Inflammation and cardiometabolic disease in South Asians: The fire and fire tenders

South Asians experience a disproportionately high burden of atherosclerotic cardiovascular disease at younger ages and at lower body mass index compared with other populations, a pattern that is not adequately explained by traditional risk assessment models. An inflammation centered framework explains this excess risk, with visceral adiposity and insulin resistance amplifying inflammatory tone and lipoprotein(a) acting as fuel.

The objective of this review is to synthesize current evidence supporting an inflammation-centered framework for cardiometabolic disease in South Asians and to translate these biological insights into population-specific strategies for risk assessment and clinical management.

Evidence is drawn from population-based cohorts, biobank analyses, pooled studies of inflammatory biomarkers, randomized trials of anti-inflammatory therapies, and mechanistic research in adipose immunobiology.

Across sources, South Asians carry more visceral fat at a given body mass, display higher high-sensitivity C-reactive protein and interleukin-6, and experience earlier atherosclerotic events. Mendelian and interventional data support causal inflammatory pathways, and residual inflammatory risk often persists despite attainment of low-density lipoprotein cholesterol targets.

A pragmatic schema follows applying ethnicity aware adiposity thresholds, measuring lipoprotein(a) once in adulthood, pairing culturally familiar fiber-rich dietary patterns with guideline directed lipid lowering, and considering selective anti-inflammatory strategies such as low dose colchicine or cytokine inhibition in high-risk secondary prevention. Gaps remain for population-specific biomarker thresholds, equitable representation in trials, and implementation strategies tailored to diaspora communities. Framing prevention through inflammation, while addressing lipoprotein(a) as an accelerant, offers a clear path to narrow outcome gaps in cardiometabolic disease among South Asians.