South Asians and cardiometabolic health: A framework for comprehensive care for the individual, community, and population - An American society for preventive cardiology clinical practice statement

doi:10.1016/j.ajpc.2025.101000

. 2025 Apr 22:22:101000.

doi: 10.1016/j.ajpc.2025.101000. eCollection 2025 Jun.

South Asians and cardiometabolic health: A framework for comprehensive care for the individual, community, and population - An American society for preventive cardiology clinical practice statement

Anand Rohatgi¹, Sonia S Anand², Meghana Gadgil³, Unjali P Gujral⁴, Sneha S Jain⁵, Zulqarnain Javed^{6

7}, Manish Jha⁸, Parag H Joshi¹, Venkat Sanjay Manubolu⁹, Khurram Nasir¹⁰, Pradeep Natarajan^{11

12

13}, Neha Pagidipati¹⁴, Latha Palaniappan¹⁵, Aniruddh P Patel^{11

12

13}, Priyanka Satish¹⁶, Nilay S Shah¹⁷, Garima Sharma¹⁸, Madhukar H Trivedi⁸, Salim S Virani¹⁹, Martha Gulati²⁰, Jaideep Patel²¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
² Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario Canada.
³ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Hubert Department of Global Health, Rollins School of Public Health, Atlanta, Georgia.
⁵ Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA.
⁶ Division of Cardiology, Department of Preventive Cardiology, Houston Methodist Hospital, Houston, TX, USA.
⁷ New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.
⁸ Center for Depression Research and Clinical Care, Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Division of Cardiology, Department of Internal Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA.
¹⁰ Center for Cardiovascular Computational Health and Precision Medicine (C3PH), Department of Cardiology, Houston Methodist Research Institute, Houston, TX, USA.
¹¹ Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹² Harvard Medical School, Boston, MA, USA.
¹³ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁴ Duke Clinical Research Institute, Durham, North Carolina, USA.
¹⁵ Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
¹⁶ Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
¹⁷ Department of Medicine (Cardiology) and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁸ 1-Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA. 2- Division of Cardiology, Northwestern University, Chicago, IL, USA.
¹⁹ The Aga Khan University, Karachi, Pakistan.
²⁰ Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA and the Baim Institute for Clinical Research, Boston, MA, USA.
²¹ South Asian Cardiovascular Health Initiative, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore MD.

PMID: 40475260
PMCID: PMC12139456
DOI: 10.1016/j.ajpc.2025.101000

South Asians and cardiometabolic health: A framework for comprehensive care for the individual, community, and population - An American society for preventive cardiology clinical practice statement

Anand Rohatgi et al. Am J Prev Cardiol. 2025.

. 2025 Apr 22:22:101000.

doi: 10.1016/j.ajpc.2025.101000. eCollection 2025 Jun.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
² Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario Canada.
³ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Hubert Department of Global Health, Rollins School of Public Health, Atlanta, Georgia.
⁵ Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA.
⁶ Division of Cardiology, Department of Preventive Cardiology, Houston Methodist Hospital, Houston, TX, USA.
⁷ New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.
⁸ Center for Depression Research and Clinical Care, Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Division of Cardiology, Department of Internal Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA.
¹⁰ Center for Cardiovascular Computational Health and Precision Medicine (C3PH), Department of Cardiology, Houston Methodist Research Institute, Houston, TX, USA.
¹¹ Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹² Harvard Medical School, Boston, MA, USA.
¹³ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁴ Duke Clinical Research Institute, Durham, North Carolina, USA.
¹⁵ Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
¹⁶ Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
¹⁷ Department of Medicine (Cardiology) and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁸ 1-Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA. 2- Division of Cardiology, Northwestern University, Chicago, IL, USA.
¹⁹ The Aga Khan University, Karachi, Pakistan.
²⁰ Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA and the Baim Institute for Clinical Research, Boston, MA, USA.
²¹ South Asian Cardiovascular Health Initiative, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore MD.

PMID: 40475260
PMCID: PMC12139456
DOI: 10.1016/j.ajpc.2025.101000

Abstract

South Asians (SAs) represent an increasing proportion of North American populations and demonstrate excess cardiometabolic risk. Multiple factors likely contribute; however, much is not yet known about what leads to this excess risk. Diet composition, physical activity, and mental health are important lifestyle contributors. Specific adverse pregnancy outcomes are higher in SA women and represent an early opportunity for intervention. More broadly, comprehensive assessments of adiposity, diabetes, hypertension, dyslipidemia, coronary atherosclerosis via imaging, and genetic risk may improve detection and awareness among SAs and those treating SAs. At an individual level, culturally tailored preventive clinics may foster awareness and detection, leading to improved prevention and management of cardiometabolic risk. At a community and population level, assessments of the impact of social determinants, acculturation, and the environment may lead to broader initiatives to improve health in SAs. Lastly, supporting expanded investigation, policy, and other health and science measures at an institutional and societal level may lead to broad but impactful changes across the North American diaspora. In this clinical practice statement, we aim to provide a roadmap of the path forward in each of these domains for health care providers and health systems, community outreach groups, and stakeholders invested in investigation and policy to mitigate risk and empower SAs to lead healthy lives.

Keywords: Cardiometabolic; Coronary; Diabetes; Ethnic; Lifestyle; Prevention; Social determinants of health; South Asian.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anand Rohatgi reports a relationship with Johnson & Johnson Services Inc that includes: speaking and lecture fees. Anand Rohatgi reports a relationship with Raydel Australia Pty Ltd that includes: consulting or advisory. Anand Rohatgi reports a relationship with CSL Behring LLC that includes: funding grants. Anand Rohatgi reports a relationship with Quest Diagnostics Inc that includes: non-financial support. Anand Rohatgi reports a relationship with SANSAR that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1 — **Fig. 1**
Healthful SA Plates. Panel A lists serving sizes of South Asian (SA) foods in categories with suggestions to increase, moderate or typical intake. Panel B depicts two healthy SA Meals, one vegetarian and the other non-vegetarian, and a subset of important nutrition facts, including protein, types of fat and fiber intake. Images generated using Bing AI. ^a Quantities described within parentheses represent the equivalent of one serving ^b 3 oz poultry is about as thick as a deck of cards ^c The individual columns represent examples of food groups and do not add up to a complete meal. Portion sizes adapted from U.S. Department of Agriculture. “What Is MyPlate? .” *Www.myplate.gov*, U.S. Department of Agriculture, 2024, www.myplate.gov/eat-healthy/what-is-myplate.

Fig 2 — **Fig. 2**
Addressing Physical Activity Levels in South Asians.

Fig 3 — **Fig. 3**
Key takeaways relevant to awareness, diagnosis and management of T2D in SA populations.

Fig 4 — **Fig. 4**
Addressing Gaps in Hypertension in South Asians.

Fig 5 — **Fig. 5**
Addressing Hyperlipidemia in South Asians.

Fig 6 — **Fig. 6**
Addressing Gaps in Adiposity Assessments in South Asians.

Fig 7 — **Fig. 7**
Challenges and Opportunities in Addressing Adverse Pregnancy Outcomes in Pregnancy Capable Individuals.

Fig 8: — **Fig. 8**
Framework for South Asian Mental Healthcare. The proposed framework for improving mental health literacy, clinical research, and connecting SA patients to mental healthcare. TRAD – Texas Resilience Against Depression; SHAKTI - Studying the Health of Asians to Advance Knowledge, Treatments, and Interventions for Depression.

Fig 9 — **Fig. 9**
Coronary artery calcium from non- contrast CT scan and Coronary CT angiography depicting semiquantitative and quantitative analysis. 1. Coronary calcium score 2. Semiquantitative analysis (depicting high risk plaque features): A- Positive remodeling; B- Napkin-ring sign; C- Spotty calcification; d-Low attenuation Plaque 3. Quantitative plaque analysis.

Fig 10 — **Fig. 10**
Clinical ision Pathway for CAD Risk Stratification in SAs. CAC: Coronary artery calcium; CCTA: Coronary computed tomography angiography; FFR: Fractional flow reserve; LLT: Lipid lowering therapy; RA: Rheumatoid arthritis.

Fig 11 — **Fig. 11**
The Needs and Potential for Genetic Testing in SAs.

Fig 12 — **Fig. 12**
Social Determinants of Health, Public Health and Community Advocacy.

Fig 13 — **Fig. 13**
Key Elements to Consider when Designing a South Asian Cardiometabolic Prevention Clinic.

Fig 14 — **Fig. 14**
Community Engagement Strategies and Key Stakeholders for Research in the SA Population.

See this image and copyright information in PMC

References

1. Agarwala A., et al. Identification and management of atherosclerotic cardiovascular disease risk in South Asian populations in the U.S. JACC Adv. 2023;2(2) doi: 10.1016/j.jacadv.2023.100258. - DOI - PMC - PubMed
1. Volgman A.S., et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–e34. doi: 10.1161/CIR.0000000000000580. - DOI - PubMed
1. Kandula N.R., Tirodkar M.A., Lauderdale D.S., Khurana N.R., Makoul G., Baker D.W. Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians. Am J Prev Med. 2010;38(4):439–442. doi: 10.1016/j.amepre.2009.12.034. - DOI - PMC - PubMed
1. Dhar M., et al. South Asian Working Action Group on SARCOpenia (SWAG-SARCO) - A consensus document. Osteoporos Sarcopenia. 2022;8(2):35–57. doi: 10.1016/j.afos.2022.04.001. - DOI - PMC - PubMed
1. Eastwood S.V., et al. Thigh fat and muscle each contribute to excess cardiometabolic risk in South Asians, independent of visceral adipose tissue. Obesity (Silver Spring) 2014;22(9):2071–2079. doi: 10.1002/oby.20796. - DOI - PMC - PubMed

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[1] Agarwala A., et al. Identification and management of atherosclerotic cardiovascular disease risk in South Asian populations in the U.S. JACC Adv. 2023;2(2) doi: 10.1016/j.jacadv.2023.100258. - DOI - PMC - PubMed

[2] Agarwala A., et al. Identification and management of atherosclerotic cardiovascular disease risk in South Asian populations in the U.S. JACC Adv. 2023;2(2) doi: 10.1016/j.jacadv.2023.100258. - DOI - PMC - PubMed

[3] Volgman A.S., et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–e34. doi: 10.1161/CIR.0000000000000580. - DOI - PubMed

[4] Volgman A.S., et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–e34. doi: 10.1161/CIR.0000000000000580. - DOI - PubMed

[5] Kandula N.R., Tirodkar M.A., Lauderdale D.S., Khurana N.R., Makoul G., Baker D.W. Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians. Am J Prev Med. 2010;38(4):439–442. doi: 10.1016/j.amepre.2009.12.034. - DOI - PMC - PubMed

[6] Kandula N.R., Tirodkar M.A., Lauderdale D.S., Khurana N.R., Makoul G., Baker D.W. Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians. Am J Prev Med. 2010;38(4):439–442. doi: 10.1016/j.amepre.2009.12.034. - DOI - PMC - PubMed

[7] Dhar M., et al. South Asian Working Action Group on SARCOpenia (SWAG-SARCO) - A consensus document. Osteoporos Sarcopenia. 2022;8(2):35–57. doi: 10.1016/j.afos.2022.04.001. - DOI - PMC - PubMed

[8] Dhar M., et al. South Asian Working Action Group on SARCOpenia (SWAG-SARCO) - A consensus document. Osteoporos Sarcopenia. 2022;8(2):35–57. doi: 10.1016/j.afos.2022.04.001. - DOI - PMC - PubMed

[9] Eastwood S.V., et al. Thigh fat and muscle each contribute to excess cardiometabolic risk in South Asians, independent of visceral adipose tissue. Obesity (Silver Spring) 2014;22(9):2071–2079. doi: 10.1002/oby.20796. - DOI - PMC - PubMed

[10] Eastwood S.V., et al. Thigh fat and muscle each contribute to excess cardiometabolic risk in South Asians, independent of visceral adipose tissue. Obesity (Silver Spring) 2014;22(9):2071–2079. doi: 10.1002/oby.20796. - DOI - PMC - PubMed

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South Asians and cardiometabolic health: A framework for comprehensive care for the individual, community, and population - An American society for preventive cardiology clinical practice statement

Affiliations

South Asians and cardiometabolic health: A framework for comprehensive care for the individual, community, and population - An American society for preventive cardiology clinical practice statement

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

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