Why do South Asians develop heart disease earlier?

South Asians have higher rates of insulin resistance, abdominal obesity at lower BMI, elevated Lp(a), and strong family clustering of premature coronary artery disease — patterns that standard risk calculators were not designed to capture.

Should South Asians check lipoprotein(a)?

Yes. Lp(a) is more prevalent in South Asians and is not included on a standard lipid panel. Major cardiology societies recommend checking Lp(a) at least once in adulthood, particularly for those with a family history of early heart disease.

What does a coronary calcium score mean?

A coronary artery calcium (CAC) scan measures calcified plaque in the heart arteries. A score of zero is highly reassuring. A non-zero score is direct evidence that plaque has formed and warrants more intensive risk factor management.

Is LDL enough to assess heart risk in South Asians?

Often not. South Asians may have elevated ApoB even when LDL appears normal. Lp(a), ApoB, and coronary calcium scoring provide a more complete picture.

What is ApoB and why does it matter?

ApoB measures the total number of atherogenic particles in the blood — a more precise cardiovascular risk marker than LDL alone, particularly in patients with metabolic syndrome or diabetes.

Heart Health Education

South Asian Heart Health

Name: South Asian Heart Health Education Tool
Creator: Murtaza Bharmal

Standard cholesterol tests and risk calculators often miss the patterns that drive heart disease in South Asian populations. This tool helps identify what to look for — and what to discuss with your physician.

Educational only — not a diagnostic tool, not a substitute for medical advice. Most relevant for South Asian adults 35 and older, or younger adults with a family history of premature heart disease.

Murtaza Bharmal, MD · Interventional Cardiologist · Last reviewed March 2026

Does any of the following apply to you?

Prior heart attack, stent, bypass surgery, or stroke
Known coronary artery disease or peripheral artery disease
CAC score above 300 already under active cardiology care
New or unexplained chest pain or shortness of breath

One or more of these apply to me

None of these apply to me

This tool is not the right starting point for you.

Please discuss prevention and management directly with your cardiologist. If you have current symptoms, seek care promptly.

Contact Dr. Bharmal ↗

Inherited Risk

Family History

Has a close relative had a heart attack at a young age?

Father or brother before 55; mother or sister before 65.

Yes

Unsure

Lipoprotein(a) — Lp(a)

Have you had your Lp(a) checked?

A genetic cholesterol particle not on standard panels — more prevalent in South Asians.

Yes — elevated

Yes — normal

Never checked

Metabolic Risk

Blood Sugar

What is your blood sugar status?

South Asians develop diabetes at lower BMI thresholds than standard guidelines assume.

Normal

Prediabetes (physician-diagnosed)

Type 2 diabetes

Never checked

Blood Pressure

What is your blood pressure status?

Elevated is 130/80 mmHg or above.

Normal (below 130/80)

Elevated or on medication

Never checked

Abdominal Weight

Do you carry significant weight around your midsection?

South Asian thresholds: waist above 35 inches (men) or 31 inches (women).

Yes

Unsure

Cholesterol / ApoB

What do you know about your cholesterol?

ApoB measures total plaque-forming particle count — more precise than LDL alone.

Never checked

LDL normal, ApoB never checked

LDL or ApoB elevated or on treatment

Both LDL and ApoB checked and at goal

Smoking

What is your smoking status?

Smoking significantly accelerates plaque formation.

Never smoked

Former — quit more than 5 years ago

Former — quit within the last 5 years

Current smoker

Plaque Evidence

If you have had a coronary calcium scan, enter your score. If not, select the first option.

Coronary Artery Calcium (CAC) Score

Have you had a coronary calcium scan?

Unlike other risk factors, a CAC score is direct evidence of plaque already present — not just a prediction of future risk.

I have not had a CAC scan

CAC score of 0

CAC score 1–99

CAC score 100–299

CAC score 300 or higher

All questions must be answered before viewing results.

Your Profile Summary

Here Is What Your Answers Suggest

How Cardiovascular Risk Builds

Inherited Risk

Biology

Family history
Lp(a)

Metabolic Risk

Metabolism

Diabetes · BP
Cholesterol · Smoking

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Plaque Evidence

Disease

CAC score
(direct measurement)

Risk factors predict future disease. The CAC score measures what's already present.

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Inherited / Family Signals

⚗️

Metabolic Signals

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Plaque Evidence

Possible Next Steps to Discuss With Your Physician

Questions About Your Results?

Dr. Bharmal specializes in South Asian cardiovascular risk and advanced lipid assessment.

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South Asian Heart Health

This tool is not the right starting point for you.

Inherited Risk

Metabolic Risk

Plaque Evidence

Here Is What Your Answers Suggest

How Cardiovascular Risk Builds

Possible Next Steps to Discuss With Your Physician

Related Reading

Questions About Your Results?