On a sunny Saturday morning in May, the India Cultural Center of South Jordan was alive with activity. Families mingled in the community center to music from the hallway speakers, chatting and eating, many making their way to or from the Hindu temple attached to the center. In a small classroom space off the main hallway, a group of community members, health workers, and volunteers were ready to find out if their efforts of the past year had worked.
Filling the room were the participants and researchers involved in an intervention focused on improving heart health in South Asian populations: the Utah South Asian Cardiovascular Health Initiative (U-SACHI). The intervention started last summer with a free heart health screening; since then, participants at risk of heart disease met at the ICC every month to learn practical, relevant, and evidence-based ways to improve their health.
A Personal Mission
At the front of the class, Kevin Shah, MD, a cardiologist in the Spencer Fox Eccles School of Medicine at the University of Utah and the head of U-SACHI, recapped what the group had covered in a year of monthly health classes.
But Shah’s mission to improve cardiovascular health in South Asian populations began nearly 20 years earlier.
“This is a personal issue for me,” Shah says. “I’m South Asian, I’m a cardiologist, and I chose medicine as a profession because of a personal loss.” Shah’s father passed away due to a heart attack at age 54. Shah was 20.
Such a loss is sadly not uncommon. Compared to other ethnic groups, people from India, Pakistan, Nepal, and other South Asian countries are more at risk of severe and early heart disease, which tends to develop about 10 years earlier than in other populations. South Asian populations also tend to have heart attacks at earlier ages.
The reasons why aren’t totally clear. Some of the known risk factors for heart disease, including diabetes and sedentary lifestyles, are more common in South Asian populations, and additional genetic factors probably raise the risk even further, Shah says.
Practical Change-Making
The classes at the ICC acknowledged that some risk factors are unavoidable, but the main focus was on factors that participants could change, like nutrition and exercise. Participants learned concrete guidelines that were tailored to be relevant to South Asian populations. For instance, whole grains are an important part of a heart-healthy diet for everyone, but the specific grains discussed as examples were ones commonly used in South Asian cuisines, including brown rice, jowar (sorghum), and bajra (pearl millet).
Importantly, the intervention also included information on the social and cultural side of healthy behaviors. “In certain communities, if someone offers you food, it’s insulting to turn it down, even if you don’t need it,” Shah says, which can make eating healthy more difficult at group events.
Participants discussed ways to change that conversation, destigmatize healthy eating, and work with their loved ones to support their health goals.
Course participants said that the class helped them make practical lifestyle changes and gave them the tools to better understand their cardiovascular health. Ram Jayakumar notes that the class helped put his health metrics into perspective. “The focus on South Asian populations helps us understand how the test results we get at the doctor’s office actually apply to us,” Jayakumar said. And Deepa Ramkumar started eating more fruit and checking food labels for nutrition information.
For another participant, Juganu Chhabra, a major draw of the intervention was its integration into a research study geared towards his demographic. “Most studies focus on Western populations, and we all have different DNA,” Chhabra said. “I wanted to be part of a study on the South Asian population.”
A Journey of Collaboration
The final step of the study was a last round of heart health measurements, which would be compared to participants’ initial metrics to see if the intervention helped. Parked outside the ICC was the Wellness Bus, a mobile clinic on wheels, ready to take group members’ blood pressure readings and test for indicators of cardiovascular disease risk like cholesterol. The heart health measurements also included blood tests for molecules that have been specifically implicated as cardiovascular risk factors for South Asian populations.
Collaboration with the Wellness Bus and community partners at the ICC were essential to the initiative’s success. “I’ve been really impressed by how much the local South Asian community is interested in this issue,” Shah said, “and I realized that when you dig, it’s because almost everyone within the community has been personally affected. They’ve had a family member or close friend, someone they grew up with, who had a heart attack at a very young age. So it tends to resonate within the community.”
Shah adds that while his work with U-SACHI is very different from his clinical work, he finds it extremely rewarding. “You get to build these actual interpersonal relationships within the community,” he said, “and you get to directly try to help people, even if it’s just with time and education and awareness. There’s a lot of value that comes from that.”