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.

Additional Resources:

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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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Smokefree generation law could see English smoking prevalence drop below 5% decades earlier than expected





University of Nottingham
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New research, led by experts at the University of Nottingham, has found that smoking prevalence among 12 to 30-year-olds in England could drop below 5% decades earlier than expected, if the government progressively raises the age of tobacco sale.

With less than a year to go until the planned introduction of the “smokefree generation” law, researchers at the University have modelled the policy’s potential impact on smoking rates and health inequalities. The findings are published in the BMJ-owned journal Tobacco Control.

The proposed legislation, part of the Government’s Tobacco and Vapes Bill, would progressively raise the age of sale so that anyone born in 2009 or later can never legally be sold tobacco, starting from 2027.

Using detailed modelling, the team projected how smoking prevalence among 12 to 30-year-olds in England could change over the coming decades if the law is implemented, compared with a scenario in which it is not. The project was funded by the National Institute for Health and Care Research (NIHR).

They found that the smokefree generation law could push smoking prevalence below 5% in the 2040s, decades earlier than would be expected without the law. However, males and the most deprived communities are forecast to reach this milestone later unless the law and support is effectively targeted. 

The key findings of the report were:

  • The policy could meaningfully accelerate declines in smoking prevalence.
  • Smoking prevalence among 12 to 30-year-olds falls below 5% in the 2040s, with prevalence continuing to decline thereafter. 
  • Health gains build over time, with tens of thousands of extra healthy years of life. By 2075, the policy could deliver around 88,000 additional years of healthy life compared with no new law, reflecting substantial long-term benefits from fewer people regularly smoking. 
  • Benefits are biggest in disadvantaged communities where smoking remains highest. Around 30% of total healthy life years gained are projected to occur in the most deprived 20% of neighbourhoods. 
  • Modelling suggests that tailored communication and greater targeted investment in enforcement may reduce both absolute and relative inequalities and bring smoking prevalence below 5% sooner. 

Nathan Davies, lead author and researcher in the School of Medicine at the University of Nottingham, said: “This modelling suggests the smokefree generation law could help stop young people from ever starting to smoke, accelerating progress towards a tobacco-free future. But how the policy is implemented will matter. Stronger enforcement, communication and stop smoking support in communities where smoking remains most common could help ensure the benefits are shared across the country and achieved more rapidly.”

The research team’s projections differ from the government’s published impact assessment because they use more cautious assumptions about how much the policy will reduce smoking initiation year-on-year.

The UK government’s modelling assumes a 30% cumulative annual reduction in smoking initiation based on the decline seen when the age of sale increased from 16 to 18 in England. The University of Nottingham team’s central scenario uses a more conservative assumption of a 5% cumulative annual reduction, informed by evidence from international age of sale laws, alongside a scenario aligned with government assumptions. Even under these more cautious assumptions, the modelling still suggests the policy could deliver substantial reductions in prevalence and large long-term health gains compared to no law. If declines are in line with the government’s assumptions, then the 5% prevalence target could be reached in the 2030s. 

Hazel Cheeseman, Chief Executive of Action on Smoking and Health (ASH) said:

“We cannot yet be certain of the full impact of the smokefree generation law, but this modelling shows it could be a once-in-a-generation opportunity to transform the nation’s health for the long term. It also sends a clear warning: without further action, some people will be left behind. As this law comes into force, the Government must set out how it will ensure every smoker has the support they need to quit, so that no one is excluded from the benefits of a truly smokefree generation.”

Alizée Froguel, prevention policy manager at Cancer Research UK, said: 

“Smoking is the leading cause of cancer deaths in England. This study highlights what a landmark step the age of sale legislation will be in helping protect future generations from a lifetime of deadly, costly addiction. Strong enforcement and effective implementation of this policy will also be critical to its success. 

“The UK Government must now swiftly pass and implement the Tobacco and Vapes Bill alongside sustainable funding for stop smoking services. Smoking rates are three times higher in the most deprived areas of the country, so it’s vital that this support is tailored to people who need it the most.” 

 

END

Journal

Tobacco Control

Method of Research

Observational study

Subject of Research

People

Article Title

Impact of the UK’s smokefree generation policy on tobacco-related equity in England: a simulation study

Article Publication Date

11-Feb-2026

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Science made simple: book dispels five misconceptions about carbon pricing




Potsdam Institute for Climate Impact Research (PIK)

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Gradually increasing the price of fossil fuels is considered a key element of effective climate policy – and yet it remains the subject of bitter controversy. In a new book, experts from the Potsdam Institute for Climate Impact Research (PIK) explain this concept and correct false perceptions. The publication (in German) is aimed at professionals and laypeople who want to gain a thorough understanding of the topic. It is available in print from Springer Gabler and can be downloaded free of charge as a PDF and e-book.

“We want to build bridges between the camps,” says PIK Director Ottmar Edenhofer, who co-authored the book with political scientist Cecilia Kilimann and economist Christopher Leisinger from his scientific staff. “We address the objections of those who, like us, want strong climate policy, but equate carbon pricing with blind faith in the market and the abandonment of government regulation. The finding of climate economics is that this is a misunderstanding. For pricing to reduce CO₂ emissions efficiently and without collateral damage, comprehensive government capacities and accompanying measures are needed.”

The publication presents the latest research findings from renowned journals, including several highly acclaimed articles by PIK and the Mercator Research Institute on Global Commons and Climate Change (MCC), which has been part of PIK since the beginning of 2025. Presented in an easy-to-understand format, the book corrects five popular misconceptions about carbon pricing as a core instrument of climate policy:

  • Misconception 1: “No steering effect”. Fuel is becoming more and more expensive, yet people are not driving less – observations like this make many people doubt the efficacy of the carbon price. But the research team provides a different perspective: that this rather suggests a need for complementary measures such as bans, standards and subsidies – which are most effective in combination with carbon prices. They explain simply but scientifically how pricing environmental damage pushes “dirty” products, such as coal-fired power plants, out of the market and promotes “clean” products. The analysis also looks at individual motivations: when well designed, market control is also well suited to ethically motivated climate protection.
  • Misconception 2: “Politically unfeasible”. The numbers prove the opposite. Worldwide, 28 percent of all CO₂ emissions are now directly priced – and in the EU, this figure will rise to 75 percent in 2028 when a second emissions trading system is launched for transport and buildings. The book shows that more and more countries, including large emerging economies, are relying on this instrument. Its success is based on its flexibility: it can be designed as a tax, as emissions trading, or as a hybrid system and thus adapted to political requirements.
  • Misconception 3: “Socially unjust”. Indeed, according to empirical findings cited by the research team, carbon pricing without social compensation can place a disproportionate burden on poorer households. However, this also applies to climate policy through standards or bans – and carbon pricing has the advantage of generating revenue that can be used to counteract this. Four variants of compensation are presented: a per capita flat rate, innovative climate money for buildings, a reduction in electricity costs and hardship compensation.
  • Misconception 4: “Obsolete model”. Why go to the trouble of establishing a pricing system when there will be nothing left to price in the climate-neutral world we are striving for? The book counters this objection with a special section on atmospheric carbon removals. These are necessary to achieve the net-zero target while there are still residual emissions that are difficult to avoid. Later on, they can even offset exceeding the 1.5°C limit for global warming through net negative emissions. Carbon pricing can therefore help balance supply and demand for remaining emissions and removals for many decades to come, thereby creating a financing system and providing incentives for investment.
  • Misconception 5: “Only possible with a world government”. Does carbon pricing only make sense if everyone participates? Readers learn why a globally uniform price would not be a sensible goal – and how pricing, even if patchy and regionally fragmented, can help the climate. In this context, the international competitiveness of industry and its jobs are also discussed in detail. The research team presents effective mechanisms that can prevent so-called carbon leakage resulting from the relocation of production. These mechanisms could even serve as a driver for increased international cooperation in the future.

“The EU’s climate tariff system, which will come into effect at the beginning of 2026, will make carbon pricing even more important internationally,” concludes PIK Director Edenhofer. “In times of increasing geopolitical tensions, this will also become relevant to security policy because it will ultimately reduce the oil and gas revenues of authoritarian states such as Russia. The career of carbon pricing has only just begun. This book explains why that is a good thing.”

DOI

10.1007/978-3-658-50400-7 

Method of Research

Literature review

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Climate attitudes unchanged before and after Hurricane Helene




University of Gothenburg
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In late September 2024, Tropical Storm Helene swept across the south-eastern United States. When the storm subsided a few days later, the destruction was extensive and more than 250 people had lost their lives. The event occurred just five weeks before the US presidential election, prompting researchers to ask whether this type of extreme weather can influence public attitudes towards climate change and support for environmental policy.

To be able to assess cause and effect, the researchers conducted a two-wave study. The first wave took place one month before the hurricane, when 1,155 Americans responded to a survey. The second wave was conducted immediately after the hurricane, when the same participants answered the same questions again. The survey asked about voting intentions in the upcoming election, views on climate change, and concerns about extreme weather. Some participants lived in areas affected by the hurricane, while others lived in regions that were not affected.

“The results show that the hurricane did not change people’s views on climate change. Concerns about extreme weather were also unaffected, and there was no increase in the number of people planning to vote for politicians in favor of stricter climate policies. The findings relate to group-level effects of this specific hurricane and do not necessarily apply to individuals or other extreme weather events,” says Magnus Bergquist, Senior Lecturer in Psychology at the University of Gothenburg.

Previous studies that have found links between extreme weather and climate attitudes are often based on data collected at a single point in time, which makes it difficult to draw conclusions about cause and effect.

“By measuring attitudes both before and after Hurricane Helene, our study provides strong evidence of unchanged concern about climate change and stable support for climate policy, even among people exposed to an extremely severe hurricane,” says Magnus Bergquist.

The researchers also analyzed the role of political affiliation. In line with previous research, political preference proved to be a much stronger predictor of voting intentions than exposure to a powerful hurricane. Democrats showed greater support for politicians advocating climate policy reforms than Republicans. Differences between supporters of the respective parties were substantially larger than differences between affected and non-affected regions, or between measurements taken before and after the hurricane.

“This may point to the importance of how extreme weather events are portrayed in the media. Media coverage following Hurricane Helene largely focused on the responsibility of politicians and institutions in managing the crisis, rather than on links to climate change. This may have influenced how people interpreted the event and could help explain why neither climate-related attitudes nor voting intentions were affected,” says Sofiia Skipor, PhD student in Psychology.

Study:

For more information, please contact:

  • Magnus Bergquist, Associate professor in Psychology, Phone: +46 (0)31 786 15 56 or +46 (0)702 49 25 13, E-mail: magnus.bergquist@psy.gu.se
  • Sofiia Skipor, PhD student, Phone: +46 (0)31 786 16 80, Eemail: sofiia.skipor@psy.gu.se

 

Journal

Environmental Research Communications

DOI

10.1088/2515-7620/ae2f91 

Method of Research

Survey

Subject of Research

People

Article Title

Attitudes unchanged: no support for increased climate change beliefs, concerns, or voting intentions after Hurricane Helene

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