BY RACHNA RELWANI, MD*
When a 38-year-old cardiologist, a specialist trained to diagnose and treat heart disease, collapsed on his treadmill during his morning run, his colleagues were stunned. He was fit. He didn’t smoke. He had two young children. He spent his career teaching patients how to prevent the very tragedy that claimed his own life within minutes.
“How could this happen? He was so young.” But if you look closely at what’s unfolding in the South Asian diaspora, the real question is: How could it not?
I’ve practiced medicine for nearly twenty years, and in the past decade, the pattern has become impossible to ignore. Perfectly “healthy” South Asian men and women, running 10Ks, eating vegetarian diets, are showing up with severe coronary artery disease in their 30s, 40s, and early 50s. Not occasionally. Not rarely. Routinely.
And yet, most had no warning signs, no traditional risk factors, and no early testing.
This is the silent crisis in our community.
And most families still have no idea it’s happening.
A Risk So High, It’s Almost Predictable – But Still Being Missed
Worldwide data now confirms what many of us have witnessed anecdotally for years: people of South Asian ancestry have up to four times the risk of premature heart disease. They also develop narrower, more inflammatory, more rupture-prone plaque, and they often develop it a decade or two earlier than non-South Asian populations.
This means:
- A 40 year old South Asian can have the arteries of a 60 year old non-South Asian.
- A normal BMI is not protective.
- Normal cholesterol can be misleading.
- Absence of family history does not mean low risk.
- And distressingly, the first symptom is often the heart attack itself.
This isn’t theory. This is real life.
My husband was one of these “exceptions.”
The Symptoms We Dismiss – And Why They Matter
The day my husband nearly died of a massive heart attack at 44, he didn’t have chest pain. No arm tingling. No dramatic movie-scene symptoms.
He just felt nauseous.
And that was it.
He thought it was too much coffee.
But something didn’t seem right. I took him to the ER.
Minutes later, his EKG revealed an ongoing heart attack, from a 99% blockage in his LAD – (the “widowmaker” artery). We’re very lucky he survived. Even his cardiologist said someone must have been looking out for us that day.
This is the reality of South Asian heart disease: subtle symptoms, aggressive disease.
By the time we feel something, it may already be too late.
Why Our Healthcare System Isn’t Catching This
I say this with deep love and respect for my colleagues: physicians are brilliant, dedicated, and doing their best in a system that gives them minutes per patient and guideline-based checklists written for the average American – not the South Asian community.
But here’s the truth:
South Asians are not average-risk.
And the science proving this is ahead of U.S. medical guidelines. Many doctors simply haven’t been exposed to ethnic-specific data.
Despite the clear evidence:
- Lipoprotein(a) — disproportionately high in South Asians — is rarely checked.
- ApoB, the strongest predictor of plaque, is still considered “optional.”
- Early imaging (calcium scoring, CT angiography) is recommended by experts but not standardized in primary care. And the type of imaging matters.
- Insulin resistance is often present even in thin, athletic South Asians — but standard labs don’t identify it.
So patients get told:
- “Your numbers look fine.”
- “You’re young; you don’t need screening.”
- “Come back in a year.”
Meanwhile, plaque quietly builds.
This gap between what research shows and what clinical guidelines include is costing lives in our community.
A Biology That Behaves Differently
South Asians carry unique metabolic traits that make early plaque formation more likely:
- Higher baseline inflammation
- More visceral fat even at normal weights
- Smaller LDL particles that penetrate arteries easily
- Elevated Lp(a) and ApoB
- Hyperreactive stress pathways
- Earlier onset of insulin resistance
This is why someone who “looks healthy” externally can develop life-threatening disease internally.
A South Asian heart simply cannot be evaluated by a Western rulebook.
What Every South Asian Should Discuss With Their Doctor
We cannot wait for guidelines to catch up. There are simple, accessible tools that can dramatically reduce the risk of a first heart attack.
Ask your doctor about:
- Coronary calcium scoring by age 40–45
- ApoB
- Lp(a)
- Insulin resistance panel
- hsCRP
- Triglyceride-to-HDL ratio
- Waist circumference, not BMI, for metabolic risk
Targets for South Asians may need to be more aggressive:
- Lower LDL goals
- Lower blood pressure thresholds
- Earlier diabetes and metabolic screening
- More structured strength training
- Reducing refined carbohydrates
- Intentional stress and sleep management
These shifts can literally change the trajectory of a family.
Why I Left My Medical Practice to Focus on This Full Time
After my husband’s heart attack – and after losing another cousin to heart disease this summer – I realized something painful:
Our community was drowning in misinformation, outdated guidelines, and late diagnoses. And no one was dedicated solely to fixing this.
So I left my medical practice of nearly twenty years and founded DesiDil, the only program in the country entirely focused on cardiometabolic risk prevention for South Asians.
I now work outside the limitations of the traditional medical model. I offer deep, personalized risk decoding, advanced lab interpretation, early imaging recommendations, and culturally tailored prevention strategies.
This spring, I will be speaking at a national medical conference about South Asian heart disease, helping educate clinicians across the country on this urgent issue. The momentum is finally building. However, our families should not have to wait.
This Crisis Is Silent – But It Doesn’t Have to Be Invisible
South Asians don’t need more fear.
We need clarity, tools, and a plan.
We are not destined for early heart disease.
We simply need care that recognizes our biology.
If you want to learn more about protecting your family with evidence-based guidance built specifically for our community, I write a free newsletter on South Asian cardiometabolic health at www.desidil.org.
Awareness saves lives.
The right testing saves lives.
And for our community, both are overdue.
Awareness saves lives.
The right testing saves lives.
And for our community, both are overdue.
A clinician with more than 15 years of experience in internal medicine and education, Dr. Rachna Relwani founded DesiDil, the nation’s first cardiometabolic prevntion practice for South Asians. She combines clinical expertise, precision risk assessment, and cultural literacy to help the community understand its true cardiometabolic risk before disease develops.
