Heart failure (HF) remains a progressive syndrome with high morbidity and mortality, and accounts for many hospitalisations globally with a downstream impact of increasing healthcare costs. South Asian individuals account for most of the global burden of non-communicable diseases. In this systematic review, a literature search was performed for all studies focusing on South Asians and HF using PubMed as the primary research tool and citations were included from relevant MEDLINE-indexed journals. Upon identification of relevant studies, pertinent data points were extracted systematically from each eligible study. South Asians have an earlier age of onset of many non-communicable diseases compared to other ethnic groups worldwide, including cardiovascular disease (CVD). Given the large number of South Asians impacted by CVD and both traditional and non-traditional risk factors for CVD, HF has the potential to become an epidemic among South Asians across the world. Individuals of South Asian origin are at elevated risk for CVD compared to many other populations and should be followed closely for the potential development of HF. This review describes what is unique to South Asian individuals at risk for and with established HF, as well as management and prognostic considerations. Future directions and potential policy changes are highlighted that can reduce the HF burden among South Asians globally.

UNASSIGNED: Weight and waist gain are significant concerns in adulthood. Both weight and waist gain are particularly important among South Asians, known to have an increased risk of developing chronic cardiometabolic complications at any body mass index compared to other racial and ethnic groups. The aim of this study was to investigate factors predicting weight and waist gain in a longitudinal cohort of South Asians living in the US (United States).
UNASSIGNED: This was a prospective analysis using data from exam 1 (2010-2013) and exam 2 (2015-2018) of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a prospective cohort study of South Asians (recruited from San Francisco and Chicago), with a mean 4.8 years of follow-up.
UNASSIGNED: Of 634 participants studied (42.7 % women, mean age 55 years, BMI 25.7 kg/m2, weight 70.4 kg at exam 1), 34.7 % had gained ≥5 % weight and 32.3 % gained ≥5 % waist at exam 2. In the adjusted models, older age, higher number of years of US residence, and having diabetes were associated with lower odds of weight gain; being female and having higher adiponectin were associated with higher odds of weight gain. Being female and being employed full/part time or being retired predicted lower likelihood of waist gain. Being single, separated/divorced, having a higher leptin and a higher C-reactive protein level predicted higher likelihood of waist gain.
UNASSIGNED: The current study identified several social, demographic, and clinical factors that can serve as targets for obesity interventions among US South Asians. In addition, this study also raises hypotheses about associations of adipokine levels with weight and waist gain.

South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. Thus, the aim of this review is to identify South Asian individuals\' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services.

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BACKGROUND: COPD can affect both men and women leading to deteriorating impact on general well-being, personal, and family life and decreased quality of life. Anxiety, depression, and self-care behaviours can affect the quality of life of individuals with COPD. There is a dearth of sex-based comparative analyses of anxiety, depression, quality of life, and predictors of quality of life among South Asian individuals with COPD.
OBJECTIVE: To identify the sex-based differences in depression, anxiety, and quality of life and the predictors of quality of life among South Asian individuals with COPD.
METHODS: A cross-sectional survey of 294 men and 114 women with COPD was conducted in Khyber Pakhtunkhwa, Pakistan. Hospital Anxiety and Depression scale, World Health Organization Quality of Life-brief version, Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care Self-Efficacy in COPD Scale were used for data collection. Bayesian independent sample t-test was used to compare mean differences in depression, anxiety, and quality of life among men and women. Two regression models were examined to determine if age, years of living with COPD, anxiety, depression, self-care self-efficacy, self-care monitoring, management, and maintenance were predictors of quality of life among men and women.
RESULTS: Bayesian analysis showed anecdotal evidence that women had higher levels of depression, but lower levels of anxiety compared to men. Anecdotal evidence indicated that the physical quality of life of men was better than women, but strong evidence that their social relationship and environmental quality of life was better than women. Years of living with COPD, anxiety, depression, self-care self-efficacy, self-care management, self-care monitoring, and self-care maintenance were stronger predictors of women\'s quality of life. Anxiety and depression only predicted men\'s psychological quality of life, but predicted women\'s psychological, social relationships, and environmental quality of life.
CONCLUSIONS: The findings contribute to literature highlighting sex-based differences in anxiety, depression, and quality of life among South Asian men and women with COPD. Men generally reported higher levels of quality of life than women across all domains. Women\'s social relationships and environmental quality of life were greatly impacted by anxiety and depression. Quality of life interventions for women should be targeted at improving their social relationships and environmental satisfaction and addressing anxiety and depression.

Cardiovascular disease (CVD) continues to pose a global health challenge, demonstrating significant disparities in occurrence among various populations. A wide number of research studies have indicated a higher prevalence of cardiovascular disease in South Asian immigrants compared to the local American population. The demand to improve the cardiovascular benefits of immigrants is increasing, which calls for further research with larger and more diverse population samples. This study will investigate the major causes of this variation, which include genetically diverse characteristics and changes in nutritional status among the study population groups. To assess the increase in the prevalence of cardiovascular disease among South Asian populations compared to the US population, a narrative review of accessible data is carried out. The data in support of the present document are from the Centre for Disease Prevention and Control, Statistics for Heart Diseases and Stroke 2023, a trend analysis about incidences of cardiac diseases and global burden in 2017, all dating back to the last two decades. Relevant articles from PubMed and Google Scholar have also been included, as appropriate, and their references are provided wherever necessary. Graphs for the geographical variations in disease incidence are produced using Microsoft Excel (Microsoft® Corp., Redmond, WA). The review shows that there is a significant decline in the prevalence of CVD among American citizens when compared to the steady increase in the number of cases among South Asians, which is attributed to the unique genetic predisposition of South Asians to be more prone to CVDs. The changing dietary habits also play an important role in the fall in HDL levels in South Asians when compared to Americans. This is driven by genetic disparities, including the APOA1 and APOA2 genes, and nutritional disparities, including variance in quality and quantity of dietary consumption. Addressing the escalating cases of CVD among South Asians necessitates additional research to enhance proactive preventive measures and implement screening programs specifically tailored to address prevalent risk factors within the population.

This narrative review seeks to elucidate clinical and social factors influencing cardiovascular health, explore the challenges and potential solutions for enhancing cardiovascular health, and identify areas where further research is needed to better understand cardiovascular issues in native and American Pakistani populations.
The prevalence of cardiometabolic disease is high not only in Pakistan but also among its global diaspora. This situation is further complicated by the inadequacy of current cardiovascular risk assessment tools, which often fall short of accurately gauging the risk among Pakistani individuals, underscoring the urgent need for more tailored and effective assessment methodologies. Moreover, social determinants play a crucial role in shaping cardiovascular health. The burden of cardiovascular disease and upstream risk factors is high among American Pakistani individuals. Future research is needed to better understand the heightened risk of cardiovascular disease among Pakistani individuals.

South Asians (SAs) are among the fastest growing populations in the USA. Colorism - the system of inequality that views lighter skin as more advantageous in society - is prevalent in SA culture. This study evaluates motivations of sun protection use, attitudes of colorism, and skin lightening (SL) practices among SA Americans. Two-hundred-four participants recruited from online forums and ResearchMatch completed a questionnaire. Over half (111/204) reported use of sunscreen, of which 39.6% (44/111) reported daily or frequent use. Nearly half of respondents (98/204) believed that they are not at risk for skin cancer, with 37.7% (77/204) reporting minimal knowledge of skin cancers and only 4.9% (10/204) receiving a total body skin exam. One-third (65/204) reported being more concerned about prevention of tanning than skin cancer. In total, 38.2% (78/204) of respondents reported use of SL products, of which 33.3% (26/78) reported hydroquinone-based products and 26.9% (21/78) were unaware of the ingredients in their SL product. Only 16.7% (13/78) consulted a medical professional before using SL products. While many agreed that SA culture places high importance on light skin with regards to beauty standards (82.3%, 168/204), less noted that lighter skin is more beautiful (37.0%, 74/204). SL users more strongly agreed with colorism attitudes than non-users. Limitations include a small sample size with younger participants. Dermatologists must be mindful of the cultural motivations for skin tone preferences, sun protection habits, and SL behaviors and provide culturally relevant education on sunscreen, skin cancer, and risks of SL for the SA community.

Asian Americans have been identified as a racial group that is disproportionately affected by childhood trauma. The goal of this study was  to assess if religion/spirituality moderate the effects of childhood trauma on adult depressive symptoms among a sample of South Asians in the USA. Our analysis drew from the study on stress, spirituality, and health (SSSH) questionnaire fielded in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 990) during 2016-2018. A series of regression models with multiplicative interaction terms were conducted. Emotional neglect, emotional abuse, and physical neglect were associated with higher depressive symptoms. Higher religious attendance and negative religious coping techniques were found to exacerbate this relationship. There were two findings conditional on gender. Among men, gratitude and positive religious coping also exacerbated the relationship between childhood trauma and depressive symptoms. Negative religious coping also exacerbated the association between childhood trauma and depressive symptoms for women. This is the first community-based study of US South Asians to consider the association between various forms of childhood trauma and depressive symptom outcomes. South Asians remain an understudied group in the religion and health literature, and this study sheds light on the important differences in the function and effectiveness of religion/spirituality for those faced with early life trauma.

South Asian (SA) Canadians with kidney failure have a 50%-77% lower likelihood of kidney transplant and are less likely to identify potential living donors (LDs). This study aimed to identify health system-, patient-, and community-level barriers and facilitators for accessing LD kidney transplantation in the SA community to inform the development of health system- and community-level interventions to address barriers.
Qualitative study.
20 SA recipients of an LD or deceased-donor kidney transplant, 10 SA LDs, and 41 general SA community members.
In-depth multilingual interviews were conducted with recipients and LDs. Gender-, language-, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data.
Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, and financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplant; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their health care teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care.
Limited geographic, race, and cultural representation and reliance on virtual data collection.
This study highlights several culturally relevant barriers to donation and transplant that are potentially modifiable through patient-, health system-, and community-focused engagement and education.