From hidden fat and genetics to overlooked symptoms—some of the reasons why heart disease strikes earlier in South Asian communities—and how to protect yourself.

Imagine a story that feels all too familiar in current times—one that now spans generations.

A hardworking 38-year-old woman, let’s call her Priya. Her days are full: a demanding job, family responsibilities, children’s activities, and late din- ners. Some nights it’s home-cooked roti, sabzi, and dal. Other nights it’s takeout biryani, Mediterranean food, tacos, or pizza because everyone is rushing and time is tight. Mornings often begin with chai— sometimes homemade and sometimes picked up on the way to work. She does not smoke, walks when she can, and has been told her cholesterol is “borderline but manageable.”

Then, on just another regular day, without warning, Priya suffers a major heart attack.

Stories like Priya’s are becoming far too common in South Asian families across the United States, including right here in metro Atlanta and across Georgia. Many of us know someone—a cousin, a coworker, or a younger relative—who has faced heart disease in their 30s or 40s. As a cardiologist who cares for many South Asian patients and families, I hear the same painful question again and again from both parents and adult children: How could this happen so early?

Why South Asians Face Higher Heart Risk

People of South Asian descent, with roots in India, Pakistan, Bangladesh, Sri Lanka, Nepal, and neighboring regions, are known to develop coronary artery disease earlier than many other populations. Large U.S.-based studies, including the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, along with national cardiology organizations, have consistently highlighted this elevated risk.

What makes this especially concerning is that many affected individuals appear healthy. They may not be overweight and may be staying reasonably active. Yet heart disease can still progress quietly, whether their meals are home-cooked or from restaurants.

The Risk You May Not See

A common belief in our community is, “I’m slim, so my heart must be protected.”

In reality, even at normal weights, South Asians tend to accumulate more visceral fat around internal organs. This hidden fat promotes inflammation, insulin resistance, and plaque buildup in the heart’s arteries.

Common traits that are more prevalent among South Asians that increase the risk of heart attack attacks:

• Earlier onset of type 2 diabetes and stronger insulin resistance
• Lower levels of protective HDL, or “good,” cholesterol
• Higher triglycerides
• Elevated lipoprotein(a), a genetic marker linked to premature heart attacks

As a result, standard cholesterol tests do not always capture the full heart disease risk for South Asian patients.

Lifestyle Stress and Modern Realities Across Generations

Genetics matter, but in today’s world, our lifestyle often amplifies that risk.

First-generation immigrants  often juggle high-pressure careers, long    work hours, and family obligations. Younger generations face similar demands, along with frequent eating out, processed snacks, sugary drinks, late-night screen time, and irregular sleep. Across generations, exercise is often postponed and rest is sacrificed.

Symptoms are also frequently downplayed. Within South Asian families, chest pressure may often be brushed off as “gas” and treated with home remedies. Fatigue is blamed on the workload. Shortness of breath is dismissed as being out of shape. Medical care is often delayed until a serious event forces attention.

Whether meals are traditional home-cooked or restaurant favorites like butter chicken, burgers, fries, or sweetened chai, the common thread is often larger portions, hidden oils and sugars, and increasingly sedentary routines.

Healthy Resolutions for the South Asian Heart

Despite these elevated risks, South Asians respond exceptionally well to prevention. Realistic, sustainable changes—whether you cook most meals at home or eat out frequently—can significantly reduce heart disease risk.

Here are some practical steps for all age groups:

Seek Comprehensive Screening

Talk with your primary care physician or cardiologist about whether additional testing is appropriate, especially if there is a family history of early heart disease. This may include lipoprotein(a) testing, coronary calcium scoring, or a more detailed cholesterol evaluation.

Monitor Waist, Not Just Weight

For South Asians, waist size and body fat distribution often matter more than the number on the scale. Clinicians commonly advise regular physical activity and strength training.

Make Smarter Food Choices at Home and Away

At home, aim to fill half your plate with vegetables and lentils while moderating rice and roti portions. When eating out, choose baked or grilled options over fried foods, share entrees, skip sugary drinks, and add vegetables or salads when possible.

Incorporate Daily Movement

Brisk walks, yoga, or gym sessions—everything counts. Consistency matters more than intensity.

Prioritize Quality Sleep

Aim for seven or more hours of sleep. Reducing late-night screen time supports blood pressure, blood sugar control, and inflammation reduction.

Address Stress Intentionally

Prayer, meditation, brief breathing exercises, walks, or quiet moments during busy days can help manage stress that directly affects heart health.

Use Medications When Appropriate

When recommended, medications such as statins are protective tools, especially for those with genetic risk, and can prevent future complications.

A Reflection for Heart Awareness Month

February is Heart Awareness Month—a reminder for every generation that the greatest threat is often undetected heart disease. Whether you are cooking traditional meals or grabbing takeout, better screening, honest conversations with your doctor, and sustainable daily habits can protect your heart for your family, your career, and your future.

A strong family deserves a strong heart. Taking care of it is one of the most meaningful investments you can make for everyone who depends on you.

Murti Patel, MD, is board-certified in internal medicine, cardiovascular disease, echocardiography, and nuclear cardiology, with advanced expertise in noninvasive cardiology, cardiac imaging, women’s heart health, cardiovascular disease prevention, and cardio-oncology. Multilingual and fluent in Gujarati, Dr. Patel provides culturally informed, preventive, and personalized cardiac care, working closely with South Asian patients and families to support lifelong heart health.