Community intervention programs to prevent cardiovascular disease

Purpose

The primary purpose of this investigation is to:

• systematically review, compile, and assess community intervention programs aimed at preventing cardiovascular diseases,
• describe and analyze trends concerning the occurrence and progression of cardiovascular diseases in Sweden,
• develop recommendations on community intervention programs for decision makers and staff involved with public health issues.

Methods

Systematic review of the literature and cost analysis.

Collection of Primary Data

Questionnaire survey of experts in the field of cardiovascular disease prevention to identify preventive programs that meet the inclusion criteria. Reports acquired directly from project representatives and via an on-line search of the literature.

Review of the Reports

Internal review by project group, SBU Board and SBU Expert Group. Additional external review by experts in the field.

Inclusion Criteria

The following inclusion criteria were used:

• the program must cover the entire population within a geographically defined area,
• the program must be aimed at multiple risk factors,
• the program must have a controlled design, i.e. a reference population must be included,
• the outcomes, reported as changes in cardiovascular risk factors or changes in cardiovascular disease, must be published.

Certain projects which did not fulfill the criteria listed above were briefly reviewed.

Conclusions and Recommendations

Eight projects that met the above criteria were reviewed. Cardiovascular risk factors had been reduced in several of these projects, but not substantially more in the intervention population than in the control populations. Likewise, morbidity and mortality did not decline more in the intervention populations than in the control populations.

Hence, there is no scientific evidence to support the start-up of new, large scale projects similar to the ones assessed.

Certain programs which did not meet the inclusion criteria are addressed briefly. Several of these programs reported a decline in risk factor levels, but adequate control populations are lacking. In randomized projects that addressed risk factors in high-risk individuals, the outcomes reported in the intervention groups were not generally superior to the outcomes in the control groups.

However, it is evident that risk factors such as smoking, high blood pressure, unhealthy diet, sedentary life style, and social factors play a major role in the incidence of myocardial infarction and stroke, and these diseases can, to some extent, be prevented if such risk factors are eliminated. There is a major need to further develop methodology in this field. Experience suggests that smaller, local projects may offer a better foundation for studies on how to more effectively prevent cardiovascular disease in the population.

Numerous projects aimed at preventing cardiovascular disease are underway in Sweden. Scientific expertise must be strengthened so the outcomes of preventive interventions can be more accurately assessed.