Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease

Abstract

Study objective-To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD). Design-Quasi-experimental study comparing trends in an intervention area with those in a reference area. Setting-A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510 000 inhabitants) served as the reference area. Conclusions-It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction. (J Epidemiol Community Health 1999;53:243-250) Prospective studies in diVerent populations over the past 30 years have investigated the correlations between cardiovascular disease (CVD) risk factors and CVD morbidity and mortality. Participants-All1 2 Epidemiological studies during recent decades have confirmed the necessity of further eVorts to prevent CVD, especially in populations with a pronounced risk. In the US as well as in Europe, prevention programmes using a population oriented strategy to focus on the main risk factors have aimed to increase the public awareness of life style factors, to encourage changes in life style behaviours, and to shift the risk of the entire population to a lower level. In some of these programmes, high risk people have also been identified and counselled. A major unsolved question is whether the coronary heart disease and stroke incidence rates would improve further if the population wide strategy is combined with a strategy of detecting and treating people at higher risk. Among others, the Population Panel of the National Cholesterol Education Program (NCEP) hypothesised and anticipated a combined and compatible eVect in their report by a simultaneous implementation of the two strategies.

Screening for increased cardiometabolic risk in primary care: a systematic review

“…The highest response rate (93%) was found by Weinehall et al who describe the results of the first 8 years of the Västerbotten Intervention Programme in Sweden. 27 The individual screening strategy was combined with a population strategy by creating a local health promotion collaboration to raise public awareness. The opportunistic screening by Cope et al lasted 1 week, but the screening uptake was 39%.…”

“…Twenty-one screening programmes were performed in mixed populations ( Table 2). [4][5][6][7][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The British Family Heart Study reported which part of their study population was not previously diagnosed with coronary heart disease, high blood pressure, high cholesterol, or diabetes. None of the other studies provided any information about the composition of their study population.…”

“…Prevalence of hypercholesterolaemia (total cholesterol ≥6.5 mmol/l) ranged between 24% and 48% for females, and 26% and 46% for males. 14,17,21,22,[25][26][27] Seven studies calculated a cardiovascular risk score for participants: 15,16,[19][20][21]24,28 five studies reported results. 15,19,20,24,28 Apparently healthy people versus a mixed population.…”

High Proinsulin Levels Precede First-Ever Stroke in a Nondiabetic Population

“…19 As a part of this program, all men and women were invited to a health survey at the age of 30, 40, 50, and 60 years. At the same time, the 2 northernmost counties in Sweden (Västerbotten and Norrbotten) joined the World Health Organization (WHO) MONICA study.…”

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

“…The interventions as well as active hospital care with percutaneous coronary intervention (PCI) is likely to have contributed to the decreased incidence in CVD over time. 25 Our prospective study of HL survivors in Sweden identifies the risk profile of the patients through similar methods but adds the clinical visit to the oncologist. Visiting a physician is essential for detecting early cardiac and carotid murmurs.…”