Community Interventions in Cardiovascular Disease Prevention
Pekka Puska National Public Health Institute-Helsinki
This chapter presents some general principles of community-based intervention programs for cardiovascular disease (CVD) prevention. General objectives concerning both medical and behavioral frameworks are presented. Some relevant behavioral social frameworks for planning and evaluation are reviewed. Major elements of the community program are given. Practical examples as well as the main 20-year results of the North Karelia Project -- the first major communitybased project for CVD prevention -- are given. Finally, some relevant recommendations are suggested.
Atherosclerotic CVD is the leading health problem in most industrialized countries, and is a rapidly growing problem in many developing countries. Since World War II, extensive medical research has been carried out to learn about the causes and mechanisms of this disease. Research has involved large epidemiological studies within and between populations, basic biochemical and animal studies, intervention trials, and large-scale community-based prevention studies.
Although much will certainly be learned in the future, much is already known about risk factors and pathological mechanisms. Smoking, elevated serum lowdensity lipoprotein (LDL) cholesterol, and elevated blood pressure have been shown to be major causal risk factors ( 1). Key questions are: How can this existing knowledge best be used for effective prevention in real life? How can individuals and populations best be helped for optimal heart health?