Community-wide programs targeting cardiovascular disease risk reductions may improve population health over 40 years, according to a study published Jan. 13 in the Journal of the American Medical Association.

Led by N. Burgess Record, MD, the observational study analyzed data over 40 years from 22,444 rural, low-income residents in Franklin County, ME, beginning in the 1970s, using the previous decade as a baseline. The residents were exposed to the Franklin Cardiovascular Health Program, which emphasized detection and control of hypertension and hyperlipidemia; minimal tobacco use; management of diabetes; and an active lifestyle and healthy eating. Hospital staff as well as local businesses and schools were actively involved in the program to ensure continuity across the county.

Researchers measured the total and individual person encounters with program staff of adult participants, immediate risk factor outcomes, morbidity, and mortality over the four decades. The results of the study showed that as the cardiovascular disease risk factor program was introduced to the community, improvements were seen. Control over hypertension increased from 18 percent in 1975 to 43 percent in 1978, while control of elevated cholesterol increased from 0.4 percent in 1986 to 29 percent in 2010. The rate of quitting smoking improved from 49 percent in 1996 to 70 percent in 2000. The researchers note that “Franklin was the only Maine county with consistently lower adjusted mortality than predicted … [from] 1970-1989 and 1990-2010.” Mortality rates also decreased below Maine averages from 1970-2010.

The authors remark that while the study does show improved rates of relevant health markers, it does not distinguish improvements from health care reform. In addition, they note that further studies are needed to measure the effectiveness of such programs on other rural counties in the U.S., and other parts of the world.

In an accompanying editorial comment, Darwin R. Labarthe, MD, MPH, PhD, stated that “this report… should reinforce the importance of cardiovascular health promotion and disease prevention policies and practices at the community level; stimulate efforts in communities to document and publish their past experience in this area to inform related ongoing work; and foster wider application of program evaluation and implementation research, exploiting new data sources and technologies to accelerate replication and scaling up of community-based prevention.”

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