Indian and other South Asian Americans need targeted programs to improve heart health: study

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According to a new study conducted by Northwestern University scientists, the largest cardiovascular disease prevention trial to date failed to reduce risk but showed lifestyle improvements among South Asians in US.

The study, entitled “Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors:The SAHELI Randomized Clinical Trial” was conducted and co-authored by Namratha R. Kandula, MD, MPH, Nirav S. Shah, MD, MPH, and Santosh Kumar, LLP, et al.

The report which was published in the Journal of the American Medical Association: Cardiology, noted that South Asians are underrepresented in health research, despite having a disproportionately high risk of developing heart problems.

The study found a 16-week culturally tailored lifestyle program to promote healthy heart behaviors among U.S. South Asians did not produce significant reduction of clinical risk factors but did lead to improvements in diet and physical activity

Scientists and physicians have noted over the years that US health care systems are not reaching South Asians with relevant advice about diet, lifestyle.

Research has already shown that U.S. South Asians — a predominately immigrant population with heritage from India, Bangladesh, Bhutan, Maldives, Nepal, Pakistan and/or Sri Lanka — have a higher risk for developing and dying from heart problems than East Asians or non-Hispanic white people.

However, pinpointing underlying causes has proved elusive, a factor that prompted Northwestern Medicine scientists to launch the largest cardiovascular-intervention trial for U.S. South Asians.

While research has tried to explain the multiple causes for the  increased cardiovascular disease (CVD) risk among South Asians, including risk factors like Type 2 diabetes and less physical activity, relatively no work has assessed the success of attempts to change the heart health of one of the fastest-growing ethnic groups in the U.S., researchers said.

Northwestern University scientists took up the challenge and  conducted the largest lifestyle-intervention trial for U.S. South Asians, underscoring a need to build a larger body of research to better represent the diverse and vastly underrepresented group.

To the scientists’ surprise, the 16-week targeted, culturally tailored lifestyle program failed to significantly reduce cardiovascular risk factors, such as blood pressure, cholesterol and blood sugar levels compared to the control group 12 months after the study began. But in self-reports, trial participants said they were eating healthier, moving more and feeling more confident in eating and exercise choices, indicating a shift in the right direction.

“This trial marks a significant step forward in understanding how we can effectively support South-Asian communities in managing their cardiovascular health,”  Dr. Namratha Kandula, the study’s lead investigator and a professor of medicine at Northwestern University Feinberg School of Medicine, is quoted saying in the press release. “While the results show that our intervention alone was not enough to significantly alter clinical risk factors, the positive changes in health behaviors are promising and pave the way for more refined approaches.”

Kandula, also a Northwestern Medicine internal medicine physician, studies the way immigration can affect health disparities and has many affiliations across the University, including the Center for Diabetes and Metabolism, the Institute for Public Health and Medicine’s Center for Community Health and the Robert J. Havey, MD Institute for Global Health’s Center for Global Cardiovascular Health. She said she hopes the paper can be used as a model for others who are trying to engage diverse populations in clinical research.

The study was tailored to the unique cultural and linguistic needs of the South Asian community. The scientists worked with community partners, including community organizations, schools, public health officials and health coaches fluent in English, Gujarati, Hindi and Urdu, to deliver group sessions in familiar, accessible settings.

Between March 2018 and January 2022, 549 participants enrolled in the study and were randomly assigned to either a control group, which was mailed heart disease-prevention information each month, or the lifestyle-intervention group, in which participants attended tailored weekly group classes for 16 weeks.

Though the trial did not meaningfully change clinical heart-disease risk, Kandula said that could be explained by the timing of the coronavirus pandemic, the limited length of the trial and because many of the health challenges South Asians face are linked to environmental, not individual, factors.

“The trial was a way for people in the South Asian community to connect, create friendships and get support for their change in health behavior, which shows that improving heart health goes beyond the individual level, and that people need to be part of something bigger to sustain motivation and support,” Kandula said.

The study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the National Center for Advancing Translational Sciences.