If you are South Asian, you have probably heard that heart disease runs higher in our communities. What you may not have heard is how early it starts.
A study published in February 2026 in the Journal of the American Heart Association found that South Asian adults in the United States are developing the conditions that lead to heart disease by their mid-forties — years before most people are told to start worrying, and years before most doctors start screening.
What the study found
Researchers analyzed health data from 2,700 adults aged 45 to 55, drawing from two long-running national studies: the MASALA study, which follows South Asian adults tracing ancestry to Bangladesh, India, Nepal, Pakistan and Sri Lanka, and the MESA study, which follows white, Black, Hispanic and Chinese adults.
The numbers are striking.
At age 45, South Asian men had a prediabetes rate of 30.7 percent. Among white men the same age, it was 3.9 percent. Chinese men, 12.6 percent. Black men, 10.4 percent. Hispanic men, 10.5 percent.
That is nearly eight times the rate of their white peers, at an age when most people assume they have decades before this becomes a concern.
South Asian women showed the same pattern. Prediabetes at age 45 was 17.6 percent, compared with 5.7 percent in white women, 8.2 percent in Chinese women, 9.0 percent in Black women and 5.1 percent in Hispanic women.
South Asian men also had higher rates of high blood pressure — 25.5 percent, versus 18.4 percent in white men, 6.6 percent in Chinese men and 10.1 percent in Hispanic men. And 78.2 percent had high cholesterol or triglycerides, compared with 60.6 percent of Black men.
By age 55, both South Asian men and women were at least twice as likely to have developed type 2 diabetes as white adults of the same age.
The part that surprises people
Here is what makes this study genuinely important rather than simply confirming what we suspected.
The South Asian participants had the best quality diets of any group in the study. They drank less alcohol. Their exercise levels were comparable to everyone else's.
They were doing the things people are told to do. And they still developed risk factors earlier.
This matters because it changes the conversation. If you are South Asian and you have been told your numbers are creeping up because you should eat better and move more — and you already do both — that advice was never going to be enough on its own. Something else is happening.
Researchers believe it involves how South Asians store body fat, particularly visceral fat around the organs, and how insulin resistance develops at lower body weights than in other populations. A person can have a completely normal BMI and still be carrying metabolic risk that a standard screening would miss entirely.
Why standard screening misses this
Most primary care follows population-level guidelines. Screen for diabetes at a certain age, or at a certain BMI. Check cholesterol on a standard interval. Those thresholds were built largely on data from populations that do not carry this risk profile.
The American Heart Association addressed this in a 2023 scientific statement, noting that South Asian adults face disproportionately high risk for atherosclerotic cardiovascular disease and that culture, diet and economic factors all shape that risk in ways one-size-fits-all assessment misses.
Dr. Namratha Kandula, the study's senior author and a co-founder of MASALA, put the takeaway plainly: South Asian adults should maintain a healthy lifestyle and get screened sooner — checking blood pressure, glucose and A1c, and cholesterol in early adulthood rather than waiting for symptoms.
“Early adulthood. Not fifty.”
What to actually do
Get an A1c, not just a fasting glucose. A fasting sugar can look normal while an A1c is already telling a different story. Ask for both.
Know your lipid panel in full. Total cholesterol and LDL are not the whole picture. Triglycerides and HDL matter, and in South Asian patients a discussion about lipoprotein(a) — an inherited risk factor not included in standard panels — is often worth having.
Do not rely on BMI. Waist circumference is more informative for metabolic risk in South Asian adults, and the thresholds are lower than the standard cutoffs most people know.
Start in your thirties. If your parents or siblings have diabetes or heart disease, earlier still.
Ask specifically. If your doctor has ten minutes, they are working from a checklist built for the average patient. You may need to say directly: I am South Asian, I know my risk is different, what should we be checking?
Why I write about this
I am a family physician in Hillsborough, and a significant number of the families in this area are South Asian. This is not an abstract statistic here — it is the person sitting across from me whose father had a heart attack at fifty-two, who eats well, walks daily, and whose A1c has been quietly climbing for three years without anyone telling them.
Catching that requires two things. It requires knowing to look. And it requires enough time in the room to explain what the numbers mean and build an actual plan rather than saying "we'll recheck in a year."
The second one is the harder problem in most practices, and it is the reason I built mine differently. At Rawq Medicine, visits run thirty to sixty minutes and insurance doesn’t dictate what labs I can order for you — which means that we have time to discuss your full health picture, and insurance isn’t trying to be your doctor.
Risk you know about is manageable. Risk nobody screened for is the one that shows up at fifty-two.
Sources
Primary study — Pedamallu H, Aghabazaz Z, Lancki N, Rodriguez LA, Siddique J, Moorthy M, Shah NS, Allen NB, Kanaya AM, Kandula NR. "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." Journal of the American Heart Association, published online February 11, 2026. DOI: 10.1161/JAHA.124.041221 (open access)
AHA press release with full data breakdown — newsroom.heart.org, February 11, 2026
AHA 2023 Scientific Statement on cardiovascular risk among Asian Americans — DOI: 10.1161/CIR.0000000000001145
AHA/ACC 2025 Hypertension Guideline — DOI: 10.1161/CIR.0000000000001356
Study limitations worth knowing: self-reported behavior data, participants skewed toward higher socioeconomic status, and a decade gap between the MASALA and MESA baseline exams.
Nada Farooqui, M.D.
Dr. Nada Farooqui, MD
Board Certified Family Medicine · Rawq Medicine, Hillsborough NJ. A Direct Primary Care practice — a flat monthly fee, no insurance in between, and time enough to explain things properly.