A culturally adapted group-based lifestyle intervention targeted towards South Asian participants did not lead to a substantial difference in improving risk factors at one year compared with written health education materials, according to the single-blind randomized SAHELI study published in JAMA Cardiology.

In a study conducted from 2018-2023 to examine whether tailoring a lifestyle intervention to the culture and language of the participants would provide greater improvement in risk factors for cardiovascular disease, Namratha R. Kandula, MD, MPH, et al., randomized 549 South Asian adults in the greater Chicago, IL, to the intervention or control. This population has an excess of cardiovascular disease compared with other racial and ethnic groups.

Participants in the intervention group received a 16-week culturally adapted, group-based lifestyle program delivered in English, Gujarati, Hindi and Urdu by community health coaches, while those in the control group received written health education materials in their preferred language delivered monthly for one year. The intervention was originally delivered in person but switched to telehealth at the start of the COVID-19 pandemic. Participants tracked their diet and physical activity and had the option to join four additional maintenance sessions.

All participants had overweight or obesity without a history of cardiovascular events but had at least one additional cardiovascular risk factor: hypertension, dyslipidemia, prediabetes or diabetes. Their mean age was 49.2 years (range, 18-65), 57.9% were women; 98.2% were born outside of the U.S., and 42.1% reported limited English proficiency.

Results at the one-year follow-up showed no significant difference between the intervention and control arms for the primary outcomes of between-group differences in weight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin and total cholesterol.

However, there were improvements in the secondary endpoints of self-reported dietary quality, physical activity and self-efficacy in the intervention arm.

In an accompanying editorial comment, Anand Rohatgi, MD, MSCS, et al., discuss several reasons for the null result. These include the potential for earlier positive results directly after the intervention began that steadied out over the course of the year, as well as responder bias. "Lastly, while impaired lifestyle patterns contribute to increased [cardiovascular disease] risk," they write, "broad lifestyle modification strategies may be less effective than targeted interventions."

Yet, they commend the study as the largest lifestyle trial of U.S. participants with South Asian ancestry, which has been identified as a potential cardiovascular risk factor in the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.

"Perhaps the most important outcome of the SAHELI trial was gaining and increasing trust from the South Asian communities previously understudied yet at high [cardiovascular disease] risk," Rohatgi, et al., write. "This approach paves the way for future studies to improve health across all populations."