Joint analysis of three U.S. community intervention trials for reduction of cardiovascular disease risk
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During the 1980s three comprehensive community-based heart disease prevention trials were conducted in the United States. The Stanford Five-City Project, Minnesota Heart Health Program, and Pawtucket Heart Health Program involved 12 cities; six received a 5-8 year multifactorial risk reduction program. This analysis pools data from the three studies to delineate the common intervention effects with greater sample size and power than could be attained by the single studies. Time trends were estimated for cigarette smoking, blood pressure, total cholesterol, body mass index, and coronary heart disease mortality risk in women and men aged 25-64 years. The joint estimates of intervention effect were in the expected direction in nine of 12 gender-specific comparisons; however, these were not statistically significant. The results illustrate the analytic challenges of evaluating community-based prevention trials and point to the smaller than expected net differences, rather than small sample size, as the reason for few statistically significant effects in the three U.S. prevention trials.
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Similar media and education strategies in the Minnesota Heart Health Program and the Pawtucket Heart Health Program did not lead to significant improvements in cardiovascular risk factors or events when compared with control communities.
“In contrast, similar media and education strategies in the Minnesota Heart Health Program and the Pawtucket Heart Health Program did not lead to significant improvements in cardiovascular risk factors or events when compared with control communities.61–63”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [62]
In the Minnesota and Pawtucket studies, secular improvements in risk factors were also seen in the control communities, perhaps in response to similar national campaigns targeting these risk factors; these trends may have limited detection of any added effects of the community-level interventions.
“In the latter studies, secular improvements in risk factors were also seen in the control communities, perhaps in response to similar national campaigns targeting these risk factors; these trends may have limited detection of any added effects of the community-level interventions.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [62]
Intensive community-level media and education interventions that targeted physical activity as part of a comprehensive set of health factors and behaviors produced mixed results, with benefits on risk factors in 1 study but no clear benefits in the other 2 studies compared with secular trends.
“These interventions produced mixed results, with benefits on risk factors seen in 1 study49 but without clear benefits in the other 2 studies, as compared with secular trends.61,62”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [62]
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- Authors
- Winkleby, M. A., Feldman, H. A., & Murray, D. M.
- Affiliations
- Stanford University (US)
- Memorial Hospital of Rhode Island (US)
- University of Minnesota (US)
- Corresponding author
- Winkleby, Marilyn A.
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 1997-06
- Volume
- 50
- Issue
- 6
- Pages
- 645-658
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2099139180
- Cited by
- 122
- References
- 69
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 4 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 3 · 2012: 3
- FWCI
- 9.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Epidemiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl023629-15, 5r01hl025523-13, 5r01hl021906-19)
- National Heart, Lung, and Blood Institute (HL-23629, HL21906, HL 25523)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- cardiovascular disease prevention, community-based intervention, pooled analysis, smoking, blood pressure, total cholesterol, body mass index, coronary heart disease mortality, middle-aged adults, intervention effect estimation, temporal trends
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Cholesterol, Cross-Sectional Studies, Female, Health Education, Humans, Male, Risk, Risk Factors, Smoking, Socioeconomic Factors, Time Factors, United States, Confounding Factors, Epidemiologic, Body Mass Index, Treatment Outcome
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