Preventive Cardiology Guidelines for South Asians

1. Risk Assessment

• South Asians have 2–3 times higher risk of cardiovascular disease (CVD) than other ethnic groups.
• Traditional risk calculators (e.g., ASCVD Risk Score) often underestimate risk.
• ACC/AHA includes South Asian ethnicity as a risk-enhancing factor.
• Coronary Artery Calcium (CAC) scoring is recommended for borderline/intermediate risk adults (Age 40–75).

2. Lifestyle Modification

• Diet: Emphasize plant-based foods, reduce saturated fat, refined carbs, and sweets.
• Exercise: 150 minutes/week moderate or 75 minutes/week vigorous aerobic activity.
• Avoid all tobacco forms (including smokeless tobacco).
• Limit alcohol; increases risk of hypertension and arrhythmia.

3. Lipid Management

• Lower LDL targets recommended: <100 mg/dL for primary prevention, <70 mg/dL for high-risk individuals.
• Use statins as first-line; consider ezetimibe or PCSK9 inhibitors as adjuncts.

4. Hypertension

• Common at lower BMIs and younger ages among South Asians.
• Target blood pressure: <130/80 mmHg.
• Emphasize home BP monitoring, salt reduction, and weight management.

5. Diabetes & Metabolic Syndrome

• Screen early (age 35+ or younger if risk factors present).
• Use HbA1c, fasting glucose, and 2-hour OGTT.
• South Asians prone to insulin resistance and central obesity.

6. Obesity & BMI

• Overweight: BMI >23 kg/m²; Obesity: BMI >25 kg/m² (WHO Asia-Pacific criteria).
• Waist circumference thresholds: >90 cm (men), >80 cm (women).

7. Aspirin Use

• For primary prevention: only if high ASCVD risk and low bleeding risk.
• Strongly recommended for secondary prevention (post-MI, stroke, or stenting).

8. Psychosocial & Cultural Factors

• Address stress, depression, and acculturation issues.
• Use culturally tailored diet and exercise plans.
• Promote community-based programs.

9. Family History & Genetic Factors

• Strong family history of premature CVD is common.
  
• Screen first-degree relatives of patients with early-onset CVD.