Population-level interventions for coronary heart disease prevention: what have we learned since the North Karelia project?

PURPOSE OF REVIEW: The prevalence of coronary heart disease (CHD) risk factors in the population necessitates investment in the design and delivery of effective population-level interventions to prevent and enhance the management of CHD. This review examines the approaches that have been central to the design and delivery of previous, seminal population-level CHD prevention programs; it offers recommendations for the design and evaluation of the next generation of population-level CHD prevention trials. RECENT FINDINGS: Almost 50% of the decline in the rates of CHD mortality in the developed world can be attributed to population-level declines in CHD risk factors, including cholesterol, hypertension, and smoking. There is evidence that community-based CHD prevention interventions can have a positive impact on these risk factors within a distinct population. More recent community-based CHD trials have focused on discrete populations including the socioeconomically deprived, ethnic minorities, and rural communities. SUMMARY: There has been large variability in the success experienced by population-level CHD prevention trials. Best practices have emerged which may be used to inform the design of future trials. These include the need for multisectoral partnerships, coordination of multi-level interventions (programs and policy), and delivering a sufficient intervention dose to targeted populations.