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February 4, 2026
South Asian adults in the U.S. report doing many of the right things for heart health, yet they show significantly higher rates of prediabetes, diabetes and hypertension than white and Chinese adults, and higher than or roughly similar rates to Black and Hispanic patients, according to a new study led by Northwestern Medicine.
In a large long-term study of 2,700 adults, scientists found that participants with heritage from Bangladesh, India, Pakistan, Nepal and Sri Lanka had some of the highest prevalence of risk factors for heart disease when compared to other population groups, despite reporting healthier diets, lower alcohol use and comparable exercise habits. The study was published in the Journal of the American Heart Association.
“The mismatch between healthier lifestyle behaviors and clinical risk was surprising,” said senior author Dr. Namratha Kandula, professor of general internal medicine and epidemiology at Northwestern University Feinberg School of Medicine. “This paradox tells us we’re missing something fundamental to what is driving this elevated risk among South Asians.”
Kandula added that even though we’ve known for decades that South Asians develop heart disease younger, we didn’t have data showing exactly when risk begins.
“We’ve now identified a critical window in the 40s when risk is already high, but disease is still preventable,” she said.
The study followed 2,700 adults living in the U.S. who were between 45 and 55 years old at the start of the studies. To do so, the scientists combined data from two long-running cohort studies: MASALA, which focuses on South Asian adults and is led by Kandula, and MESA, which includes white, Black, Hispanic and Chinese adults. Kandula and her team looked at how risk factors changed over a decade, and how patterns differed by race, ethnicity and gender.
Key findings
- At age 45, South Asian men had a far higher prevalence of prediabetes (31%) than peers in other groups (white: 4%, Black: 10%, Hispanic: 10%, Chinese: 13%).
- At age 45, South Asian men had higher rates of hypertension (25%) compared to white (18%), Hispanic (10%) and Chinese men (6%) and higher rates of high cholesterol and/or triglycerides compared to Black men (South Asian men: 78% vs. Black men: 61%).
- South Asian women showed a similar pattern. By age 45, nearly one in five had prediabetes (about 18%) — roughly twice the rate seen of white, Black, Hispanic and Chinese women.
- By age 55, both South Asian men and women were at least twice as likely to develop diabetes as white adults.
- South Asian men and women reported healthier diets, lower alcohol use, comparable physical activity and lower average BMI than most other groups.
Clues to understand the paradox
Kandula said the findings point to potential risk factors among South Asians that begin well before midlife. She noted that most MASALA participants are immigrants whose childhood and early adulthood environments may differ from current self-report.
“Early life nutrition, environment, stressors and activity patterns in childhood may increase cardiometabolic risks that show up by age 45,” Kandula said.
Prior data from MASALA show that South Asians have more fat around their organs than other population groups, even at a normal or low BMI. Other studies show that this fat pattern starts in childhood among South Asians and is an important risk factor for heart disease.
Globally, South Asians bear a disproportionate burden of heart disease. Although they make up about one-quarter of the world’s population, they account for roughly 60% of heart disease patients worldwide. In the U.S., where they are among the fastest growing demographic group, they develop atherosclerosis, which can lead to heart attacks, up to a decade earlier than the general population on average.
Perspective from a MASALA patient
Chandrika Gopal, 58, of Ohio, said taking part in MASALA has been a turning point in how she thinks about her own heart health as a South Asian woman. Born and raised in southern India, Gopal said that for generations, women in her family put everyone else first. “This study is very close to my heart,” she said.
After immigrating to North America in her early 20s, Gopal said the early years were challenging. She joined the MASALA study in her late 40s while living in suburban Chicago, encouraged by a friend. Participation has meant regular heart checkups every couple of years with Kandula, including cholesterol testing, EKGs and treadmill exams. Gopal said Kandula has been a consistent advocate and resource. “When we see other doctors, they don’t have time to explain the numbers,” she said. “Dr. Kandula always took the time, and she’s always there if I have questions.”
Since joining the study, Gopal said she has become more intentional about exercise, sleep and diet, and is transitioning to a vegan diet. “It’s so crucial to understand our heart health if we want to grow old gracefully,” she said. “Even if we eat well, we can still be at higher risk. Living in a new country, adapting to different food and routines, it all adds up.”
Clinical implications
Kandula said the findings support earlier and more proactive screening for South Asian adults. “Clinicians should start looking for high blood sugar, high blood pressure and other risk-enhancing factors, such as lipoprotein A, before midlife,” she said. Doctors should also provide “culturally appropriate lifestyle counseling to help South Asians eat healthy, exercise regularly and minimize tobacco and alcohol.”
As for patients of South Asian background, “Even if you eat well and exercise, you may still be at higher risk for diabetes and high blood pressure at younger ages. Ask your doctor about early screening — and get your blood pressure, fasting glucose (or A1c), cholesterol and lipoprotein (A) checked before middle age because early detection, treatment and control of these risk factors can prevent heart disease.”
Notes
Additional Northwestern Medicine co-authors of the study include Havisha Pedamallu, Zeynab Aghabazaz, Nicola Lancki, Juned Siddique, Meena Moorthy, Dr. Nilay Shah and Norrina Allen.
The MESA study was supported by the National Institutes of Health. The MASALA study was supported by the National Institutes of Health and through the UCSF-CTSI.
