Health Risks
Metabolic syndrome is the combination of the following conditions:
- High blood pressure
- High blood sugar (glucose intolerance), as defined by a fasting blood sugar of >=100 mg/dl
- Low level of high density lipoprotein (HDL) cholesterol, which is the “good” cholesterol
- High level of triglycerides, which is the most common type of fat in the body
- Large waist circumference (“apple shaped” body), defined as >=90 cm in male South Asians and >=80 cm in female South Asians (as compared to a cutoff of 94/ 80 cm for non-South Asians). Though most people use BMI as a way to measure body fat, it is not a good indicator of risk of heart disease, especially for South Asians. BMI does not take into account the different patterns in which fat can deposit in the body. In fact, a high Waist Hip Ratio (WHR) is more related to high risk of heart disease in South Asians. Holding more weight in the abdomen can be a sign of metabolic syndrome and indicate a higher risk of heart disease.
South Asians have a higher risk of metabolic syndrome than other racial/ ethnic groups. Metabolic syndrome is strongly associated with risk of cardiovascular disease. Prevention and treatment requires a combination of lifestyle modifications and medical therapy.
Hypertension is any blood pressure above 130/80 mmHg. Even blood pressures with a systolic blood pressure (the number on top) of 120 – 129 are considered elevated. In the United States, hypertension is one of the most common risk factors for heart disease in South Asian populations, becoming more and more common at younger ages.
Prediabetes indicates blood sugars that are higher than normal, but not yet high enough to be classified as diabetes. However, even prediabetes means a higher risk for heart disease, stroke and type 2 diabetes. Glycated hemoglobin, or HbAlc, levels measure an average of blood glucose levels over the preceding 3 months. An HbAlc level of 5.7% or more is a diagnosis of prediabetes and a HbAlc of 6.5% or more is a diagnosis of diabetes. A fasting blood sugar level of 100 or more is considered in a pre-diabetes range and a fasting blood sugar of over 125 is considered in the diabetes range.
Not everyone with prediabetes will develop diabetes. Prediabetes and even diabetes can be reversed with lifestyle modifications like diet changes and exercising more.
South Asians living in the United States have higher levels of triglycerides, total cholesterol, LDL (bad cholesterol) and lower levels of HDL (good cholesterol) than their counterparts in their native countries. Though it is not clear why this is, it could be related to lifestyle variations and higher rates of insulin resistance.
Ideally, for South Asians, the LDL level (bad cholesterol) should be <100 mg/dL in high-risk patients and <70 mg/dL for very high-risk patients.
Sometimes, additional testing, such as a lipoprotein (a) level and/ or an apolipoprotein B level may be helpful to better understand your risk of future heart attack and stroke. These cholesterol levels are higher in South Asians, though there are not yet specific treatments to target these potentially higher values.
Smokeless tobacco (like paan and gutkha) has been linked to higher rates of oral cancers, strokes, and fatal heart attacks. Techniques and resources for quitting smoking can also be used to help with quitting smokeless tobacco products.
Family history of heart disease means a close relative (mother, father, sibling, grandparent, aunt, uncle, nephew, niece, or child) has had a heart attack or heart failure at an early age (usually considered to be before 55 for men and before 65 for women).
Talk to a doctor about whether a coronary artery calcium (CAC) score may be helpful to better understand the risk of heart disease. A CAC score is a non-contrast computed tomography (CT) scan, which involves administration of x-ray radiation to identify the presence of calcified plaque in the arteries of the heart. A CAC score is calculated and compared to those of the same gender and age.