Background: South Asians are at a significantly increased risk of type 2 diabetes (T2D) and cardiovascular
disease (CVD), are diagnosed at relatively younger ages, and exhibit more severe disease phenotypes as compared with
other ethnic groups. The pathophysiological mechanisms underlying T2D and CVD risk in South Asians are multifactorial
and intricately related.
Method: Narrative review of the pathophysiology of excess risk of T2D and CVD in South Asians.
Result: T2D and CVD have shared risk factors that encompass biological factors [early life influences, impaired glucose
metabolism, and adverse body composition] as well as behavioral and environmental risk factors (diet, sedentary
behavior, tobacco use, and social determinants of health). Genetics and epigenetics also play a role in explaining the
increased risk of T2D and CVD among South Asians. Additionally, South Asians harbor several lipid abnormalities
including high concentration of small-dense low-density lipoprotein (LDL) particles, elevated triglycerides, low highdensity lipoprotein (HDL)-cholesterol levels, dysfunctional HDL particles, and elevated lipoprotein(a) that predispose
them to CVD.
Conclusion: In this comprehensive review, we have discussed risk factors that provide insights into the pathophysiology
of excess risk of T2D and CVD in South Asians.