Enhanced Atherosclerotic Cardiovascular Risk in South Asian Diaspora: A Comprehensive Review

The population of South Asians (SA) is growing rapidly, leading to an increase in the global SA diaspora. Foreign-born SAs have been one of the fastest-growing immigrant populations in the United States over the past decade. There is a growing body of evidence suggesting SAs (immigrant and non-immigrant) are at higher risk for developing atherosclerotic cardiovascular disease (ASCVD). While traditional risk factors like diabetes, hypertension, tobacco use, and physical inactivity contribute to ASCVD risk among SAs, the risk remains high even after adjusting for these factors, suggesting other etiologies for this heightened risk, including atherogenic dyslipidemia, metabolic syndrome, visceral adiposity, unfavorable adipokine profile, higher lipoprotein (a), acculturation patterns, and unique dietary and psychosocial factors. The existing risk assessment tools for major adverse cardiovascular events have not been well studied in the South Asian population. The cardiovascular assessment strategies should involve using circulating biomarkers like ApoB, subclinical atherosclerosis imaging with coronary calcium scan (or carotid ultrasound), and newer tools like polygenic risk scores. Statins remain the foundation for lipid-lowering in SAs, just as in other populations. There are many knowledge gaps in risk assessment and management, and it is crucial to understand in detail the unique challenges and risk factors faced by the SA diaspora in the US to identify and manage cardiovascular disease in this population effectively.