Lim and Mr. Ronnie G. Villarosa and. Bailan had a lecture on the prevention and control of Hypertension emphasizing on the healthy diet which significantly minimize the risk of developing heart diseases.
On the same day, a Zumba exercise was done which considered as the best thing to prevent heart diseases and attended by 68 individual from different 4 services Medical, Nursing, Hospital Operations and Support System, and Allied-Ancillary and Finance Service CRMC employees. In line with the celebration of the Valentines Day, the highlight of the activity was the search for Mr. The following were the winners: Mr. The other set of winner were Dr. Superiodedad as Ms Heart Month and Mr. Abbreviations: DBP, diastolic blood pressure; Di.
Possible scores ranged from 0 to 8. Selection of studies included in a systematic review of the effectiveness of community programs for prevention of cardiovascular disease CVD , — All programs included a media-based approach, using combinations of radio, television, and printed material to communicate heart health messages. Program lengths ranged from 1 year to more than 20 years during the period —, and the sizes of the intervention populations ranged from approximately people to over 1,, people.
Risk factor levels in control and experimental groups were measured preintervention, postintervention, and, in some cases, during the intervention period.
Program evaluation varied in quality Table 1. In the majority of studies, protection against contamination was not clear. In some studies, intervention and control groups were not similar at baseline and only self-reported outcome measures were used, resulting in overall poorer quality scores.
Of the 36 included programs, 22 provided sufficient information on physiologic CVD risk factors cholesterol, blood pressure, and smoking to calculate the net treatment effect on year CVD risk. In 7 studies, investigators reported changes in mortality rates primarily CVD mortality , and results are given in Table 2. Data were reported as change and percent change in CVD mortality rate and change in total mortality rate. In 2 studies, researchers presented postintervention mortality rates but not baseline mortality rates; therefore, it was not possible to calculate net change for those studies.
Net changes in individual CVD risk factors were mixed but generally showed a trend towards a positive program effect Table 3. There appeared to be reasonable consistency in outcome changes—that is, where positive effects were seen in 1 risk factor, there also tended to be positive changes in others.
However, since there was no formal meta-analysis, these may not necessarily represent valid summary estimates. Calculation of overall net changes in year CVD risk showed a more consistent trend Table 3 and Figures 2 and 3 , with an average net reduction in year CVD risk of 0. When expressed as a percentage of baseline risk, the average net reduction in year CVD risk was 5.
When expressed as a percentage of baseline risk, this reduction was 6. For complete names of programs, see Table 1. There are a number of well-known community CVD prevention programs, but this systematic review identified an unexpectedly large number of additional programs, and many of these have not been featured in previous systematic reviews.
Therefore, this systematic review brought together a large body of previously unreviewed evidence. The favorable trend toward reduced rates of CVD mortality suggests that these programs may be beneficial for the prevention of CVD, but the limited number of studies presenting these data and the lack of statistically significant findings limit the interpretation of mortality results.
A larger amount of data was available on changes in physiologic CVD risk factors. Consistent trends in favor of CVD programs for individual risk factors were evident, but in isolation the sizes of these effects appeared clinically insignificant.
On the basis of a potential cumulative effect of individual risk factor changes, it appeared likely that the overall effect might be more clinically significant, and this was the purpose of considering the impact on an overall risk score. The calculated risk score findings suggest that there is a net favorable effect associated with community CVD prevention programs.
Although it was not obtained via meta-analysis, the average net reduction of 0. This risk reduction equates to a number needed to treat of in order to avoid 1 case of CVD over 10 years. In population terms, this may have important benefits, where large-scale, whole-population approaches are being implemented. Investigators have sought to untangle possible determinants of program success 51—53 , and in 1 review, Sellers et al.
Although variation in both the nature of programs and the apparent effectiveness of programs was observed, the limited information on the nature of each program, the large number of other factors which also varied between programs, and the lack of statistical information made further investigation of the effect of variation in intervention futile.
This key question thus remains unanswered by this systematic review. This intervention appears not to have been unique, and there may be more uniformity in the ability of programs to bring about reduction in risk than previously thought.
Net increases in CVD risk were observed in some cases, and 4 programs showed net negative effects Coalfields 19 , Minnesota 34 , National Research Program 39 , and Zurich On the whole, the size of these increases was relatively small, but for the Zurich study, there appears to have been a large increase in predicted CVD risk associated with the intervention. The study investigators discussed this finding and noted that there may have been some systematic error in the measurement of cholesterol levels They also commented on the limited intensity of the intervention program and suggested that this may have been responsible for the unfavorable results These factors may have contributed to the apparent ineffectiveness of this particular program, but the potential for harm cannot be ruled out.
It is possible that a program of this kind, if received badly or implemented in a way that increases social inequalities, could result in adverse effects. Of those that did recall media messages, the less educated and manual workers, particularly men, were less likely to report having been influenced by those messages However, when health outcomes were examined according to social stratum, net changes in overall estimated risk were found to be similar, if not more beneficial, in persons with a low educational level compared with persons with a high educational level, and investigators concluded that this project had, if anything, reduced health inequalities Despite these findings, it remains uncertain whether programs of this type have the potential to increase health inequalities, and the potential for harm may be an important consideration.
The observed results are affected by uncertainty arising from limitations in the primary research and review method. All of the included studies used a controlled before-after or controlled interrupted time series design, and a potentially important methodological issue is the mode of outcome data collection.
The scale of the intervention populations dictated that only samples of the whole population could be evaluated, and differences in approach are potentially important.
In some studies, researchers employed a cohort approach, using the same subpopulation to measure outcomes throughout the study, while others used a cross-sectional approach, where different randomly selected samples of the whole population were chosen at different time points. These study designs are open to different sources of bias contamination in cross-sectional surveys and differential attrition in cohort studies.
Cohort studies may provide a better measure of an intervention's effect on a stable population, whereas cross-sectional studies may provide a better measure of the total population effect including the effect of contamination.
Where treatment and control areas are similar with respect to social and geographic factors that govern rates of dropout, differential attrition may be unlikely. In the majority of studies, the investigators stated that communities with similar age ranges and socioeconomic profiles were selected as controls.
Although differential attrition cannot be discounted, it appears unlikely that this factor had a major influence on results for cohort evaluations. Results for cross-sectional surveys appear to have been less favorable than those for cohort surveys, and a potential cause may be cross-community contamination. In order to select controls with similar socioeconomic profiles and secular trends in CVD, investigators often chose control communities that were located reasonably close to intervention communities.
The spread of media coverage and individual migration between the intervention and control communities may, to some extent, have reduced the apparent intervention effect in programs evaluated by means of cross-sectional surveys. Another potential source of bias associated with these types of studies is the choice of control group.
Differences in intervention and control groups at baseline may not in themselves be a source of bias, since baseline measurements are taken into account in the calculation of net change. However, differences present at baseline may reflect differences in the types of people living in each community. Where control and intervention groups are well-matched at baseline, secular trends are more likely to be equivalent, and there may be less risk of bias.
However, where there are substantial differences at baseline, these may reflect differences in population groups with different underlying secular trends.
It is unclear in which direction this source of bias may act, but the quality of control group selection is an important consideration in assessing the validity of these types of studies. The applicability of programs included in this review to the present is also uncertain. Changes in the prevalence of risk factors and changes in attitudes, lifestyles, and community settings may have an impact on the effectiveness of these types of programs and may limit the generalizability of findings.
Areas for intervention were often selected on the basis of elevated CVD risk, and this may have implications for their applicability to future program implementation. It is unclear from the current review whether these types of programs have a lesser or greater effect in high-risk communities, but the possibility of differential program effectiveness should be considered.
Another issue relating to the applicability of programs is the nature of subjects taking part in evaluation surveys. Persons who lead less healthy lifestyles, younger persons, ethnic minorities, and persons of lower socioeconomic status may be less likely to participate in surveys, and this can lead to response bias.
Weinehall et al. However, only minor differences regarding socioeconomic status assessed by employment type and educational level were found. Survey respondents had a more favorable total cholesterol level but higher average blood pressure, and there were no differences in body mass index or rates of smoking However, these findings may not be true in all cases, and the extent to which response bias affects the applicability of findings to whole populations is unclear.
In addition to limitations arising from the nature of the primary research, there are some limitations arising from the review method. In this review, because of a lack of statistical information in the majority of included studies, it was not possible to calculate confidence intervals or to carry out meta-analysis.
For approximately half of the included studies, no information relating to within-study error for risk factor changes was given. This hinders the interpretation of the overall findings, since overall statistical significance could not be assessed.
Additionally, risk factor data that could be used to generate a CVD risk score were not reported for all included programs. Results for the 14 programs that were not included in the calculation of CVD risk were mixed Appendix Table 2. Although some showed favorable results, overall these programs appeared less promising than those for which CVD risk was calculated, and their exclusion may have produced an overly optimistic result.
However, for programs that were included in the calculation, missing values for certain risk factors diabetes status and high density lipoprotein cholesterol level were missing for most programs, smoking status was missing for 3 programs, diastolic blood pressure and total cholesterol level were missing for 2 programs, and systolic blood pressure was missing for 1 program would tend to counteract this.
Missing values are likely to reduce apparent effect size, since, where values are missing, risk factors are presumed to remain constant, resulting in smaller apparent treatment-versus-control differences. Therefore, the calculated average net CVD risk reduction may be a realistic estimate of the effectiveness of community CVD programs. Finally, an ever-present threat in systematic reviews is the possibility of publication bias. We were able to guard against this to a considerable degree because of the comprehensive search used, which included possible sources of gray literature.
It is therefore improbable that there were large numbers of negative studies missed from the review, and publication bias appears unlikely to overturn the current findings. Community interventions for the prevention of CVD appear to have generally achieved favorable changes in overall CVD risk. Considerable uncertainty remains, but this review provided no evidence that community prevention can be rejected as a useful approach to preventing CVD. However, programs implemented in the past need to be adapted to current circumstances, and revised approaches should be reevaluated before widespread implementation.
This work was supported by the Centre for Public Health Excellence of the United Kingdom National Institute for Health and Clinical Excellence as part of its public health guidance development program. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account.
Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Oxford Academic. Since the limited perspectives, the projects could not achieve the greatest impact comparison of the projects used policy and environmental approaches.
For example, in Stanford Five-City Project, the intervention conducted in the treatment cities was a 6-year multifactor risk reduction program including newspapers, television and radio, mass-distributed print media, classes, contents, and correspondence courses The results showed that changes in risk factors were observed, but no evidence of a treatment-control difference in terms of combined-event rate of cardiovascular disease between and 9, On the contrary, community-based projects to prevent cardiovascular disease in the Europe, who using approaches focusing on policy and environmental changes have been more successful than those in the USA.
The results indicated that major changes have taken place in the levels of target risk factors in North Karelia Table 1 3. The risk factors targeted by the program could explain most of the decline in ischamic heart disease observed over 20 years Another example is Heartbeat Wales project. The effective community-based secondary prevention programme would prevent many deaths that occur in middle- and older age and substantially reduce disability related to CVD.
Secondary prevention involves identifying, treating and rehabilitating these patients to reduce their risk of recurrence, to decrease their need for interventional procedures, to improve their quality of life and to extend their overall survival Several studies have demonstrated the effective-ness of community-based secondary prevention interventions in the control of CVDs Data from this study indicate that secondary prevention and changes in coronary care are strongly linked with declining coronary end-points.
It is now clearly evident that lifestyle changes such as smoking cessation, healthy dietary practices, weight control and regular moderate physical activity, can significantly contribute to reduction in cardiovascular mortality in people with established CVD and their recurrence.
One reason is that a sensitive and valid tool for assessment of quality of life for CVD patients may not be available.
Lack of assessment instruments makes it difficult for health service providers to identify the needs of patients, and less fitted interventions or services provide.
Here I will briefly describe existing quality of life assessment tool and indicators for testing effectiveness of CVD interventions or treatments. There is no consensus definition of quality of life until now. Different quality of life assessment tools are based on different concepts and consist of different domains dimensions of quality of life.
There are twenty-four facets subdomains are incorporated within six domains. Quality of life assessment instruments can be classified as a generic instruments to assess quality of life in a variety of situations and population groups and b specific instruments to assess quality of life of specific populations e.
Table 2. Summary of commonly used questionnaires and indicators for assessment of quality of life in patients with CVD. The aforementioned WHOQOL instruments, for instance, are generic ones, which have six uses: in medical practice; improving the doctor-patient relationship; in assessing the effectiveness and relative merits of different treatments; in health services evaluation; in research; and in policy making.
Although many studies on quality of life in patients with CVD can be found 33,37 , no specific instrument exists. Normally different scales are used together to assess the quality of life in patients with CVD according to different concepts and narrow or broad domains covered. In terms of quality of life assessment for testing effectiveness of CVD interventions, the studies and practices have been predominantly done in clinical settings, including assessment of changes in quality of life for patients receiving coronary artery bypass grafting CABG , percutaneous tansluminal coronary angioplasty PTCA , cardiac transplants, valvular surgeries, exercise rehabilitation, and so on 37 The commonly used questionnaires scales , domains Indicators are listed in Table 2.
CVD Prevention at the community-level is essential because modifiable causal risk factors are deeply entrenched in the social and cultural framework of society. From the limited publications included in this paper, several experiences and evidence should be completely understood and emphasized. Both community-based primary prevention and secondary prevention are needed for CVD prevention and control.
Primary intervention is directed to susceptiable people before they develop a cardiovascular disease. The key objective of primary prevention is to reduce the incidence of disease and consequently, its sequelae 5.
But the effects of CVD prevention and control must include not only changes in the frequency and severity of CVDs but also preventing recurrence of the established CVD, reducing mortality of those patients and improving their quality of life.
The World Health Organization global strategy for the prevention and control of noncommunicable disease emphsized that in addition to reducing the common risk factors in the population, secondary prevention of major cardiovascular events fatal and non-fatal myocardial infarction; fatal and non-fatal stroke; sudden cardiac death, re-vascularization procedures should be regarded as a key component of any public health strategy to reduce the rising burden of CVD in low and middle income countries But we should avoid completely using less cost-effective secondary interventions, such as high-tech methods to identifying patients, pharmacological methods to treat patients.
The key areas for improving secondary prevention of major CVD include: community-based approach, patient-oriented delivery system and support for self-management Community-based primary prevention of CVD should target main cardiovascular risk factors, especially four behavioral risk factors tobacco, unhealthy diet, physical inactivity, alcohol using comprehensive risk-management strategies.
World Health Report showed that, obesity, high blood pressure, high cholesterol, alcohol and tobacco — independently and often in combination, are the major causes of CVDs The scientific evidence is strong that a change in dietary habits, physical activity, tobacco control and alcohol consumption can produce rapid changes in population risk factors for CVDs.
Comprehensive risk-management for community cardiovascular risk decreasing is because CVD is multifactorial disease process Many people have more than two cardiovascular risk factors at the same time. Community-based primary prevention of CVD need combination of population approach and high-risk approach. Cardiovascular risks often occur as a continuum throughout the population.
Shifting population distributions of exposure can gain large potential reduction in CVD morbidity and mortality Since most CVD occurs in the masses of people not at the highest risk level high-normal to borderline level , high-risk approach will do little to quell the current epidemic of CVD, especially in the developing countries, where limited medical resources can not afford the interventions mainly relying on treatment of high risk subjects.
A combination of high-risk and population-based approach is essential to shift the cardiovascular risk profile. Prevention through population-wide behavior modification will be more cost effective than high-risk approach intervention The changes in risk achieved in population-based studies are often small, but it should be realized that even small changes in the distribution of risk factors in the population will bring about sizable changes in CVD mortality as demonstrated among different countries.
Furthermore, high-risk intervention should more focus on routine health counseling in primary health system and other evidence-based, cost-effective measures which have the feasibility of being implemented on a mass scale. A major emphasis and strength of the community interventions for CVD prevention and control should be attempted to change social and physical environments in the community.
Behavioral psychologist have long recognized that behavior change may not depend on personal factors, but be more influenced by the social and physical environmental elements, especially for behaviors like physical activities, eating habits, stop smoking, which need to maintain day after day.
Another rationale for expanding community-based programs to include more environmental- and policy-level activities comes from behavioral science theory e.
Using life course perspective to consider community cardiovascular disease prevention and control. Most of community intervention programs are limited to the community resident aged 25 years and over.
The risk of CVD is influenced by social and biological exposures not only in adulthood but also in fetal life, infancy, childhood, adolescence. Some studies confirmed the origin of atherosclerosis in childhood and showed that the prevalence and extent of fatty streaks and fibrous plaques increase rapidly during the to year age span The life course perspective carries the potential of identifying the most appropriate and effective prevention strategies in different populations, because it considers the factors and processes that act at all stages of the life-span to affect risk of later disease Since the earlier in the CVD process preventive measures are instituted, the greater the likelihood for overall effectiveness and benefit, more community-based primary prevention programs target the youth aged less than 18 years should be advocated in the future.
Future community-based intervention for CVD prevention and control, especially secondary and tertiary prevention, should pay more attention to improve the quality of life in patients with CVD and related high-risk populations.
The measurement of quality of life should include developing new specific instruments or identifying more suitable questionnaires both multi-dimensional ones e. Although not including all related publications, this review clearly show that there are strong evidence base for community-based intervention for CVD prevention and control.
The success of community-based intervention for CVD prevention and control achieved in the past 30 years and experience of a few similar projects in developing countries, provide the ideas, approaches, strategies, models to help the developing countries and low-resource developed countries to address CVD.
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