August 28, 2025 • 22 mins
Episode Description: In this episode of Soma Says, Dr. Soma Mandal takes an in-depth look at the significant yet under-recognized threat of heart disease in South Asian women. She explains the genetic predispositions, metabolic risk factors, and cultural influences that make this demographic particularly vulnerable.
Along with uncovering why symptoms are often dismissed, Dr. Soma shares actionable prevention strategies and outlines the key health screenings every South Asian woman should consider.
Tune in to gain knowledge that could save your life—or the life of a woman you love. And don’t forget to download the special Thinkific resource on heart health and explore Dr. Soma’s new book, Midlife Masala, for more empowering insights.
Episode Timeline:
00:00 Introduction and Disclaimer
00:52 Welcome to Soma Says
01:01 The Silent Threat of Heart Disease in South Asian Women
02:23 Understanding the Genetic and Cultural Factors
06:41 The Importance of Early Detection and Screening
10:11 Cultural Barriers and Stigma
13:05 Advocating for Your Health: Essential Tests
16:57 Effective Prevention Strategies
19:53 A Patient’s Story: The Power of Advocacy
21:03 Conclusion and Resources
📖 Get Dr. Soma’s Book: Midlife Masala Available wherever books are sold:
🌐 Amazon
📱 Kobo
⭐ BookBub
Or download the Thinkific companion resource directly from my website: www.somamandalmd.com 📸 Instagram: @drsomamandalmd 👥 LinkedIn: Dr. Soma Mandal ▶️ YouTube: Soma Says Podcast
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi, this is Dr.
(00:01):
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show.
(00:52):
Hi everyone.
Welcome to Soma Says, where we explore the unspoken sides of women's health with clarity, compassion, and a whole lot of conversation.
I'm your host, Dr.
Soma, and today we're diving into a topic that hits especially close to home, the silent but deadly threat of heart disease in South Asian women.
(01:13):
How many of you have known women who are either your age or slightly older that have been diagnosed with heart disease or have even had heart attacks? If that's you.
Then raise your hand if that's your mom.
Then raise your hand again.
If that's your sister, raise your hand.
(01:34):
Again.
It is so prevalent that it is something that I feel passionate about addressing with each and one of my patients to assess and make sure that we do appropriate.
Testing as well as prevention.
Did you know that South Asians are four times more likely to have heart disease than the general population? And that this often starts earlier and progresses more aggressively in women? We're going to explore why this happens, what the signs are, how culture plays into it, and most importantly, how you can advocate for your own heart health.
(02:18):
or support someone you love.
Let's start with the big picture.
South Asians, particularly those from India, Pakistan, Bangladesh, Sri Lanka, and Nepal have a genetic predisposition to insulin resistance, abdominal obesity, and disc lipid, even at lower bmi.
(02:42):
But what is less known is how often women go.
Undiagnosed.
For example, a South Asian woman with A BMI of 23 might be told she's quote unquote normal weight, but her waist to hip ratio, LDL particle size or insulin resistance.
(03:02):
Could all still be dangerously elevated.
We also metabolize carbohydrates differently, and many of our traditional foods, though delicious, are high in simple starches and key when combined with sedentary lifestyles and stress.
This adds fuel to the fire.
(03:24):
South Asian women face a uniquely high risk of heart disease with research showing they are up to four times more likely to develop heart disease than the general population, and this risk often earlier and with greater severity, Earlier onset and aggressive progression studies consistently show that South Asians, including women, develop coronary artery disease at a younger age and experience more severe disease compared to other ethnic groups.
(03:59):
In India, for example, about 30% of all coronary artery deaths occur in people under 40 compared to just one to 4%.
In the United States, whites and blacks under 45.
The US data also indicates that Asian Indian women have the highest age, standardized mortality rates from ischemic heart disease among all racial and ethnic groups, and this rate is rising traditional cardiovascular risk calculators such as the A HA.
(04:33):
Which is the American Heart Association American College of Cardiology.
Pooled cohort equations often underestimate risk in South Asian women because they are not validated in this population.
The 2018 A-H-A-A-C-C guidelines now recognize that South Asian ethnicity as a risk enhancer when considering statin therapy, but even newer tools like the Q risk and the JBS three still tend to underestimate risk in women of South Asian descent.
(05:10):
South Asian women are more likely to have low HDL cholesterol, higher rates of diabetes, and lower levels of physical activity compared to other groups.
These risk factors are compounded by social determinants such as migration, stress, socioeconomic status, and cultural dietary patterns.
(05:32):
in Asia, about 39% of cardiovascular deaths occur before age 70 compared to 23% in the US and 22% in Europe.
South Asian women in Western countries, in including the us, Canada, and the UK have a disproportionately higher risk of heart disease and related mortality compared to their white counterparts.
(05:58):
Effective prevention and education programs for South Asian women are those that are culturally tailored.
For example, community outreach in religious centers, workplace health fairs, and virtual classes that address diet and physical activity is a culturally relevant way.
These findings underscore the urgent need for awareness, for South Asian women who remain under-recognized and underserved in traditional cardiovascular risk models and public health campaigns.
(06:32):
we're under screened, underdiagnosed, and often dismissed.
we're tired, short of breath, or just not feeling right.
Now let's talk about women and heart disease in general.
Heart disease is still seen even by many healthcare providers as a man's disease, but it's the number one killer of women including South Asian women.
(06:56):
And the difference is that our symptoms are often atypical.
South Asian women are at high risk for heart disease due to a combination of genetic predisposition, unique metabolic factors, and environmental influences, and these risks are often missed by standard screening and clinical assumptions.
(07:19):
South Asians, including those from India, Pakistan, Bangladesh, Sri Lanka and Nepal have a well-documented genetic predisposition to insulin resistance, abdominal obesity, and dyslipidemia.
Notably low HDL cholesterol and elevated lipoprotein A even at lower BMIs.
(07:41):
This means that a South Asian woman with A BMI of 23, which is considered normal by Western standards, may still have a high waist to hip ratio, increased visceral fat and atherogenic lipid profiles, all of which are strongly linked to cardiovascular risk.
research has also shown that standard BMI.
(08:02):
And waste circumference, cutoffs, underestimates risk In South Asians, the World Health Organization and other bodies now recommend lower BMI and waste circumference threshold for South Asians to better capture risk.
For example, A BMI of 23.
Or a waist circumference above 80 centimeters in women should prompt further metabolic evaluation.
(08:28):
South Asians metabolize carbohydrates differently with a tendency towards higher postprandial glucose and insulin levels.
Traditional diets, often rich in refined grains, white rice and key further exacerbate this risk, especially when combined with sedentary.
Lifestyles and chronic stress.
(08:50):
South Asian women are under screened and underdiagnosed for cardiovascular disease.
Risk calculators like the A-H-A-A-C-C pooled cohort equations, and even the UK Q Risk two and JB BS three often underestimate risk in South Asian women because they are not validated in this population.
(09:13):
Symptoms such as fatigue.
Shortness of breath or vague malaise are frequently dismissed or attributed to non-cardiac causes leading to missed opportunities for early intervention, migration, socioeconomic stress and lack of culturally tailored health education, further compound risk and contribute to disparities in care and outcome.
(09:40):
Instead of the crushing chest pain in movies, women may feel extreme fatigue.
Jaw pain or upper back tightness, shortness of breath, dizziness or nausea.
South Asian women who are often the caretakers are also less likely to seek medical attention quickly.
(10:01):
And cultural stigma, don't complain.
Be strong, take care of the family first.
And we have a recipe for silent suffering.
Let's go deeper into culture in many South Asian households, health conversations are taboo, especially around chronic illness.
(10:22):
There's a sense of shame or culture or failure.
Attached to needing medication or seeing a cardiologist.
Many of us, myself included, grew up watching our mothers serve everything at the table, eat last and rarely sit down.
This mentality extends to health one's needs comes last, and.
(10:46):
Then there's language.
Many of our elders may not fully understand what LDL or angioplasty means, especially if English isn't their first language.
This creates a communication barrier that can delay testing, treatment and lifestyle change.
Research strongly supports the impact of cultural factors on cardiovascular health outcomes among South Asian women.
(11:11):
Highlighting several key blind spots, stigma and silence around illness.
Studies show that in South Asian communities chronic illnesses, especially those requiring ongoing medication or specialist care are often associated with stigma, shame, or a sense of personal failure.
(11:33):
This can lead to delayed care seeking reluctance to discuss symptoms and poor adherence.
To prescribed therapies, a 2021 review in the Journal of Immigrant and Minority Health found that South Asian women frequently under report symptoms and delay seeking help due to fear of burdening their families or being perceived as weak.
(11:56):
Traditional gender roles where women prioritize family needs over their own, are well-documented in South Asian cultures.
Research from the Masala study and others has shown that South Asian women are less likely to engage in preventive health behaviors, attend regular checkups, or advocate for their own health, often citing family obligations as a barrier.
(12:21):
This self-sacrificing mentality is linked to lower rates of screening and later stage diagnosis of heart disease.
Limited English proficiency is a significant barrier to effective healthcare for many first generation South Asian women.
a 2019 study in circulation, cardiovascular quality and outcomes found that South Asian patients with limited English skills were less likely to understand medical terminology.
(12:49):
Less likely to follow through with recommended testing and more likely to experience poor outcomes.
Health literacy gaps are compounded by the lack of culturally and linguistically appropriate educational materials.
Now let's talk about testing and what to ask for, and this is where advocacy really becomes vital.
(13:13):
As a South Asian woman, even in your thirties or forties, it's smart to ask for a complete lipid panel including LDL particle size and lipoprotein A, your hemoglobin A1C, and fasting insulin, A coronary calcium score, especially if you have a family history and a cardio C reactive.
Protein to look at inflammation.
(13:35):
South Asian women, even in their thirties and forties, should proactively request expanded cardiovascular and metabolic screening due to their elevated and often under-recognized.
Risk profile, standard risk calculators and screening protocols frequently underestimate risk in this population.
(13:55):
So advocacy is essential.
The key test to request Complete lipid panel, including an LDL particle size and LPA, which is also known as a lipoprotein a South Asians have a higher prevalence of atherogenic dyslipidemia, including elevated LEL.
Low HDL and increased lipoprotein A, even at lower bmi.
(14:19):
LDL particle size and lipoprotein A are not routinely checked, but are important as small dense LDL and high lipoprotein A are linked to early aggressive atherosclerosis in this group.
insulin resistance, and type two diabetes.
Develop at lower BMI in South Asians and often pres present before overt hyperglycemia.
(14:44):
Early detection with A1C and fasting insulin can identify risk before standard glucose thresholds are crossed.
Coronary artery calcium score.
A ca coronary artery calcium score is a powerful tool for detecting subclinical atherosclerosis.
south Asians may have lower coronary artery calcium volume, but a higher number of calcified vessels and early calcium score testing is recommended, especially with a family history of premature heart disease.
(15:17):
Guidelines suggest considering coronary artery scores in South Asians at younger ages than the general population.
high sensitivity cardio.
C reactive protein is a marker of vascular inflammation and is often elevated in South Asians, reflecting increased cardiometabolic risk even when other markers are borderline.
(15:41):
Many clinicians do not routinely order advanced lipid testing, coronary artery scores, or fasting insulin unless specifically requested and standard risk calculators like the A-H-A-A-C-C pooled cohort equations, the Q risk two, the JB S3 underestimate risk in South Asian women.
(16:02):
Early and aggressive risk factor identification is critical as South Asian women often present with advanced disease at a younger age and with fewer traditional warning signs.
The 2018 A-H-A-A-C-C cholesterol guidelines now recognize South Asian ethnicity as a risk enhancer for statin initiation.
(16:26):
New Zealand and US guidelines also recommend earlier screening for South Asians.
With some suggesting starting at age 30 for men and 40 for women, or even earlier with family history or other risk factors.
Many doctors may not routinely order these unless you push for them.
(16:46):
I've had patients come in after being told you're fine only to find early blockages or significant metabolic issues.
Knowledge is power.
Don't be afraid to ask the good news Prevention works and it's never too late to start.
Here's what's powerful for South Asian women Prevention is effective for South Asian women at risk for heart disease and research supports the power of culturally tailored lifestyle changes in improving cardiovascular risk factors.
(17:23):
Regular physical activity such as walking after meals, 30 minutes of moderate exercise daily, and strength training twice a week has been shown to improve blood pressure, lipid profiles and glycemic control in South Asian adults.
Even modest increases in activity can yield significant benefits, especially when integrated into daily routines.
(17:51):
Shifting the diet to include more plant-based proteins like lentils, beans, eggs, tofu, and lean meats, while reducing refined carbohydrates like white rice, roti made from white flour and saturated fats like key is associated with lower cholesterol and improved metabolic health diets, rich and vegetables, fruits, whole grains, and healthy fats such as those found in Mediterranean or Vean.
(18:19):
Portfolio diets are particularly beneficial for South Asians mind body practices such as pranayama, which is y yogic breathing, guided meditation and gratitude journaling have been shown to lower cholesterol, reduced blood pressure, and improve overall being these cultural.
(18:41):
These culturally familiar practices can be powerful tools for stress reduction and cardiovascular risk mitigation.
Poor sleep is linked to increased insulin resistance, higher inflammatory markers, and greater in and greater cardiovascular risk.
Prioritizing sleep hygiene is a critical, often overlooked component.
(19:04):
Of heart health, culturally tailored community-based interventions such as group classes, WhatsApp, walking groups, or community health challenges have demonstrated improved dietary quality, increased physical activity, and greater self.
Efficacy among South Asian women.
Social support is a key driver of sustained behavior change and leveraging cultural strengths can transform community norms from obstacles into engines for health.
(19:36):
And here's a big one.
Don't go it alone.
Create a circle of accountability, A friend group, a WhatsApp group, a walking chat, a community health challenge.
Your culture doesn't need to be an obstacle.
It can become your engine.
I want to share a story about a patient who's 47 years old, south Asian, I'll call her arena.
(20:00):
She came to me with persistent fatigue and lightheadedness.
She'd been told it was just stress by other providers.
But something didn't sit right with me.
We ran a coronary calcium scan and found plaque buildup in her left anterior descending artery.
Rena was shocked.
She ate healthy, never smoked and was slim, but she had a family history of early heart attacks, low HDL and her triglycerides were creeping up.
(20:28):
We built a plan.
Statins, yes, but also yoga strength training and adding Omega threes and coq 10 a year later.
Not only is her heart healthier, but she told me I feel like I got my life back.
It's stories like these that keep me doing this work, and I know Rena's story is not unique.
(20:51):
Heart disease doesn't care if you are the quiet one.
The giver, the one who never complains it will sneak in unless you look for it, talk about it and act on it.
I want you to be empowered, so I've put together a special think if download to support your journey.
It features my new book, midlife Masala, where I talk about menopause heart health hormone shifts, and what it means to be a Desi woman in midlife taking charge of her own story.
(21:22):
you can download it now@somamandelmd.com
and go to the midlife masala link.
Please share this episode with a sister, cousin, or a friend who might need it.
And don't forget to subscribe to Soma Says on Apple Podcasts and on YouTube or your favorite podcast app.
(21:42):
Until next time, take a deep breath, move with purpose and lead with love.
And don't forget to like, share and review my podcast.
Remember, it's always ladies first on Soma Says.
Let's make a difference one conversation at a time.
Hi, this is Dr.
(00:01):
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show.
(00:52):
Hi everyone.
Welcome to Soma Says, where we explore the unspoken sides of women's health with clarity, compassion, and a whole lot of conversation.
I'm your host, Dr.
Soma, and today we're diving into a topic that hits especially close to home, the silent but deadly threat of heart disease in South Asian women.
(01:13):
How many of you have known women who are either your age or slightly older that have been diagnosed with heart disease or have even had heart attacks? If that's you.
Then raise your hand if that's your mom.
Then raise your hand again.
If that's your sister, raise your hand.
(01:34):
Again.
It is so prevalent that it is something that I feel passionate about addressing with each and one of my patients to assess and make sure that we do appropriate.
Testing as well as prevention.
Did you know that South Asians are four times more likely to have heart disease than the general population? And that this often starts earlier and progresses more aggressively in women? We're going to explore why this happens, what the signs are, how culture plays into it, and most importantly, how you can advocate for your own heart health.
(02:18):
or support someone you love.
Let's start with the big picture.
South Asians, particularly those from India, Pakistan, Bangladesh, Sri Lanka, and Nepal have a genetic predisposition to insulin resistance, abdominal obesity, and disc lipid, even at lower bmi.
(02:42):
But what is less known is how often women go.
Undiagnosed.
For example, a South Asian woman with A BMI of 23 might be told she's quote unquote normal weight, but her waist to hip ratio, LDL particle size or insulin resistance.
(03:02):
Could all still be dangerously elevated.
We also metabolize carbohydrates differently, and many of our traditional foods, though delicious, are high in simple starches and key when combined with sedentary lifestyles and stress.
This adds fuel to the fire.
(03:24):
South Asian women face a uniquely high risk of heart disease with research showing they are up to four times more likely to develop heart disease than the general population, and this risk often earlier and with greater severity, Earlier onset and aggressive progression studies consistently show that South Asians, including women, develop coronary artery disease at a younger age and experience more severe disease compared to other ethnic groups.
(03:59):
In India, for example, about 30% of all coronary artery deaths occur in people under 40 compared to just one to 4%.
In the United States, whites and blacks under 45.
The US data also indicates that Asian Indian women have the highest age, standardized mortality rates from ischemic heart disease among all racial and ethnic groups, and this rate is rising traditional cardiovascular risk calculators such as the A HA.
(04:33):
Which is the American Heart Association American College of Cardiology.
Pooled cohort equations often underestimate risk in South Asian women because they are not validated in this population.
The 2018 A-H-A-A-C-C guidelines now recognize that South Asian ethnicity as a risk enhancer when considering statin therapy, but even newer tools like the Q risk and the JBS three still tend to underestimate risk in women of South Asian descent.
(05:10):
South Asian women are more likely to have low HDL cholesterol, higher rates of diabetes, and lower levels of physical activity compared to other groups.
These risk factors are compounded by social determinants such as migration, stress, socioeconomic status, and cultural dietary patterns.
(05:32):
in Asia, about 39% of cardiovascular deaths occur before age 70 compared to 23% in the US and 22% in Europe.
South Asian women in Western countries, in including the us, Canada, and the UK have a disproportionately higher risk of heart disease and related mortality compared to their white counterparts.
(05:58):
Effective prevention and education programs for South Asian women are those that are culturally tailored.
For example, community outreach in religious centers, workplace health fairs, and virtual classes that address diet and physical activity is a culturally relevant way.
These findings underscore the urgent need for awareness, for South Asian women who remain under-recognized and underserved in traditional cardiovascular risk models and public health campaigns.
(06:32):
we're under screened, underdiagnosed, and often dismissed.
we're tired, short of breath, or just not feeling right.
Now let's talk about women and heart disease in general.
Heart disease is still seen even by many healthcare providers as a man's disease, but it's the number one killer of women including South Asian women.
(06:56):
And the difference is that our symptoms are often atypical.
South Asian women are at high risk for heart disease due to a combination of genetic predisposition, unique metabolic factors, and environmental influences, and these risks are often missed by standard screening and clinical assumptions.
(07:19):
South Asians, including those from India, Pakistan, Bangladesh, Sri Lanka and Nepal have a well-documented genetic predisposition to insulin resistance, abdominal obesity, and dyslipidemia.
Notably low HDL cholesterol and elevated lipoprotein A even at lower BMIs.
(07:41):
This means that a South Asian woman with A BMI of 23, which is considered normal by Western standards, may still have a high waist to hip ratio, increased visceral fat and atherogenic lipid profiles, all of which are strongly linked to cardiovascular risk.
research has also shown that standard BMI.
(08:02):
And waste circumference, cutoffs, underestimates risk In South Asians, the World Health Organization and other bodies now recommend lower BMI and waste circumference threshold for South Asians to better capture risk.
For example, A BMI of 23.
Or a waist circumference above 80 centimeters in women should prompt further metabolic evaluation.
(08:28):
South Asians metabolize carbohydrates differently with a tendency towards higher postprandial glucose and insulin levels.
Traditional diets, often rich in refined grains, white rice and key further exacerbate this risk, especially when combined with sedentary.
Lifestyles and chronic stress.
(08:50):
South Asian women are under screened and underdiagnosed for cardiovascular disease.
Risk calculators like the A-H-A-A-C-C pooled cohort equations, and even the UK Q Risk two and JB BS three often underestimate risk in South Asian women because they are not validated in this population.
(09:13):
Symptoms such as fatigue.
Shortness of breath or vague malaise are frequently dismissed or attributed to non-cardiac causes leading to missed opportunities for early intervention, migration, socioeconomic stress and lack of culturally tailored health education, further compound risk and contribute to disparities in care and outcome.
(09:40):
Instead of the crushing chest pain in movies, women may feel extreme fatigue.
Jaw pain or upper back tightness, shortness of breath, dizziness or nausea.
South Asian women who are often the caretakers are also less likely to seek medical attention quickly.
(10:01):
And cultural stigma, don't complain.
Be strong, take care of the family first.
And we have a recipe for silent suffering.
Let's go deeper into culture in many South Asian households, health conversations are taboo, especially around chronic illness.
(10:22):
There's a sense of shame or culture or failure.
Attached to needing medication or seeing a cardiologist.
Many of us, myself included, grew up watching our mothers serve everything at the table, eat last and rarely sit down.
This mentality extends to health one's needs comes last, and.
(10:46):
Then there's language.
Many of our elders may not fully understand what LDL or angioplasty means, especially if English isn't their first language.
This creates a communication barrier that can delay testing, treatment and lifestyle change.
Research strongly supports the impact of cultural factors on cardiovascular health outcomes among South Asian women.
(11:11):
Highlighting several key blind spots, stigma and silence around illness.
Studies show that in South Asian communities chronic illnesses, especially those requiring ongoing medication or specialist care are often associated with stigma, shame, or a sense of personal failure.
(11:33):
This can lead to delayed care seeking reluctance to discuss symptoms and poor adherence.
To prescribed therapies, a 2021 review in the Journal of Immigrant and Minority Health found that South Asian women frequently under report symptoms and delay seeking help due to fear of burdening their families or being perceived as weak.
(11:56):
Traditional gender roles where women prioritize family needs over their own, are well-documented in South Asian cultures.
Research from the Masala study and others has shown that South Asian women are less likely to engage in preventive health behaviors, attend regular checkups, or advocate for their own health, often citing family obligations as a barrier.
(12:21):
This self-sacrificing mentality is linked to lower rates of screening and later stage diagnosis of heart disease.
Limited English proficiency is a significant barrier to effective healthcare for many first generation South Asian women.
a 2019 study in circulation, cardiovascular quality and outcomes found that South Asian patients with limited English skills were less likely to understand medical terminology.
(12:49):
Less likely to follow through with recommended testing and more likely to experience poor outcomes.
Health literacy gaps are compounded by the lack of culturally and linguistically appropriate educational materials.
Now let's talk about testing and what to ask for, and this is where advocacy really becomes vital.
(13:13):
As a South Asian woman, even in your thirties or forties, it's smart to ask for a complete lipid panel including LDL particle size and lipoprotein A, your hemoglobin A1C, and fasting insulin, A coronary calcium score, especially if you have a family history and a cardio C reactive.
Protein to look at inflammation.
(13:35):
South Asian women, even in their thirties and forties, should proactively request expanded cardiovascular and metabolic screening due to their elevated and often under-recognized.
Risk profile, standard risk calculators and screening protocols frequently underestimate risk in this population.
(13:55):
So advocacy is essential.
The key test to request Complete lipid panel, including an LDL particle size and LPA, which is also known as a lipoprotein a South Asians have a higher prevalence of atherogenic dyslipidemia, including elevated LEL.
Low HDL and increased lipoprotein A, even at lower bmi.
(14:19):
LDL particle size and lipoprotein A are not routinely checked, but are important as small dense LDL and high lipoprotein A are linked to early aggressive atherosclerosis in this group.
insulin resistance, and type two diabetes.
Develop at lower BMI in South Asians and often pres present before overt hyperglycemia.
(14:44):
Early detection with A1C and fasting insulin can identify risk before standard glucose thresholds are crossed.
Coronary artery calcium score.
A ca coronary artery calcium score is a powerful tool for detecting subclinical atherosclerosis.
south Asians may have lower coronary artery calcium volume, but a higher number of calcified vessels and early calcium score testing is recommended, especially with a family history of premature heart disease.
(15:17):
Guidelines suggest considering coronary artery scores in South Asians at younger ages than the general population.
high sensitivity cardio.
C reactive protein is a marker of vascular inflammation and is often elevated in South Asians, reflecting increased cardiometabolic risk even when other markers are borderline.
(15:41):
Many clinicians do not routinely order advanced lipid testing, coronary artery scores, or fasting insulin unless specifically requested and standard risk calculators like the A-H-A-A-C-C pooled cohort equations, the Q risk two, the JB S3 underestimate risk in South Asian women.
(16:02):
Early and aggressive risk factor identification is critical as South Asian women often present with advanced disease at a younger age and with fewer traditional warning signs.
The 2018 A-H-A-A-C-C cholesterol guidelines now recognize South Asian ethnicity as a risk enhancer for statin initiation.
(16:26):
New Zealand and US guidelines also recommend earlier screening for South Asians.
With some suggesting starting at age 30 for men and 40 for women, or even earlier with family history or other risk factors.
Many doctors may not routinely order these unless you push for them.
(16:46):
I've had patients come in after being told you're fine only to find early blockages or significant metabolic issues.
Knowledge is power.
Don't be afraid to ask the good news Prevention works and it's never too late to start.
Here's what's powerful for South Asian women Prevention is effective for South Asian women at risk for heart disease and research supports the power of culturally tailored lifestyle changes in improving cardiovascular risk factors.
(17:23):
Regular physical activity such as walking after meals, 30 minutes of moderate exercise daily, and strength training twice a week has been shown to improve blood pressure, lipid profiles and glycemic control in South Asian adults.
Even modest increases in activity can yield significant benefits, especially when integrated into daily routines.
(17:51):
Shifting the diet to include more plant-based proteins like lentils, beans, eggs, tofu, and lean meats, while reducing refined carbohydrates like white rice, roti made from white flour and saturated fats like key is associated with lower cholesterol and improved metabolic health diets, rich and vegetables, fruits, whole grains, and healthy fats such as those found in Mediterranean or Vean.
(18:19):
Portfolio diets are particularly beneficial for South Asians mind body practices such as pranayama, which is y yogic breathing, guided meditation and gratitude journaling have been shown to lower cholesterol, reduced blood pressure, and improve overall being these cultural.
(18:41):
These culturally familiar practices can be powerful tools for stress reduction and cardiovascular risk mitigation.
Poor sleep is linked to increased insulin resistance, higher inflammatory markers, and greater in and greater cardiovascular risk.
Prioritizing sleep hygiene is a critical, often overlooked component.
(19:04):
Of heart health, culturally tailored community-based interventions such as group classes, WhatsApp, walking groups, or community health challenges have demonstrated improved dietary quality, increased physical activity, and greater self.
Efficacy among South Asian women.
Social support is a key driver of sustained behavior change and leveraging cultural strengths can transform community norms from obstacles into engines for health.
(19:36):
And here's a big one.
Don't go it alone.
Create a circle of accountability, A friend group, a WhatsApp group, a walking chat, a community health challenge.
Your culture doesn't need to be an obstacle.
It can become your engine.
I want to share a story about a patient who's 47 years old, south Asian, I'll call her arena.
(20:00):
She came to me with persistent fatigue and lightheadedness.
She'd been told it was just stress by other providers.
But something didn't sit right with me.
We ran a coronary calcium scan and found plaque buildup in her left anterior descending artery.
Rena was shocked.
She ate healthy, never smoked and was slim, but she had a family history of early heart attacks, low HDL and her triglycerides were creeping up.
(20:28):
We built a plan.
Statins, yes, but also yoga strength training and adding Omega threes and coq 10 a year later.
Not only is her heart healthier, but she told me I feel like I got my life back.
It's stories like these that keep me doing this work, and I know Rena's story is not unique.
(20:51):
Heart disease doesn't care if you are the quiet one.
The giver, the one who never complains it will sneak in unless you look for it, talk about it and act on it.
I want you to be empowered, so I've put together a special think if download to support your journey.
It features my new book, midlife Masala, where I talk about menopause heart health hormone shifts, and what it means to be a Desi woman in midlife taking charge of her own story.
(21:22):
you can download it now@somamandelmd.com
and go to the midlife masala link.
Please share this episode with a sister, cousin, or a friend who might need it.
And don't forget to subscribe to Soma Says on Apple Podcasts and on YouTube or your favorite podcast app.
(21:42):
Until next time, take a deep breath, move with purpose and lead with love.
And don't forget to like, share and review my podcast.
Remember, it's always ladies first on Soma Says.
Let's make a difference one conversation at a time.
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