Monday, February 16, 2026

 

US South Asians face elevated heart risk at age 45 despite healthier habits



South Asians have more diabetes, hypertension than most other population groups by midlife



Northwestern University



  • By age 45, nearly one in three South Asian men had prediabetes; one in four had hypertension
  • South Asians were twice as likely to develop diabetes by age 55 compared to white adults
  • Their risk was elevated despite reporting healthier diets, lower alcohol use and comparable exercise habits
  • Study highlights need for earlier screening and culturally tailored care for South Asian adults

CHICAGO --- South Asian adults in the U.S. report doing many of the right things for heart health, yet they show significantly higher rates of prediabetes, diabetes and hypertension than white and Chinese adults, and higher than or roughly similar rates to Black and Hispanic patients, according to a new study led by Northwestern Medicine.

In a large long-term study of 2,700 adults, scientists found that participants with heritage from Bangladesh, India, Pakistan, Nepal and Sri Lanka had some of the highest prevalence of risk factors for heart disease when compared to other population groups, despite reporting healthier diets, lower alcohol use and comparable exercise habits.

“The mismatch between healthier lifestyle behaviors and clinical risk was surprising,” said senior author Dr. Namratha Kandula, professor of general internal medicine and epidemiology at Northwestern University Feinberg School of Medicine. “This paradox tells us we’re missing something fundamental to what is driving this elevated risk among South Asians.”

Kandula added that even though we’ve known for decades that South Asians develop heart disease younger, we didn’t have data showing exactly when risk begins.

“We’ve now identified a critical window in the 40s when risk is already high, but disease is still preventable,” she said.

The study will publish Feb. 11 in the Journal of the American Heart Association.

How the study was conducted

The study followed 2,700 adults living in the U.S. who were between 45 and 55 years old at the start of the studies. To do so, the scientists combined data from two long-running cohort studies: MASALA, which focuses on South Asian adults and is led by Kandula, and MESA, which includes white, Black, Hispanic and Chinese adults. Kandula and her team looked at how risk factors changed over a decade, and how patterns differed by race, ethnicity and gender.

Key findings

  • At age 45, South Asian men had a far higher prevalence of prediabetes (31%) than peers in other groups (white: 4%, Black: 10%, Hispanic: 10%, Chinese: 13%).
  • At age 45, South Asian men had higher rates of hypertension (25%) compared to white (18%), Hispanic (10%) and Chinese men (6%) and higher rates of high cholesterol and/or triglycerides compared to Black men (South Asian men: 78% vs. Black men: 61%).
  • South Asian women showed a similar pattern. By age 45, nearly one in five had prediabetes (about 18%) — roughly twice the rate seen of white, Black, Hispanic and Chinese women.
  • By age 55, both South Asian men and women were at least twice as likely to develop diabetes as white adults.
  • South Asian men and women reported healthier diets, lower alcohol use, comparable physical activity and lower average BMI than most other groups.

Clues to understand the paradox

Kandula said the findings point to potential risk factors among South Asians that begin well before midlife. She noted that most MASALA participants are immigrants whose childhood and early adulthood environments may differ from current self-report.

“Early life nutrition, environment, stressors and activity patterns in childhood may increase cardiometabolic risks that show up by age 45,” Kandula said.

Prior data from MASALA show that South Asians have more fat around their organs than other population groups, even at a normal or low BMI. Other studies show that this fat pattern starts in childhood among South Asians and is an important risk factor for heart disease.

Globally, South Asians bear a disproportionate burden of heart disease. Although they make up about one-quarter of the world’s population, they account for roughly 60% of heart disease patients worldwide. In the U.S., where they are among the fastest growing demographic group, they develop atherosclerosis, which can lead to heart attacks, up to a decade earlier than the general population on average.

Perspective from a MASALA patient

Chandrika Gopal, 58, of Ohio, said taking part in MASALA has been a turning point in how she thinks about her own heart health as a South Asian woman. Born and raised in southern India, Gopal said that for generations, women in her family put everyone else first. “This study is very close to my heart,” she said.

After immigrating to North America in her early 20s, Gopal said the early years were challenging. She joined the MASALA study in her late 40s while living in suburban Chicago, encouraged by a friend. Participation has meant regular heart checkups every couple of years with Kandula, including cholesterol testing, EKGs and treadmill exams. Gopal said Kandula has been a consistent advocate and resource. “When we see other doctors, they don’t have time to explain the numbers,” she said. “Dr. Kandula always took the time, and she’s always there if I have questions.”

Since joining the study, Gopal said she has become more intentional about exercise, sleep and diet, and is transitioning to a vegan diet. “It’s so crucial to understand our heart health if we want to grow old gracefully,” she said. “Even if we eat well, we can still be at higher risk. Living in a new country, adapting to different food and routines, it all adds up.” Gopal is available to speak with media.

Clinical implications

Kandula said the findings support earlier and more proactive screening for South Asian adults. “Clinicians should start looking for high blood sugar, high blood pressure and other risk-enhancing factors, such as lipoprotein A, before midlife,” she said. Doctors should also provide “culturally appropriate lifestyle counseling to help South Asians eat healthy, exercise regularly and minimize tobacco and alcohol.”

As for patients of South Asian background, “Even if you eat well and exercise, you may still be at higher risk for diabetes and high blood pressure at younger ages. Ask your doctor about early screening — and get your blood pressure, fasting glucose (or A1c), cholesterol and lipoprotein (A) checked before middle age because early detection, treatment and control of these risk factors can prevent heart disease.”

The study is titled, “Prevalence and Trends in Cardiovascular Risk Factors Among Middle Aged South Asian Adults Compared with other Race and Ethnic Groups in the United States: A Longitudinal Analysis of Two Cohort Studies.”

The MESA study was supported by the National Institutes of Health (contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 and grants UL1-TR-000040, UL1 TR 001079 and UL1-RR-025005).

The MASALA study was supported by the National Institutes of Health (grants R01HL093009 and R01HL120725) and through the UCSF-CTSI Grants UL1RR024131 and UL1TR001872.

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.124.041221 

Subject of Research

People

Article Title

Prevalence and Trends in Cardiovascular Risk Factors Among Middle Aged South Asian Adults Compared with other Race and Ethnic Groups in the United States: A Longitudinal Analysis of Two Cohort Studies

Article Publication Date

11-Feb-2026


Heart disease risk factors appeared at younger age among South Asian adults in the U.S.



American Heart Association

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Research Highlights:

  • South Asian adults begin developing risk factors for heart disease earlier—by their mid-40s—according to an analysis of data from two long-running health studies in the United States.
  • Despite healthier lifestyle/behaviors, such as higher diet quality, lower alcohol use and comparable exercise levels, South Asian adults were more likely to have high blood pressure and/or prediabetes or type 2 diabetes compared to white, Chinese and Hispanics adults of the same age.
  • At age 45, South Asian men were nearly 8 times more likely and South Asian women about three times more likely to have prediabetes than their white peers.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, Feb. 11, 2026

DALLAS, Feb. 11, 2026 — South Asian adults in the U. S. were more likely to have risk factors for atherosclerotic cardiovascular disease (ASCVD) by age 45 when compared to white, Black, Chinese or Hispanic adults in the same age group, according to a study published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association. These ASCVD risk factors can lead to earlier heart disease if they are not treated and managed.

To understand why, researchers analyzed health data for 2,700 adults, ages 45–55 from two national studies in the U.S. The health data examined were from two long-term studies that followed a diverse group of adults from different regions in the U.S.: the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, and the Multi-Ethnic Study of Atherosclerosis (MESA)

The MASALA Study, based at Northwestern University in Chicago, IL and University of California, San Francisco, collected initial health checkups for South Asian participants, who traced their ancestry to Bangladesh, India, Nepal, Pakistan, or Sri Lanka, between 2010–2013 and with follow-up health exams in 2016–2018. Researchers compared the health data of participants in MASALA to publicly available MESA data for white, Black, Hispanic and Chinese adults of the same age. MESA began initial health checkups in 2000–2002 and conducted follow-ups every two years, with the most recent exam visits in 2016–2018.

The analysis examined health conditions that raise heart disease risk—such as high blood pressure, prediabetes and type 2 diabetes—as well as lifestyle behaviors, including diet, tobacco, alcohol use, physical activity and sex differences.

The lifestyle measures collected during office visits, several components that are part of the American Heart Association’s Life’s Essential 8, included determining diet quality, physical activity and alcohol consumption based on self-reported information. Alcohol use was defined as drinking one or more alcoholic drinks per week.

Key findings from the study:

  • The difference in heart disease risks between South Asians and other populations was largely driven by prediabetes, diabetes and high blood pressure. 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.
  • 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.

Senior study author Namratha Kandula, M.D., M.P.H., a professor of medicine in internal medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago and a co-founder of the MASALA study, said, “The earlier accumulation of health conditions that increase the chance of heart disease among U.S. South Asian adults signals the need for earlier screening, tailored prevention and prompt risk-factor management. If you are a South Asian adult, maintain a healthy lifestyle and get screened sooner — check blood pressure, glucose/A1c levels and cholesterol in early adulthood rather than waiting for symptoms.”

A 2023 scientific statement from the American Heart Association likewise reported that South Asian adults face disproportionately high risk for ASCVD caused by the buildup of plaque within the arteries. To mitigate this, it advises some dietary modifications—such as increasing whole‑grain intake, selecting cooking oils lower in saturated fat and avoiding deep‑fried preparation methods—to help reduce this elevated risk.

The long-term data analyzed in this study illustrate how health factors that contribute to cardiovascular disease, like high blood pressure; elevated levels of cholesterol and/or triglycerides (dyslipidemia); and prediabetes, appeared earlier among South Asian adults when compared to peers in other population groups. Identifying risk factors early can lead to early prevention and treatment strategies for South Asian adults in the U.S. and reduce their risk for heart disease.  

The study has several limitations including the use of self-reported behaviors can be inaccurate because individuals may forget details or give answers they think may sound more desirable. Also, both the MASALA and MESA studies relied on participants following up, and these individuals were most often participants with higher educational and socioeconomic status. In addition, there may be limited generalizability beyond the populations studied in MASALA and MESA. Lastly, the MASALA and MESA had a gap of a decade between initial baseline exams – the MASALA baseline exam was initially conducted in 2010-2013, while the initial baseline exam for participants in MESA took place between 2000 and 2002.

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.124.041221 

Article Title

Prevalence and Trends in Cardiovascular Risk Factors Among Middle-Aged South Asian Adults Compared With Other Racial and Ethnic Groups in the United States: A Longitudinal Analysis of 2 Cohort Studies


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