The silent killer in South Asian families
South Asians have their first heart attacks years earlier than most other groups, often with no warning. Most of that risk can be found early, and much of it can be treated. Learn the signs, know your numbers, and find help.
of the world’s population, about 1.8 billion people, is South Asian.1
earlier: first heart attacks at an average age of 53.0, vs. 58.8 elsewhere.2
the risk of heart disease from clogged arteries, compared with White Europeans in the UK Biobank.1
diabetes in South Asian vs. White Americans, after accounting for age.3
Why “The Silent Killer Project”
The name reflects one of the most concerning features of cardiovascular disease in South Asian communities: risk can develop quietly for years, often before noticeable symptoms appear. For some individuals, a heart attack or other cardiovascular event may be the first indication that significant disease is already present.
For me, this issue is also personal. I lost both of my grandfathers to heart attacks, one in his late fifties and the other in his early sixties. Their deaths made me wonder how many cardiovascular events might be prevented if people understood their risk earlier and knew when to seek screening.
My experiences in cardiovascular research, clinical observation and emergency medical training strengthened my interest in this issue and led me to create The Silent Killer Project.
Through this project, I hope to make information about cardiovascular risk in South Asian communities clear and accessible, encourage families to talk about heart health earlier, and emphasize prevention before the first warning sign becomes an emergency.
James A. Umapathi · About James
The risk starts earlier and hides better
The American Heart Association says most of the extra risk in South Asians comes from known risk factors, especially those tied to insulin resistance.4 These factors show up younger and at lower body weight, so they are easy to miss.
Diabetes at a lower weight
BMI 23.9South Asians reach the same diabetes risk at a BMI of 23.9 that White adults reach at 30.5 For Asian Americans, diabetes testing is advised from a BMI of 23, not 25.6
Belly fat, even when slim
“Thin-fat”Fat around the abdomen and organs drives insulin resistance, even at a normal weight. Abdominal obesity in South Asians is often under-recognized.19
A harmful lipid pattern
TG ↑ · HDL ↓High triglycerides and low HDL (“good”) cholesterol are common.4 U.S. guidelines list South Asian ancestry as a risk-enhancing factor for heart disease.8
High lipoprotein(a)
31 vs 19Median Lp(a), in nmol/L, among South Asian vs. White participants in the UK Biobank.7 Lp(a) is set by genes, doesn’t show up on a routine cholesterol test, and needs to be checked only once.
High blood pressure
130/80Stage 1 high blood pressure starts at 130/80.13 It is common in South Asians and often undertreated.19
Family history
<55 · <65Heart disease in a father or brother before 55, or a mother or sister before 65, raises your own risk. Tell your doctor.
Know the signs. Minutes matter.
Heart attacks and strokes are emergencies. Fast treatment saves heart and brain tissue, and lives.
Heart attack
- Chest discomfort: pressure, squeezing, fullness or pain that lasts more than a few minutes or comes and goes
- Discomfort elsewhere: one or both arms, the back, neck, jaw or stomach
- Shortness of breath, with or without chest discomfort
- Other signs: cold sweat, nausea or lightheadedness
Women, older adults and people with diabetes are more likely to have subtle symptoms such as shortness of breath, nausea, back or jaw pain, or unusual tiredness.17
Stroke: BE FAST
- BBalance: sudden loss of balance or coordination
- EEyes: sudden trouble seeing
- FFace: one side of the face droops
- AArms: one arm is weak or numb
- SSpeech: slurred or strange speech
- TTime: call 911 right away
Paramedics can start treatment on the way and send an ECG ahead, so the hospital team is ready when you arrive.
Eight things to know before your next checkup
Tick off each number you already know. Then copy the list and bring it to your next doctor’s visit. Your answers stay in your own browser.
This list is for education, not diagnosis. Your doctor will decide which tests are right for you and when.
Small changes, started early
The American Heart Association measures heart health with eight factors, called Life’s Essential 8.15 Here they are, with tips for South Asian kitchens and routines.
Eat better
Cut back on white rice, maida, sweets and fried snacks. Fill half the plate with vegetables, and choose dal, beans and whole grains.
Move more
Aim for at least 150 minutes a week of brisk walking or similar activity, plus strength exercises twice a week.16
Quit tobacco
Avoid every form, including cigarettes, vaping and smokeless tobacco such as paan with tobacco and gutka.
Sleep well
Most adults need 7–9 hours a night. Poor sleep raises blood pressure and blood sugar.15
Watch the waist
Keep track of your waist size as well as your weight. South Asian cut-offs are lower.
Control cholesterol
Know your LDL and Lp(a). If your doctor recommends a statin, it is one of the best-proven ways to prevent heart attacks.
Manage blood sugar
Catch prediabetes early. Lifestyle programs can prevent or delay type 2 diabetes.
Manage blood pressure
Check it at home and at the doctor’s office. Less salt, more activity and medicine when needed.
Resources for South Asians and anyone seeking help
Free risk checks, South Asian heart programs, low-cost care and support. All links open the official site in a new tab.
Urgent
Check your risk in a few minutes
South Asian heart programs
Clinics and programs in the U.S. that focus on heart risk in South Asians. Check each program for cost, insurance and whether it offers virtual visits.
Preventive cardiology near Washington, DC and Baltimore
Find affordable care and coverage
Quit tobacco
Learn more
Listing a program or website does not mean endorsement, and this site is not affiliated with any of them. Phone numbers, fees and eligibility can change, so check with each program directly.
What the evidence shows
- 53.0 vs 58.8Average age at first heart attack, South Asian countries vs. elsewhere (INTERHEART, 52 countries).2
- HR 2.03Risk of heart disease from clogged arteries in South Asian vs. White UK Biobank participants. It was still 1.45 after adjusting for known risk factors.1
- 23%Diabetes among South Asian Americans in MASALA, the highest of any group compared.3
- >45%Share of new heart attacks that were silent, never recognized when they happened (ARIC study).11
Diabetes and the heart’s rhythm
Diabetes harms the heart in more than one way. It clogs arteries, weakens heart muscle, and raises the risk of atrial fibrillation, an irregular heartbeat that can cause stroke. At the Johns Hopkins University School of Medicine, the laboratory of Dr. Olurotimi Mesubi studies how diabetes leads to atrial fibrillation. The lab and its collaborators found that, in diabetic mice, oxidative stress switches on an enzyme called CaMKII and makes heart cells leak calcium between beats. A sugar-driven protein change, O-GlcNAcylation, also promoted atrial fibrillation through a separate pathway.18
Research like this helps explain why diabetes, so common in South Asian families, is so dangerous for the heart.
References (19)
- Patel AP, Wang M, Kartoun U, Ng K, Khera AV. Quantifying and understanding the higher risk of atherosclerotic cardiovascular disease among South Asian individuals: results from the UK Biobank prospective cohort study. Circulation. 2021;144(6):410-422. doi:10.1161/CIRCULATIONAHA.120.052430
- Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286-294. doi:10.1001/jama.297.3.286
- Kanaya AM, Herrington D, Vittinghoff E, et al. Understanding the high prevalence of diabetes in U.S. South Asians compared with four racial/ethnic groups: the MASALA and MESA studies. Diabetes Care. 2014;37(6):1621-1628. doi:10.2337/dc13-2656
- Volgman AS, Palaniappan LS, Aggarwal NT, 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
- Caleyachetty R, Barber TM, Mohammed NI, et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2021;9(7):419-426. doi:10.1016/S2213-8587(21)00088-7
- American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S20-S42. doi:10.2337/dc24-S002; and ADA, Diagnosis. diabetes.org
- Patel AP, Wang M, Pirruccello JP, et al. Lp(a) (lipoprotein[a]) concentrations and incident atherosclerotic cardiovascular disease: new insights from a large national biobank. Arterioscler Thromb Vasc Biol. 2021;41(1):465-474. doi:10.1161/ATVBAHA.120.315291
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625
- Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-3946. doi:10.1093/eurheartj/ehac361
- Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. 2024. doi:10.1016/j.jacl.2024.03.001
- Zhang ZM, Rautaharju PM, Prineas RJ, et al. Race and sex differences in the incidence and prognostic significance of silent myocardial infarction in the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2016;133(22):2141-2148. doi:10.1161/CIRCULATIONAHA.115.021177
- Wackers FJT, Young LH, Inzucchi SE, et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27(8):1954-1961. doi:10.2337/diacare.27.8.1954
- American Heart Association. 2025 high blood pressure guideline: top things to know; and Understanding blood pressure readings. professional.heart.org · heart.org
- International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome (ethnic-specific waist circumference values). idf.org
- Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078
- American Heart Association. Recommendations for physical activity in adults and kids. heart.org
- American Heart Association. Warning signs of a heart attack; and American Stroke Association, Stroke symptoms. heart.org · stroke.org
- Mesubi OO, Rokita AG, Abrol N, et al. Oxidized CaMKII and O-GlcNAcylation cause increased atrial fibrillation in diabetic mice by distinct mechanisms. J Clin Invest. 2021;131(2):e95747. doi:10.1172/JCI95747
- Agarwala A, Satish P, Al Rifai M, et al. Identification and management of atherosclerotic cardiovascular disease risk in South Asian populations in the U.S. JACC Adv. 2023;2(2):100258. doi:10.1016/j.jacadv.2023.100258
About James A. Umapathi
James A. Umapathi is a senior at Gonzaga College High School in Washington, D.C., with an interest in medicine and cardiovascular health.
He spent two summers in cardiovascular research at the Johns Hopkins University School of Medicine, where he observed and assisted with basic science work involving cardiovascular disease and diabetes. He also gained exposure to outpatient cardiology through clinical observation.
James has completed EMT training through George Washington University and has participated in hospital and community service.
Through The Silent Killer Project, he hopes to use these experiences to help South Asian individuals and families better understand cardiovascular risk, prevention and the importance of early screening.
james.umapathi@gmail.com Share this page