If you are of South Asian or East Asian background, this article is written specifically for you, and it carries a message that is ultimately optimistic, not alarming.

Yes, the evidence shows that people from these communities face cardiovascular risks that are not fully captured by standard medical tools designed for Western populations. But the reason to know this is not to worry, it is to act. Because the cardiovascular risks that affect South and East Asian populations are well understood, largely preventable, and highly responsive to early intervention.

The most powerful thing you can do with the information in this article is use it to start a more specific and more informed conversation with your doctor. That conversation, had early, before symptoms develop, is where the difference is made.

Why Standard Risk Tools Sometimes Miss the Picture

Doctors use scoring tools and calculators to estimate a patient’s risk of having a heart attack or stroke over the next ten years. These tools consider age, blood pressure, cholesterol levels, smoking history, and family history, and they are genuinely useful. But they were developed and tested primarily using data from white Western European and North American populations.

For people of South Asian or East Asian background, these tools can underestimate risk, sometimes significantly. The body weight thresholds, cholesterol ranges, and blood pressure cut-offs that signal concern in a Western patient do not always apply in the same way. The result is that some people from these communities are told their risk is low when a more targeted assessment would identify important factors worth addressing.

This is not a failure of medicine, it is a gap that is now well recognised and being actively addressed in cardiovascular research. Knowing about it puts you in a position to ask the right questions.

South Asian Communities, What the Evidence Shows

Who this section applies to

South Asian refers to people with family roots in India, Pakistan, Bangladesh, Sri Lanka, Nepal, and Bhutan. This is one of the largest communities in Australia, the United States, the United Kingdom, and Canada, and one that carries a cardiovascular risk profile that deserves specific attention and specific action.

Heart disease tends to arrive earlier

Coronary artery disease, the narrowing of the arteries that supply the heart with blood, tends to develop earlier in South Asian individuals than in Western populations. This is not inevitable, and it is not a reason for fatalism. It is a reason for earlier, more proactive engagement with cardiovascular risk assessment, because identifying and managing risk factors in your thirties or forties is far more effective than waiting for symptoms to appear.

The disease also tends to affect the smaller coronary arteries, which are harder to see on some investigations and more diffuse in its distribution. This is another reason why a thorough assessment, rather than a single test, gives the most complete picture.

Body weight, why standard measures can be misleading

The standard BMI, body mass index, thresholds used in Western medicine define overweight as a BMI above 25 and obese above 30. These thresholds were developed using data from Western populations and do not translate directly to South Asian individuals.

South Asian bodies tend to carry more fat around the abdomen, even at lower overall body weights, and this abdominal fat pattern is more strongly linked to metabolic problems like insulin resistance, high blood sugar, and abnormal cholesterol than fat carried elsewhere. As a result, a South Asian person with a BMI of 23 or 24, technically “normal weight” by standard measures, may already have a metabolic profile that warrants attention and management.

Waist circumference, the measurement around the middle, is a more useful indicator of this risk than BMI alone. If you are of South Asian background, asking your doctor to measure your waist circumference alongside your weight gives a more complete picture of your cardiometabolic health.

Diabetes, why it develops earlier and at lower weights

Type 2 diabetes, a condition where the body does not manage blood sugar properly, is two to four times more common in South Asian populations than in white Western populations, and it tends to develop at younger ages and lower body weights. This matters enormously for cardiovascular health because diabetes significantly amplifies the risk of heart disease and stroke when it is present.

The practical implication is that a blood sugar test, specifically an HbA1c, which gives a three-month average of blood sugar control, is worth requesting even if you are not overweight and have no obvious symptoms of diabetes. Identifying pre-diabetes or early diabetes early gives the best chance of reversing it before it affects the heart.

Lp(a), an inherited risk factor worth knowing about

Lipoprotein(a), usually written as Lp(a) and pronounced “L-P-little-a”, is an inherited particle in the blood that raises cardiovascular risk. It is not affected by diet, exercise, or standard cholesterol-lowering medications, and it is carried in elevated amounts by a higher proportion of South Asian individuals than most other populations.

Most people have never had their Lp(a) measured, because it is not part of standard cholesterol testing. But it is a simple blood test, needs only to be done once in a lifetime, and identifies an important risk factor that completely changes the management conversation when it is elevated. We have a dedicated article on Lp(a) and what it means for your heart on Heart Matters. If you are of South Asian background, particularly with a family history of early heart disease, asking your doctor about Lp(a) is one of the most valuable things you can do at your next appointment.

As someone of South Asian background myself, this is not an abstract clinical observation, it is something I see in my own extended family and community. The patients who arrive in my operating theatre with advanced coronary disease in their forties are often people whose risk was underestimated for years because the standard tools were not built with them in mind. Earlier conversations change outcomes. I have seen it.

— Prof. Jai Raman, Cardiothoracic Surgeon

East Asian Communities, What the Evidence Shows

Who this section applies to

East Asian refers to people with family roots in China, Japan, Korea, Taiwan, Hong Kong, and Mongolia. Southeast Asian encompasses Vietnam, Thailand, the Philippines, Indonesia, Malaysia, Cambodia, and neighbouring countries. While these are richly diverse populations with very different cultural and dietary traditions, they share some important cardiovascular patterns that are worth understanding.

Stroke, the priority risk to manage

East Asian populations generally have lower rates of coronary artery disease, blocked heart arteries, compared to South Asian or Western populations. This is genuinely positive and reflects the protective effects of traditional dietary patterns and historically lower rates of obesity in these communities.

However, stroke rates are higher, and this is the cardiovascular priority for East Asian populations. A stroke occurs when blood supply to part of the brain is interrupted, either by a blocked artery or a burst blood vessel. Both types are more common in East Asian populations than in Western ones, and both are strongly driven by high blood pressure, which is the most important cardiovascular risk factor to manage in these communities.

Blood pressure and salt, a particularly important connection

High blood pressure, or hypertension, is the dominant cardiovascular risk factor in East Asian populations, and it responds particularly strongly to dietary salt intake. Many traditional East Asian cuisines are naturally high in sodium, from soy sauce, fish sauce, miso, preserved vegetables, and processed foods, and this dietary pattern can contribute meaningfully to blood pressure elevation over time.

The good news is that this is one of the most modifiable risk factors available. Reducing dietary sodium, alongside medication where needed, produces very meaningful reductions in blood pressure and stroke risk. Having your blood pressure checked regularly, and monitoring it at home with a home blood pressure device, is one of the highest-value health habits for anyone of East Asian background. We have a dedicated article on monitoring blood pressure at home on Heart Matters.

Atrial fibrillation, a specific conversation worth having

Atrial fibrillation, or AF, is a common heart rhythm condition where the upper chambers of the heart beat irregularly rather than in a coordinated rhythm. When AF is present, blood can pool in the heart and form clots, which can travel to the brain and cause a stroke. We have a dedicated article on AF and stroke risk on Heart Matters.

In East Asian populations, the stroke risk associated with AF appears to be somewhat higher than in Western populations, which means the decision about whether to use blood-thinning medication to protect against stroke is particularly important. If you have been diagnosed with AF and are of East Asian background, having an explicit conversation with your cardiologist about your stroke risk and the best approach to managing it is very worthwhile.

Sleep apnoea at lower body weights

Obstructive sleep apnoea, a condition where breathing repeatedly stops and starts during sleep, is a significant but under-recognised cardiovascular risk factor. It is associated with high blood pressure, atrial fibrillation, and heart failure. Most people are aware that it is more common in people who are overweight, but in East and Southeast Asian populations, sleep apnoea develops at significantly lower body weights than in Western populations, due to differences in facial bone structure that affect the size of the upper airway.

This means that a lean East Asian person with heavy snoring, morning headaches, or unrefreshing sleep should be assessed for sleep apnoea regardless of their weight. We cover this in detail in our dedicated article on obstructive sleep apnoea and the heart.

Alcohol, an important note for East Asian individuals

Approximately one in three people of East Asian background carries a genetic variation that affects how the body processes alcohol. When alcohol is consumed, the body normally breaks it down through a series of steps. In people with this genetic variation, one of those steps does not work properly, causing a build-up of a toxic substance called acetaldehyde. This produces the characteristic facial flushing, redness of the face and neck, that many East Asian people experience after even small amounts of alcohol.

This flushing is not merely a cosmetic reaction. The acetaldehyde that builds up is a direct cardiovascular toxin and is also linked to an increased risk of certain cancers. For people of East Asian background who experience this flushing response, there is a particularly strong cardiovascular reason to keep alcohol consumption to a minimum. We discuss this further in our dedicated article on alcohol and the heart.

The Positive Picture, What Early Action Achieves

Everything described in this article is actionable. Every risk factor mentioned, blood pressure, blood sugar, Lp(a), sleep apnoea, cholesterol, dietary sodium, alcohol, can be identified with simple tests, and most can be meaningfully reduced with a combination of lifestyle changes and, where needed, medication.

The cardiovascular outcomes for South and East Asian patients who are identified early and managed proactively are excellent. The gap in outcomes between these populations and Western populations is not biological destiny, it is largely a consequence of later presentation and less targeted risk assessment. Change those two things, and the outcomes change with them.

The most important step is the first one: a conversation with your doctor that explicitly addresses your background and what it means for your cardiovascular risk assessment.

The patients I worry least about are the ones who come to see me early, before symptoms, before a crisis, and say “I know my background puts me at higher risk, so I want to understand where I stand.” That conversation, had in your thirties or forties, gives us every opportunity to protect your heart for decades to come.

— Prof. Peter Barlis, Interventional Cardiologist

A Note on Acculturation, Second and Third Generations

One pattern worth understanding is what happens as South and East Asian families become more established in Western countries across generations. First-generation immigrants often maintain the dietary patterns of their home country, which, particularly for East Asian families, can be quite protective. Second and third generations frequently adopt more Western eating habits, more processed food, more refined carbohydrate, less of the traditional plant-based and fermented foods, while sometimes losing awareness of the specific cardiovascular risks their background carries.

If you are a second or third-generation Australian, American, or British person of South or East Asian descent, the cardiovascular risk profile of your ethnic background applies to you just as much as it does to a first-generation immigrant. It is worth knowing about, and worth discussing with your doctor.

Conclusion

The cardiovascular risks that affect South and East Asian communities are real, well understood, and highly manageable when identified early. The standard medical tools that doctors use every day were not built with your specific background in mind, which means you may need to be the one who brings this conversation to your appointment.

That is not a burden, it is an opportunity. The person who walks into their doctor’s office armed with this awareness, asks the right questions, and gets the right assessment is the person who gives themselves the best possible chance of a long and healthy life.

Your background is not your destiny. It is information, and information, acted on early, is one of the most powerful tools in cardiovascular medicine.

More from Heart Matters

• Lipoprotein(a): The Inherited Heart Risk Most People Have Never Heard Of
• Understanding Your Cardiovascular Risk Factors
• Atrial Fibrillation and Stroke Risk
• Rheumatic Heart Disease: A Preventable Condition Affecting Millions
• Monitoring Your Blood Pressure at Home