Building a Lasting Foundation for South Asian Heart Health

“Find an area that excites you—one that matters to public health and society.”

That advice shaped my career. But long before I became a physician-scientist, I understood what resilience and purpose meant.

My parents were born in Sindh and forced to migrate to India during the 1947 Partition. They rebuilt their lives from nothing. Their courage and quiet determination instilled in me a belief that our work in this world must serve others.

Years later, after immigrating to the United States and training as a primary care physician, I found myself confronting a disease that had touched nearly every branch of my own family tree: diabetes. I had seen relatives struggle with diabetes complications, heart attacks, and disability. I had seen how early it struck. And I noticed something unsettling in my clinical practice—South Asians seemed to develop diabetes and heart disease earlier and more aggressively than many of my other patients.

When I turned to scientific literature for answers, I was shocked.

Despite South Asians being one of the largest and fastest-growing populations in the world, there was almost no rigorous, long-term data explaining why these diseases were so common—or how to prevent them. What existed were snapshot studies from the 1950s in places like Singapore, the U.K., and South Africa. They showed higher rates of disease among South Asian immigrants compared to local populations, but they did not explain why.

It was a glaring gap—nearly two billion people of South Asian ancestry worldwide—and no roadmap. It became clear that this gap could not remain unaddressed. 

If landmark studies like Framingham transformed our understanding of heart disease in White Americans, South Asians deserved the same depth of scientific attention. We needed a longitudinal study—one that would follow people over time, deeply measure risk factors, and uncover actionable solutions.

That idea eventually became the MASALA Study (Mediators of Atherosclerosis in South Asians Living in America).

But the path was anything but smooth.

In 2006, after several attempts, I secured NIH funding for a small pilot study. What we discovered confirmed what clinicians had long suspected: South Asians had unique risk profiles that traditional models did not explain. That small study laid the groundwork for a significant grant in 2010 which expanded MASALA from San Francisco to Chicago. Today, the MASALA Study includes over 2,300 South Asians across the Bay Area, Chicago, and New York. We have followed many participants for almost 15 years. 

And what we have learned is helping refine how medicine understands risk in South Asians.

We found that type 2 diabetes is highly prevalent in South Asians and begins at younger ages and at lower body weights. South Asians with a body mass index (BMI) as low as 19.6 have as many diabetes risk factors as White individuals with a BMI of 25. 

At the time, national guidelines recommended screening when BMI reached 25 or greater—an approach that risked missing many South Asians. Based on findings from our study and other Asian American research, we worked with national partners to revise screening recommendations to begin at lower BMI thresholds.

We uncovered distinct fat-storage patterns: more fat in the liver and muscles, and less protective lean muscle mass. These differences help explain why “normal weight” does not necessarily mean “low risk” in our community.

We discovered that South Asian men develop higher levels and faster progression of coronary artery calcium—an early marker of heart disease. 

Most encouragingly, we have identified culturally relevant prevention strategies. Plant-based diets rich in whole grains, legumes, fruits, vegetables, and nuts are associated with lower liver fat and a lower risk of diabetes. These are not foreign solutions—they are rooted in many of our traditional food patterns.

Over the last 15 years, the study’s findings have contributed to more than 130 scientific publications, informed national screening guidelines for diabetes and cholesterol, and helped train a new generation of investigators focused on South Asian health.

But beyond the publications and policy changes, what moves me most are the participants. Men and women who respond to our surveys year after year and come in for long clinical exams every 5 years, because they believe in the mission. Individuals who say, “If my data can help prevent this disease in my children or grandchildren, it’s worth it.” They remind us that research is not abstract—it is deeply human.

And yet, this work remains fragile.

Federal research funding has become increasingly uncertain. Shifting priorities make it more difficult to sustain long-term cohort studies—the very kind needed to understand chronic disease. At the same time, South Asians continue to be one of the most underrepresented groups in major health studies.

The need is both urgent and enduring.

We are now exploring aging, cognitive health, and intergenerational patterns of risk—questions that will shape South Asians’ health trajectories for decades to come. With diabetes and heart disease rising globally, especially in India and across the diaspora, the need for rigorous, community-centered research is urgent. The MASALA Study represents a long-term commitment to ensuring that South Asians are seen in science, understood in medicine, and supported in health.

Every community deserves to be studied with rigor and respect. And every generation deserves the chance to live longer, healthier lives.

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About the Author

Dr. Alka Kanaya is Professor of Medicine, Epidemiology & Biostatistics at the University of California, San Francisco. She is a general internist and clinical researcher who founded and leads the MASALA Study, the first long-term study of cardiovascular disease among South Asians in the United States.