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Indian American Women

Cardiovascular Risk among Indian American Women

  • Asian Indian women have a high burden of premature deaths from heart disease as is true all over the world.1 Both standardized mortality ratios (SMR) and proportional mortality ratios (PMR) have shown an excess of premature death from CAD (coronary artery disease) in women younger than 65 years of age in the state of California. With 100 as the standard, the SMR for CAD was 130 and PMR was 220 for women 45-64 years of age. 2
  • The gender gap in HDL-C (high density lipoprotein cholesterol) is significantly smaller in Asian Indians (7mg/dl) compared with whites (15mg/dl) independent of geographical location.3
  • The overall prevalence of low HDL-C in Asian Indian women is double that of Europid women in Dallas and three times higher among lean Indian women compared to lean Europid women (72% vs 25%).3
  • Despite a high prevalence of insulin resistance, abdominal obesity (62%), prediabetes, high triglycerides, and low HDL-C, the prevalence of metabolic syndrome is similar or lower than whites in many studies due to the use of inappropriate criteria.4-8
  • Compared with Europid women, Asian Indian women have significantly smaller overall HDL-C particle size at similar levels, which may reflect impaired, reverse cholesterol transport. These HDL abnormalities may partly explain the higher CAD rates in Asian Indian women.9
  • Many Asian Indian women have a higher prevalence of emerging risk factors such as fibrinogen than Europid women. 10
  • Smoking and unhealthy use of alcohol is very low among Asian Indian women but gestational diabetes and other diabetes are particularly more common.11 Lipoprotein(a) levels have been uniformly high among women as it is in men.8, 10
  • Physical activity is lower in Indian women than in women of other ethnic origin.8, 10


1. Wild SH, Laws A, Fortmann SP, Varady AN, Byrne CD. Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990. Annals of epidemiology. 1995;5(6):432-439.

2. Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease mortality for six ethnic groups in California, 1990-2000. Annals of epidemiology. Aug 2004;14(7):499-506.

3. Chandalia M, Mohan V, Adams-Huet B, Deepa R, Abate N. Ethnic difference in sex gap in high-density lipoprotein cholesterol between Asian Indians and Whites. J Investig Med. Mar 2008;56(3):574-580.

4. Enas EA, Senthilkumar A, Juturu V, Gupta R. Coronary artery disease in women. Indian heart journal. May-Jun 2001;53(3):282-292.

5. Flowers E, Molina C, Mathur A, et al. Prevalence of metabolic syndrome in South Asians residing in the United States. Metabolic syndrome and related disorders. Oct 2010;8(5):417-423.

6. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. Journal of the cardiometabolic syndrome. Fall 2007;2(4):267-275.

7. Palaniappan LP, Kwan AC, Abbasi F, Lamendola C, McLaughlin TL, Reaven GM. Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women. Metabolism. Jul 2007;56(7):899-904.

8. Kamath SK, Hussain EA, Amin D, et al. Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women. Am J Clin Nutr. 1999;69(4):621-631.

9. Bhalodkar NC, Blum S, Rana T, Kitchappa R, Bhalodkar AN, Enas EA. Comparison of high-density and low-density lipoprotein cholesterol subclasses and sizes in Asian Indian women with Caucasian women from the Framingham Offspring Study. Clin Cardiol. May 2005;28(5):247-251.

10. Palaniappan L, Anthony MN, Mahesh C, et al. Cardiovascular risk factors in ethnic minority women aged less-than-or- equal30 years. Am J Cardiol. 2002;89(5):524-529.

11. Hedderson M M, Darbinian JA, Ferrara A. Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Paediatr Perinat Epidemiol. Sep 2010;24(5):441-448.

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