A combined community strategy to reduce cholesterol and other risk factors.

Our primary objective was to conduct an integrated program to reduce coronary risk factors in the population of an Israeli kibbutz. The population-based objective was to reduce the mean community total cholesterol level. The individual-based objective was to provide counseling and treatment for individuals at high risk and to reduce individual total and low-density lipoprotein cholesterol levels. The intervention included food policy changes in the central kibbutz kitchen, health education programs aimed at all age groups, and health counseling for individuals at risk. Evaluation was by questionnaire at baseline and at the end of two years, blood lipoproteins, and monitoring of all food purchased by the kibbutz. Fifty-three percent of the adult population (100 of 187) had borderline to high baseline total cholesterol levels. At one year, 27% of these were in the normal category. Egg consumption dropped by 6%, liquid oil by 7%, and red meat by close to 19%. Consumption of fish, chicken meat, and vegetarian patties increased. Consumption of 1% milk increased by almost 300%. We conclude that an integrated health education program targeting individuals and the community together can be effective in reducing risk factors for coronary artery disease.