A 2018 American Heart Association scientific statement reports that South Asians have higher proportional mortality rates from atherosclerotic cardiovascular disease compared with other Asian groups and non-Hispanic whites [1]. That finding contradicts what you see when Asian Americans are counted as a single group, which appears lower-risk, largely because East Asian populations carry lower risk [1]. The aggregation hides the real picture. This article separates the data from the destiny, names what screening can reveal, and points to the risk factors that can change.

Why does the Asian American number look so different from the South Asian number?

When Asian Americans are counted as one group, the result looks reassuring: lower heart disease risk than the general US population. But that number averages together at least six very different populations with very different risks. East Asian populations, which are larger in the US Asian population, carry lower cardiovascular risk. When you combine them with South Asians, the higher-risk group gets buried in the middle [1].

The 2018 American Heart Association statement pulled South Asians out of that average and looked at the data separately. What emerged was a different picture: higher proportional mortality from atherosclerotic cardiovascular disease in South Asians than in other Asian groups and non-Hispanic whites [1]. That is the honest finding. It is also directional, not a measured risk ratio for the US population. The statement identifies a real pattern in the data. It does not give you a number that says how much higher your personal risk is.

What does the metabolic data show?

The metabolic side of the picture is clearer. In the MASALA and MESA studies, US South Asian adults aged 44 to 84 had an age-adjusted type 2 diabetes prevalence of 23%, compared with 6% in white adults, 18% in African American adults, 17% in Latino adults, and 13% in Chinese American adults [3]. That is a measured US figure in a real population. MASALA is a longitudinal research project on heart disease risk factors among US South Asians, coordinated by the University of California San Francisco Department of Medicine, and it describes itself as the first of its kind in this population [4].

The diabetes number matters for heart disease because type 2 diabetes is a major cardiovascular risk factor. A person with diabetes has a much higher chance of developing heart disease than a person without it. When 23% of a population has diabetes, the cardiovascular load on that population is substantial.

But elevated group risk is not the same as individual destiny. The question for any one person is whether screening will show diabetes, prediabetes, or normal glucose levels, and that is something only a test can answer.

What screening actually reveals

Most people with prediabetes have no symptoms [6]. You cannot feel your blood glucose creeping up. You cannot feel your blood pressure rising. That is why screening matters. An A1C test measures your average blood glucose over the past 3 months [2]. An A1C of 5.7% to 6.4% is prediabetes; 6.5% or higher is diabetes [2].

The American Diabetes Association recommends testing in adults with a BMI of 23 or higher if you are of Asian ancestry, or 25 or higher if you are not, who have one or more additional risk factors [2]. Those risk factors include a first-degree relative with diabetes, high blood pressure, abnormal cholesterol or triglyceride levels, a history of cardiovascular disease, polycystic ovary syndrome, or physical inactivity [2].

An hs-CRP test measures very tiny increases in C-reactive protein and is used to estimate your risk of heart disease [5]. Your clinician may order it as part of a cardiovascular risk assessment. It is one piece of the picture, not a diagnosis on its own.

The guides section includes detailed articles on South Asian diabetes risk and metabolic blood tests explained that walk through what each test means and what the thresholds are.

What risk factors can actually change?

The AHA statement identifies the pattern. The next question is what you can do about it. Several risk factors for heart disease and diabetes are modifiable: blood pressure, cholesterol and triglyceride levels, physical activity, smoking, and weight. These are the levers you and your clinician can pull.

In the Diabetes Prevention Program, losing 5% to 7% of body weight lowered the chance of developing type 2 diabetes [6]. That is a measured result in a real trial. It is not a promise, but it is concrete evidence that weight change matters.

Physical inactivity is a documented risk factor [2]. So is smoking [6]. So is abnormal cholesterol or triglyceride levels [2]. None of these are fixed. All of them are things a clinician can help you address.

What the data does and does not say

Here is what you can trust from the numbers:

What the data shows What it does not show
South Asians have higher proportional mortality from heart disease than other Asian groups and non-Hispanic whites [1] A specific risk ratio for any individual South Asian person
Type 2 diabetes prevalence is 23% in US South Asian adults aged 44 to 84 [3] That you will develop diabetes, or that you have it now
Most people with prediabetes have no symptoms [6] Whether you have prediabetes without a test
Losing 5% to 7% of body weight lowered diabetes risk in a trial [6] That weight loss will prevent diabetes in your case
An hs-CRP test estimates heart disease risk [5] A diagnosis of heart disease

The first column is what screening and your clinician's conversation can clarify. The second column is why you need that conversation, not just a number on a page.

What to do next

  1. Ask your clinician whether you should be screened for prediabetes and diabetes. Mention if you have a BMI of 23 or higher, a parent or sibling with diabetes, high blood pressure, abnormal cholesterol, or physical inactivity.
  2. If screening is recommended, ask for an A1C test. Write down the result and the range your clinician gives you for normal, prediabetes, and diabetes.
  3. Ask about an hs-CRP test if your clinician mentions cardiovascular risk assessment. Understand what the result means in your specific situation.
  4. If you smoke, ask about cessation support. If you are physically inactive, ask what kind of activity your clinician recommends.
  5. If your blood pressure or cholesterol is abnormal, discuss what changes are possible before any medication decision.
  6. Write down any family history of diabetes or heart disease and bring it to your next appointment. Your clinician needs that context.

Sources

  1. American Heart Association scientific statement on atherosclerotic cardiovascular disease in South Asians, Circulation, higher proportional mortality in South Asians compared with other Asian groups and non-Hispanic whites, accessed 2026-08-06, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000580
  2. American Diabetes Association, Diagnosis and Classification of Diabetes, Standards of Care in Diabetes 2026, screening thresholds and risk factors, accessed 2026-08-06, https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes
  3. Kanaya and colleagues, MASALA and MESA diabetes prevalence, type 2 diabetes prevalence in US South Asian adults, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/24705613/
  4. MASALA study, longitudinal research project on heart disease risk factors in US South Asians, accessed 2026-08-06, https://www.masalastudy.org/
  5. MedlinePlus, C-reactive protein test, hs-CRP and heart disease risk estimation, accessed 2026-08-06, https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/
  6. NIDDK, insulin resistance and prediabetes, symptoms, screening, and the Diabetes Prevention Program weight loss result, accessed 2026-08-06, https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance