Review of community intervention studies on cardiovascular risk factors.

The concept of community intervention in the field of cardiovascular disease prevention was introduced in the late sixties and early seventies. The WHO European Collaborative Trial in the multifactorial prevention of coronary heart disease used communities (factories) in a traditional controlled trial. The intervention used in this trial was an extension of a medical care model with preventive elements. The first two major community intervention projects in CVD prevention--the North Karelia Project and the Stanford Heart Disease Prevention Programme--were the basis of further WHO and NHLBI coordinated projects. They have used community-based population-wide strategies including existing community leadership, social networks, mass campaigns and extensive direct education for the general population. In the evaluation of those projects quasi-experimental models are used because "perfect experiments" are not possible. Some projects have proven the feasibility of community intervention and its positive impact on lifestyles and cardiovascular risk factors in a whole population and that such a development is associated with reduced cardiovascular mortality rates.