visceral fat is more likely to lead to a cardiovascular event.

More than one-third of South Asian men and 17% of South Asian women have metabolic syndrome. Metabolic syndrome is a cluster of conditions including:

• High blood pressure
• High blood sugar levels
• Excess body fat around the waist
• Abnormal cholesterol levels that increase the risk of heart disease, stroke and diabetes

If more than one of these conditions occur in combination, the risk is even greater. South Asians are more likely to have high triglycerides and low HDL (the good cholesterol).

A variant of HDL known as HDL2b, which is thought to mediate the good effects of HDL, is low in as many as 93% of South Asian men and 63% of women.

What compounds these risks in the South Asian population is a lack of specific testing: The criteria for metabolic syndrome and the subfractionation of HDL and other lipid- and inflammatory-based cardiovascular risk biomarkers are typically not checked during routine physical exams and they are often overlooked in a standard cardiovascular workup.

The cardiovascular risk in South Asians appears to begin early: Research has shown that even in infancy, children of South Asian heritage may have high levels of cholesterol and lipoproteins in their blood.

People from India, Pakistan, Bangladesh, Nepal, Bhutan, Maldives and Sri Lanka have a higher risk of developing heart disease at an early age than any other ethnic group. Men appear to have a slightly higher risk than do women.

At the Stanford South Asian Translational Heart Initiative (SSATHI), we strongly encourage South Asians between the ages of 20 to 60 to be screened for cardiovascular risk factors, so that these can be identified and treated before heart disease sets in.

Becoming aware of your risk at an early age is an important first step. That awareness should include as much of your family’s health history as is available.

Talking with a doctor knowledgeable about this type of heart disease will also help. Adding daily exercise and eating heart-healthy foods will also contribute to lowering your heart disease risk.

You should be evaluated for cardiovascular risk and disease if you are having:

• Chest pain
• Chest pressure
• Shortness of breath when climbing stairs, walking uphill or on flat ground

But the most important risk factor is often a family history of diabetes, high cholesterol, or heart disease, all of which are highly prevalent in South Asian families.

At SSATHI, treatment begins with education to help you and your family understand your personal risk of heart disease. This begins with visiting a SSATHI cardiologist, who will perform an advanced diagnostic risk assessment for an in-depth picture of your condition. A SSATHI dietitian will provide a detailed analysis of your dietary habits and work with you to develop a clear plan to reduce your cardiovascular risk through diet and lifestyle changes.

Patients may be prescribed cholesterol- and blood pressure-lowering medications, as well as medications to control pre-diabetes. The goal is to reduce a patient’s cardiovascular risk to its lowest levels possible within a six-month time period, and to then maintain those minimal risk levels as a lifelong partner with you.

If active coronary disease is found, patients will have immediate access to Stanford’s network of cardiovascular specialists. Available treatments include the most advanced coronary procedures available, including:

• Coronary angioplasty and stenting
• Heart transplantation
• Coronary bypass and minimally invasive valvular surgery

Stanford continues to be a world leader in pioneering new cardiovascular surgical techniques, technological innovation, and many aspects of disease discovery and treatment. These resources are all available to South Asian patients through SSATHI.