THIRUVANANTHAPURAM: A pathbreaking trial by researchers at Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) has proved that a carefully structured lifestyle intervention programme -- delivered by trained community health workers -- can significantly reduce cardiovascular risk in high-risk families, at just a fraction of the cost of conventional medical treatments.
The two-year-long PROLIFIC trial (Programme of Lifestyle Intervention in Families for Cardiovascular Risk Reduction), involving 750 families and over 1,600 people, has debunked the widespread belief that drug-based therapies are the only option for people genetically predisposed to heart disease.
With cardiovascular disease remaining India’s leading cause of death, the findings offer a promising alternative, especially in Kerala, where majority of low-income households face catastrophic health expenses and many are forced to take loans or sell assets for treatment. At a modest cost of just Rs 2,806 per person, the family-focused programme achieved results comparable to those of expensive pharmacological treatments, often costing 10 to 20 times more.
“The study proves that lifestyle change is not only possible but powerful, even for those in genetically high-risk groups,” said Dr Jeemon Panniyammakal, lead author of the study and additional professor at Achutha Menon Centre for Health Science Studies, SCTIMST. “There is a wrong notion that only drugs can help those with family history of heart disease. We have demonstrated that targeted lifestyle intervention is not just effective, but much cheaper,” he said.
The trial focused on first-degree relatives and spouses of patients with premature coronary artery disease -- those most vulnerable due to shared genetics, living environment, and behaviours. Rather than doctors, the programme was delivered by trained ASHA workers, the state’s frontline health volunteers. These community health workers visited homes regularly to monitor blood pressure and glucose levels, promote tobacco cessation, encourage dietary improvements, and facilitate regular physical activity.
What set the intervention apart was its family-centred approach. By engaging an entire household and not just individuals, it tapped into the influence of shared habits and emotional support. Family members helped each other stick to goals, whether by cooking healthier meals together or reminding one another to take daily walks.
The benefits were measurable and significant. Participants in the intervention group saw improvements in blood sugar levels, cholesterol, blood pressure and waist circumference. The proportion of people achieving optimal cardiac health conditions increased by 15%, while in the control group, it remained stagnant or declined.
Notably, the study was conducted in Kerala, a state already saturated with other health programmes, emphasising that the results came despite an already high baseline of care. “So imagine the results in states or regions with weaker preventive care systems,” Dr Jeemon pointed out.
The intervention is particularly suited for scale-up under Ayushman Bharat, India’s flagship health programme. Researchers estimate that if implemented across the country’s health and wellness centres, the programme could prevent 1,75,000 cardiovascular events annually. In Kerala there are almost 5,000 such centres with health workers trained in managing non-communicable diseases.
PROLIFIC exercise
Total families enrolled: 750 (1,600 participants)
Mean age of participants: 41 years
Delivery method: Home visits by ASHA workers, periodic OP visits
Focus areas: Diet, tobacco cessation, exercise, BP/sugar monitoring
Cost per person: I2,806
Cost for 10,000 people: I1.73 lakh
Pharmacological-only care: 10-20 times more expensive