Risk Factors and Evidence Based Interventions for Cardiometabolic Disease in the South Asian Diaspora

Abstract

BackgroundSouth Asians (SAs) have higher rates of mortality from cardiometabolic disease (CMD) compared to non-Hispanic whites (NHWs) and other ethnic groups. We review the risk factors for and the relative efficacies of CMD prevention and treatment strategies in this high-risk population. MethodsA comprehensive search strategy utilizing four electronic databases was performed: Cochrane, Embase, Google Scholar, PubMed, and WHO Public Health Journal. Key terms utilized include “South Asian”, “obesity”, and “cardiometabolic disease''. ResultsSAs have increased body fat, waist to hip ratio, visceral adiposity, resistin levels and decreased adiponectin levels compared to NHWs. SAs have higher rates of NPC1 and Wnt signaling mutations associated with highly-penetrant obesity. SAs were 60% less likely than NHWs to engage in 150 minutes of moderate to vigorous physical activity per week. Safety concerns and lack of financial resources were chief barriers to physical activity, particularly in SA women. Increased acculturation in SAs is associated with greater consumption of red meat and sugary drinks. GLP-1 agonists have shown similar efficacy in SAs compared to other ethnic groups but SAs experience decreased protective effects of thiazolidinediones and gastric bypass surgery in attenuating CMD. Non-pharmacologic interventions demonstrating the greatest reductions in A1c and BMI include culturally tailored exercise, yoga, and dance classes. ConclusionRisk factors for CMD in SAs include baseline anthropometrics, genetics, and lifestyle habits. There remains a paucity of research on varying efficacies of behavioral, pharmacological and surgical interventions in this population however culturally sensitive lifestyle modifications have shown the most ability in ameliorating CMD.