South Asian background and heart health

Your ethnic origin can increase your risk of heart and circulatory disease and diabetes. Dr Sandy Gupta, consultant cardiologist at Whipps Cross and Barts Health NHS Trust, explains to senior cardiac nurse Christopher Allen.

Does South Asian background affect heart risk?

We’ve known for more than 50 years that the risk of coronary heart disease (CHD) is up to 50 per cent higher in first-generation South Asians than in the white European population in the UK. The sad thing is, it’s still a problem, despite us knowing this for so long.

What do we mean by South Asian background?

We’re talking about people of the Indian subcontinent (India, Pakistan, Bangladesh and Sri Lanka) living in the UK. Even within the South Asian group, there are differences in risk. Those at highest risk are the Bangladeshi population, followed by Pakistanis, Indians and Sri Lankans – but even Sri Lankans may be at higher risk than white Caucasians.

What is the reason for this increase in risk?

It is partly to do with body shape and diabetes. South Asians mainly develop central obesity (fat around the middle). Extra fat, particularly on the middle, increases insulin resistance (meaning you must produce more insulin to stabilise blood sugar, among other processes) and therefore risk of developing type 2 diabetes. For this reason, the waist circumference indicating increased risk is lower for a South Asian person than a white European.

Diabetes increases your risk of CHD and of having a heart attack. It is also linked to high levels of triglycerides and low levels of HDL (‘good’) cholesterol.

South Asians are diagnosed with type 2 diabetes at a much younger age, and at higher rates (rates are at least twice as high in South Asian communities as in the general population). It’s often a silent condition, so a diagnosis may come years after onset, when blood glucose levels have been unstable for some time and have already caused harm to the body.

Lifestyle factors may play a role, but part of it is genetic. A school playground study showed that children of South Asian background aged 10–14 had early markers of insulin resistance – a precursor to type 2 diabetes. Environmental factors such as a poor diet or smoking increase this genetic risk.

Does a traditional South Asian diet increase risk?

The components of a South Asian diet are healthy, such as lentils, vegetables and oily fish. But traditionally, many foods are fried. This means they’re higher in energy [calories], which can contribute to weight gain.

Traditional fats such as ghee are high in saturated fat, which is linked to raised LDL cholesterol levels. Salt is also a big issue and, over time, a high-salt diet
is associated with high blood pressure.

Some typically South Asian snacks, such as samosas (made with deep-fried pastry), are very unhealthy. In South Asian culture, there are often large gatherings and family functions, where exposure to these foods is frequent and it’s easy to graze and not realise how many calories you’re eating. Culturally, it may also be seen as rude to turn down food someone has prepared for you.

It’s important, however, not to ‘ban’ any foods. Recognise what is a ‘luxury’ item that should be eaten rarely, and what is a healthy item that can be enjoyed regularly. Dietary changes shouldn’t be viewed as a punishment, but be conscious of portion sizes and preparation methods.

Meet the expert: Dr Sandy Gupta

Dr Sandy Gupta is a Consultant Cardiologist at Whipps Cross and St Bartholomew’s Hospital. Dr Gupta was awarded a BHF research fellowship to explore the relationship between inflammation and heart disease.