A culturally adapted lifestyle intervention for South Asian adults in the United States did not significantly reduce cardiovascular disease (CVD) risk factors compared to standard health education materials, according to a recent study published in JAMA Cardiology. The trial, which involved 549 participants, raises questions about the effectiveness of current lifestyle interventions in this high-risk population.
The study, named SAHELI (South Asian Healthy Lifestyle Intervention), was a single-blind randomized clinical trial conducted across community sites in the Chicago metropolitan area from March 2018 to February 2023. Participants were South Asian adults aged 18 to 65 years who were overweight or obese and had at least one additional CVD risk factor, such as hypertension, dyslipidemia, prediabetes, or diabetes. The intervention group received a 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches, with counseling in English, Gujarati, Hindi, and Urdu. The control group received monthly written health education materials.
The primary outcomes measured were changes in CVD risk factors from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol. Results showed no significant differences between the intervention and control groups. Specifically, the mean difference in weight change was -0.07 kg (95% CI, -0.55 to 0.42), SBP was 0.47 mm Hg (95% CI, -1.85 to 2.79), DBP was 0.44 mm Hg (95% CI, -1.06 to 1.95), cholesterol was -2.47 mg/dL (95% CI, -8.51 to 3.57), and HbA1c was -0.07% (95% CI -0.20% to 0.07%).
While the intervention did not reduce CVD risk factors, participants in the intervention group reported greater improvements in dietary quality, physical activity, and self-efficacy compared to the control group. This suggests that while the culturally adapted program had some positive impact on health behaviors, it was not sufficient to translate into measurable improvements in physiological risk factors.
"South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups," the authors noted. The study highlights the need for further research to identify more effective CVD prevention interventions for this population. The authors suggest that future interventions may need to be more intensive or address other factors contributing to CVD risk in this population.
The SAHELI trial's findings underscore the complexity of addressing CVD risk in diverse populations and the importance of culturally tailored interventions. However, the lack of significant reduction in key risk factors calls for a re-evaluation of current approaches and the development of more effective strategies to improve cardiovascular health in South Asian adults.
