Title : The long-term effects of structured lifestyle interventions on the absolute 10-year cardiovascular disease risk among Asian Indians: Results from the follow-up study of the Kerala Diabetes Prevention Program
Abstract:
Background: Studies have demonstrated the short-term effectiveness of structured lifestyle interventions in lowering absolute cardiovascular disease (CVD) risk among individuals at high risk for type 2 diabetes. However, their long-term impact remains unclear.
Objective: This study aimed to evaluate the 9-year effects of structured lifestyle interventions on the predicted 10-year CVD risk in a population of Asian Indians with a high risk for type 2 diabetes.
Methods: The Kerala Diabetes Prevention Program (K-DPP) included 1007 individuals (500 control, 507 intervention) with an Indian Diabetes Risk Score of ≥60 and no diagnosed diabetes at baseline. The intervention group underwent a 12-month structured lifestyle modification program delivered by trained lay peer leaders through 15 group-based sessions, while the control group received a healthy lifestyle advice booklet. Participants were followed up at 1, 2, and 9 years post-baseline. The primary outcome measure was the predicted 10-year CVD risk, calculated using the Framingham Risk Score, which incorporates variables such as age, sex, smoking status, blood pressure, HDL-cholesterol, diabetes status, and hypertension treatment. Mixed-effects linear regression models were employed to analyze the differences in the mean change of the predicted 10-year CVD risk from baseline to follow-up periods between the intervention and control groups.
Result: Of the 1007 participants enrolled at baseline, 982 (97.5%) were followed up at 1 year, 964 (95.7%) at 2 years, and 861 (85.5%) at 9 years. The mean score for the predicted 10-year CVD risk in the control group and intervention group at baseline was 7.86 (7.04) and 8.41 (7.83) respectively. The mean predicted 10-year CVD risk increased by 1.56% (95% CI: 0.92, 2.21; P<0.001) and 2.28% (95% CI: 1.63, 2.92; P<0.001) at 1 and 2 years, respectively, in the control group. In contrast, the respective increases were lower in the intervention group, at 0.92% (95% CI: 0.26, 1.58; P=0.006) and 1.6% (95% CI: 0.95, 2.25; P<0.001). Over the nine-year follow-up period, the CVD risk increased by 9.99% (95% CI: 9.31, 10.66; P<0.001) from baseline in the intervention group and by 9.83% (95% CI: 9.16, 10.50; P<0.001) in the control group. The differences in mean changes in CVD risk between the intervention and control groups at 1 year was -0.64 (95% CI: -1.23, -0.04; P=0.030); at 2 years, -0.68 (95% CI: -1.36, -0.01; P=0.050); and at 9 years, 0.16 (95% CI: -1.17, 1.48; P=0.810).
Conclusion: Structured lifestyle interventions significantly reduced absolute CVD risk among individuals at high risk for type 2 diabetes within the first one to two years following intervention. However, the long-term effects on sustained CVD risk reduction remain uncertain.
