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South Asians (SAs) have a significantly higher incidence and severity of type 2 diabetes and cardiovascular disease (CVD) than Caucasians and can present with atypical ischaemic symptoms. This can present a challenge for health professionals who may not be aware of the lowered thresholds recommended for SA body mass index, waist circumference and age. Although SAs are likely to have all the hallmarks of metabolic syndrome: central obesity, insulin resistance, impaired glucose tolerance, reduced high density lipoprotein, high triglycerides and hypertension, conventional risk factors alone do not fully predict the increased CVD risk among this community. Furthermore, SAs themselves may not be aware of their increased predisposition to disease nor of the dietary and lifestyle modifications which could reduce the risk and severity of their condition. Even where some modification has been attempted, there may be cultural pressure to conform to a traditional diet and the requirements for fasting and feasting. Principally, SAs should avoid large late meals, reduce sugary sweets and drinks, alcohol and foods fried in plant oils which create damaging transfats, while increasing protein and non-fried vegetables to help glycaemic control. Chewing paan, with or without added tobacco, is a particular risk factor for both CVD and cancer, on a par with the dangers of smoking. Although not in the culture, exercise would also be of great benefit.

South Asians and their increased cardiovascular risk: A review of risk factors and diet and lifestyle modification