The challenge of coronary heart disease in South Asians who have migrated to Europe and the United States

Certain populations, such as migrant South Asians from the Indian subcontinent to westernized countries, have excess burden of coronary heart disease compared with Caucasians of European descent despite a lower prevalence of traditional risk factors (except insulin resistance and type 2 diabetes). Recent studies did not show excess visceral fat in South Asians but did show larger adipocytes and abnormal adipokines that were associated with increased insulin resistance compared with Caucasians matched for total and regional fat mass. We propose that genetic predisposition to an adipocyte maturation defect when challenged with an obesogenic environment may precipitate adipose tissue dysfunction at much lower body fat content, as seen in South Asians. The shift in our thinking from excess fat mass-visceral or otherwise-to adipose tissue dysfunction being a cause of metabolic complications of obesity is warranted, especially for populations such as South Asians, to better target screening and prevention strategies.