Be it middle‑aged South Asian men or women, both had higher rates of prediabetes, type 2 diabetes and high blood pressure compared to their White, Chinese and Hispanic peers despite healthier lifestyles, diet and exercise, according to a new study in the Journal of the American Heart Association.
Since this is a South Asian-specific study, it raises red flags about the risk of early onset heart disease among the population in India and other countries in the sub-continent. According to an analysis of data from two long-running health studies involving South Asian immigrants, including Indians, in the US, they begin developing risk factors for heart disease earlier — by their mid-40s — despite healthier lifestyle/behaviours, such as higher diet quality, lower alcohol use and comparable exercise levels. At age 45, South Asian men were nearly eight times more likely and South Asian women about three times more likely to have prediabetes than their White peers.
“This study profiles the risk factors of South Asian immigrants, including Indians. But in India, the lifestyle and physical activity patterns are not the same. Indians in their home country are not into exercising the same way as their peers settled in other countries are. Besides, we are genetically predisposed, which is an unavoidable risk factor. Therefore, rather than waiting till the 40s, we need an aggressive preventive lifestyle, a diet overhaul, regular screening from a younger age and continuous movement through the day to keep the heart healthy,” says Dr Balbir Singh, Chairman, Cardiac Sciences, Max Healthcare.
What the study found
The researchers tracked the usual risk factors of heart disease such as high blood pressure, prediabetes and type 2 diabetes as well as lifestyle behaviours, including diet, tobacco, alcohol use, physical activity and sex differences.
Despite having higher rates of heart disease risk factors, South Asian adults also had the best quality diet, lower use of alcohol and comparable exercise habits. Still, South Asian men had a higher prevalence of prediabetes at age 45 (30.7%) when compared to peers in other ethnic groups (White: 3.9%, Chinese: 12.6%, Black: 10.4%, Hispanic: 10.5%). South Asian men had a significantly greater prevalence of high blood pressure (25.5%) compared to White (18.4%), Chinese (6.6%) and Hispanic men (10.1%), and a significantly greater prevalence of high cholesterol and/or triglycerides (dyslipidemia) compared to Black men (South Asian men: 78.2% vs. Black men: 60.6%).
Similarly, South Asian women had almost two times higher prevalence of prediabetes at age 45 (17.6%) compared to peers in other population groups (white women: 5.7%, Chinese women: 8.2%, Black women: 9.0%, Hispanic women: 5.1%).
At age 55, both South Asian men and women were at least two times more likely to develop type 2 diabetes when compared to White adults at the same age.
So, what should be a heart protective protocol
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“Even before this study, we knew that Indians have the highest risk of heart attack globally. This can be attributed to genetics, a high carbohydrate diet, high lipids, high triglycerides and abdominal obesity or what we call protruding belly fat,” says Dr Singh. He advocates for earlier screening so that the risk factors can be kept in range. “I have always been saying that as South Asians, we need to begin screening in our 20s. In fact, given the increasing trend of childhood obesity, hypertension and Type 2 diabetes in teens, we need a strict school programme on weight management and monitoring BP as well as an educative module for both teachers and parents,” says Dr Singh.
If a young adult has borderline risk factors on blood sugar, cholesterol and BP, then Dr Singh advises that they get checked every year. Those whose figures are normal can then get them done once in two years provided they are on a lifestyle protocol of diet and exercise. “A calcium score test, which measures plaque in the arteries in a non-invasive way, should be done after 40, which is simple, cheap and accessible,” he explains.
Not just oils and fat, count your carbs
Last year, Prime Minister Narendra Modi had pushed for cutting cooking oil by 10% daily, primarily aimed at fighting obesity, high blood pressure and liver issues. “We must have a similar government campaign on carbs. As Indians, we eat more sweets. Recent scientific evidence suggests that refined carbohydrates are more strongly linked to heart disease and heart attacks than most dietary fats. Sugar is the next smoking giant,” says Dr Singh.
Refined carbs elevate triglycerides, bad cholesterol and reduce good cholesterol. They cause insulin resistance and inflammation, both of which can damage heart vessels. Excess sugar gets converted to liver fat. “Historically, when people reduced fat intake, they often replaced it with refined carbohydrates, resulting in higher calorie consumption, weight gain and worse metabolic health. That’s why we need to reconsider our diet and have more aggressive interventions from the school meal level and at the foundational diet level in homes. We can correct diet from the first food a child has,” explains Dr Singh.
