Namratha Kandula distinctly remembers the phone call from India that brought the news of her 56-year-old grandfather’s sudden death.
“It was pretty shocking,” she recalls, “because he didn’t necessarily fit the profile [of a heart attack victim]. He didn’t smoke. He was relatively active and was someone who you wouldn’t think had an unhealthy diet. Many of us in the South Asian community have family members who have died at a young age from a heart attack.”
South Asians account for 60% of the world’s heart disease patients. And that trend continues for the 5.4 million South Asian immigrants in the U.S. Their risk for heart disease is 2 ½ times that of the general U.S. population. South Asians — the second–fastest growing minority group in the U.S. — have the highest death rate from heart disease compared with other ethnic groups.
Kandula, associate professor of medicine and preventive medicine at the Feinberg School of Medicine, is working to identify the factors that lead to heart disease in this community. As a principal investigator for the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, Kandula is partnering with researchers at the University of California, San Francisco, to understand the risk factors faced by South Asians and improve heart disease prevention and treatment. The study, now in its ninth year, has followed more than 1,100 South Asians in Chicago and the Bay Area.
“There are some unique things about this group that don’t fit with the patterns that we understand about heart disease and stroke,” Kandula says. For example, South Asian immigrants in the U.S. tend to be more highly educated. Despite that, they have low levels of physical activity that partly contribute to their higher risk of stroke and death from heart attack. And they develop high blood pressure, diabetes and heart disease at younger ages — five to 10 years earlier than other ethnic groups — even though they don’t fit the classic risk patterns.
One of the most notable differences is that South Asian Americans develop risk factors at a lower body mass index (BMI), Kandula explains, and they are not as overweight as other populations. “But even though they’re not overweight, they tend to have a lot of fat around their internal organs. And we think those hidden fat stores inside the body contribute to higher risk.”
Kandula, whose parents came to the U.S. from India for their medical residencies, is focusing on second-generation South Asians, both in terms of their risk factors and their role as conduits of health information to their immigrant parents. She is planning a study to understand whether the high risk for heart disease and stroke is similar in second-generation South Asian Americans and how changing cultural and behavioral patterns influence their health.
Progress is already being made. In 2015 the American Diabetes Association changed its guidelines to recommend screening Asian Americans for diabetes at a lower BMI, and the American Heart Association now recognizes South Asians as a high-risk group for cardiovascular disease. “As a researcher, you feel lucky if you see your research actually have a community or policy impact in your lifetime,” Kandula says. “We’ve seen that with MASALA.”