The science
The evidence, in the open.
What is known about cardiovascular risk in South Asian families, and what is still not known. What the proposed Sehat program does with that evidence. And, just as important, what has already been tried that did not work. Every figure on this page carries its source; the caveats are printed as prominently as the findings.
The epidemiology
A quarter of the world’s people.
60% of its heart disease.
Nearly a quarter of the world’s inhabitants carry roughly 60% of the global cardiovascular disease burden.1 That single pairing explains why this practice exists, and why risk tools built on other populations can read this one late.
Over 17,600 people, followed for two decades.
The LOLIPOP study tracked the health of over 17,600 South Asians across 20 years and found an almost two-fold higher risk of coronary heart disease than in their European counterparts. It is one of the longest looks at this population on record: long enough to watch risk become disease.
The disease you cannot feel, measured.
The MASALA study (Mediators of Atherosclerosis in South Asians Living in America) follows the prevalence and progression of subclinical atherosclerosis in U.S. South Asians: plaque building silently, years before any symptom. The corpus carries no cohort size or numeric findings for MASALA, so none appear here.
From 14% of deaths to 27.5%, in one generation.
In 2019, cardiovascular disease accounted for 27.5% of all deaths in the South Asia region, up from 14% in 1990 (Patel D et al., JAHA, 2025). The burden is not static. It is compounding.
A quarter of humanity; under 2% of the genomic record.
South Asians make up roughly 25% of the world’s population yet less than 2% of participants in genomic studies (OurHealth / Broad Institute). The genetic reference data behind modern prevention barely includes the population with the most at stake.
39% of cardiovascular deaths in Asia occur before age 70.
In 2019, approximately 39% of cardiovascular deaths in Asia occurred before age 70, compared with 23% in the U.S. and 22% in Europe (Gupta K et al., JACC Asia, 2022). Prevention that begins at the usual age arrives, for this population, late.
The honesty panel
What we learn from
what did not work.
Most program websites show you only the studies that support the program. This one also shows you the study that does not, because a prevention practice you cannot trust with bad news is not a prevention practice.
Cultural tailoring is necessary. It is not sufficient.
In the SAHELI trial, a 16-week, culturally tailored, community-based lifestyle intervention for U.S. South Asians did not significantly improve blood pressure, cholesterol, or blood sugar at 12 months. The conclusion the corpus draws, and this program adopts, is that cultural tailoring is a necessary but not sufficient condition. Food, language, and family structure matter; they cannot substitute for intensity, duration, medication when it is indicated, and measurement on a clock.
Telehealth helps people finish. The comparison was not randomized.
CardioClick, the telehealth pathway built for Stanford’s South Asian prevention program (SSATHI), reported that patients were far more likely to complete the year-long program: 64.4% versus 39.2% in a historical in-person cohort. The caveat belongs in the same sentence: this was an observational comparison against a historical control, not a randomized trial. We read it as encouraging evidence that removing friction keeps people engaged, not as proof of better outcomes.
Imaging that also knows when to say no.
Imaging cuts in both directions. Between 30% and 54% of intermediate-risk South Asians have a coronary calcium score of zero. For them, the scan is what makes de-escalation a rational conversation: fewer medications, lifestyle and follow-up instead. The same instrument that justifies treating earlier also knows when to step back.
The medication nuance
The same molecule.
A different dose.
Statin plasma levels run 1.5–2.3× higher in Asian patients at a given dose. FDA labeling for rosuvastatin says so directly: in Asian patients, start at 5 mg and do not exceed 20 mg. The proposed protocol begins there: lower starting doses, slower titration, and a recheck after every change, because dosing should respect the phenotype, not the average of a trial that did not include it.
The principle extends past statins: begin at the dose appropriate to the person, measure the response, and only then escalate. Medication is one pillar of the proposed program: introduced when measurement calls for it, reviewed on a defined clock, and de-escalated when the evidence allows.
From evidence to program
The evidence becomes a program.
Every element of the proposed Sehat program (the panel of tests, the imaging thresholds, the cadence of follow-up) traces back to the studies, and the caveats, on this page.
References · this page
Every figure, sourced.
- OurHealth Scientific Background: nearly a quarter of the world’s inhabitants carry ~60% of the global cardiovascular disease burden.
- LOLIPOP (Kooner et al.): over 17,600 South Asians followed for 20 years; almost two-fold higher risk of coronary heart disease than European counterparts.
- MASALA (Mediators of Atherosclerosis in South Asians Living in America): prevalence and progression of subclinical atherosclerosis in U.S. South Asians. The corpus reports no cohort size or numeric findings for this study; none are asserted here.
- Patel D et al., JAHA, 2025: cardiovascular disease accounted for 27.5% of all deaths in the South Asia region in 2019, up from 14% in 1990.
- OurHealth / Broad Institute (Kohler, 2023): South Asians are ~25% of the world’s population but <2% of participants in genomic studies.
- Gupta K et al., JACC Asia, 2022: in 2019, ~39% of cardiovascular deaths in Asia occurred before age 70, versus 23% in the U.S. and 22% in Europe.
- SAHELI: Kandula NR et al., JAMA Cardiology, 2024. A 16-week, culturally tailored, community-based intervention did not significantly improve blood pressure, cholesterol, or blood sugar at 12 months versus mailed educational materials.
- CardioClick / SSATHI: Kalwani et al., 2021. Telehealth pathway completion 64.4% versus 39.2% in a historical in-person cohort; observational, not randomized.
- Cost-Smart Cardiovascular Prevention Blueprint: 30–54% of intermediate-risk South Asians have a coronary calcium score of 0, opening a possible de-escalation discussion. The range is uncited in the corpus and is printed with that flag.
- Corpus pharmacotherapy grid: statin plasma levels run 1.5–2.3× higher in Asian patients; FDA labeling starts rosuvastatin at 5 mg (maximum 20 mg) in Asian patients.