An American Society for Preventive Cardiology clinical statement urges earlier screening, better tools, and community‑tailored care for South Asians in the U.S. and Canada.  

A new clinical practice statement led by cardiologist Anand Rohatgi, MD, pulls together what doctors and communities can do—right now—to curb the outsized burden of heart and metabolic disease in people of South Asian ancestry (Indian, Pakistani, Bangladeshi, Sri Lankan, Nepali, Bhutanese, and Maldivian). The guidance, published in the American Journal of Preventive Cardiology, calls for earlier screening, smarter risk tools, and culturally informed care across the lifespan.  

Why this matters

• Large population studies show South Asians have nearly twice the risk of coronary artery disease compared with people of European ancestry—and about half of the excess risk persists even after accounting for cholesterol, diabetes, blood pressure, and lifestyle. South Asians are also under‑represented in genetic and clinical studies, limiting precision guidance.  
• Common risk calculators can underestimate risk in South Asians; the statement recommends using imaging and additional markers to avoid missed diagnoses.  

What’s new in the guidance

1) Screen earlier—and differently.

The authors recommend a lower bar for testing, including diabetes and metabolic‑risk screening at BMI ≥20 (not ≥25), routine waist circumference or waist‑to‑height ratio, and tools that can track muscle and fat changes over time. (See Figure 6 on p. 11 for a visual checklist.)  

2) Don’t rely on calculators alone.

Because pooled risk scores can miss high‑risk South Asian adults, doctors are urged to use coronary artery calcium (CAC) scans to refine decisions on statins and other therapies, and to consider non‑calcified plaque in younger people where CAC may be limited.  

3) Use a step‑by‑step pathway.

A clinical decision pathway (Figure 10, p. 14) shows how CAC “0–99–300+” categories, plus risk enhancers—family history of premature heart disease, lipoprotein(a) ≥50 mg/dL, triglycerides ≥175 mg/dL, gestational diabetes, inflammatory diseases—should guide intensity of treatment.  

4) Look beyond the heart: pregnancy and mental health count.

The statement links adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, pre‑term birth) to later cardiovascular risk and offers an action map across pre‑conception, pregnancy, and postpartum (see Figure 7, p. 11). It also outlines a framework for South Asian mental health that connects primary care, specialty clinics, community programs, and research.  

5) Partner with communities.

A practical table on community engagement (p. 22) calls for language‑concordant care, training clinicians in cultural humility (including traditional health beliefs), and teaming with faith‑based and community organizations to improve screening and follow‑up.  

What this means for you (or your readers)

• Know your numbers early. Ask your clinician about cholesterol, blood pressure, blood sugar, waist size, and—if you’re South Asian—whether your personal risk justifies CAC scanning even if a calculator says “low risk.”  
• Ask about risk enhancers. Family history, lipoprotein(a), pregnancy‑related conditions, and inflammatory illnesses can change treatment targets.  
• Watch weight quality, not just weight. The statement highlights body‑fat pattern and muscle mass as key—aim for regular physical activity and dietary patterns that maintain muscle and reduce visceral fat.  
• Support matters. Seek culturally and linguistically matched care when possible; community programs can boost health literacy and follow‑through on tests and medicines.  

The bottom line

This expert roadmap recognizes that one‑size‑fits‑all prevention leaves South Asian communities behind. By lowering screening thresholds, using CAC and risk enhancers, addressing pregnancy and mental health, and partnering with communities, clinicians can catch disease earlier and save lives.    

Source: Rohatgi A, et al. “South Asians and cardiometabolic health: A framework for comprehensive care…” American Journal of Preventive Cardiology (2025). Figures referenced above appear on pp. 11 and 14, and the community engagement table on p. 22.  

Editor’s note: This article is for information only and is not a substitute for professional medical advice.