Title:Pathophysiological Mechanisms Underlying Excess Risk for Diabetes and Cardiovascular Disease in South Asians: The Perfect Storm
Volume: 17
Issue: 9
Author(s): Anurag Mehta, Sumitabh Singh, Anum Saeed, Dhruv Mahtta, Vera A. Bittner, Laurence S. Sperling and Salim S. Virani*
Affiliation:
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, TX,United States
Keywords:
South Asia, type 2 diabetes, atherosclerosis, pathophysiology, risk factors, prevention.
Abstract:
Background: South Asians are at a significantly increased risk of type 2 diabetes (T2D) and
cardiovascular disease (CVD), are diagnosed at relatively younger ages, and exhibit more severe disease
phenotypes as compared with other ethnic groups. The pathophysiological mechanisms underlying T2D
and CVD risk in South Asians are multifactorial and intricately related.
Methods: A narrative review of the pathophysiology of excess risk of T2D and CVD in South Asians.
Results: T2D and CVD have shared risk factors that encompass biological factors (early life influences,
impaired glucose metabolism, and adverse body composition) as well as behavioral and environmental
risk factors (diet, sedentary behavior, tobacco use, and social determinants of health). Genetics and epigenetics
also play a role in explaining the increased risk of T2D and CVD among South Asians. Additionally,
South Asians harbor several lipid abnormalities including high concentration of small-dense
low-density lipoprotein (LDL) particles, elevated triglycerides, low high-density lipoprotein (HDL)-
cholesterol levels, dysfunctional HDL particles, and elevated lipoprotein(a) that predispose them to
CVD.
Conclusion: In this comprehensive review, we have discussed risk factors that provide insights into the
pathophysiology of excess risk of T2D and CVD in South Asians.