Key result
Community-based prevention program linked to ~56% lower all-cause mortality over 13 years.
Why the study?
There was no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population reduces cardiovascular disease mortality.
Does a community-based cardiovascular disease screening and primary prevention program reduce all-cause and CVD mortality in asymptomatic adults without established CVD?
Cohort (n=2,843)
No
Does a community-based cardiovascular disease screening and primary prevention program reduce all-cause and CVD mortality in asymptomatic adults without established CVD?
Hazard Ratio: 0.44 (95% CI 0.36–0.54)
A structured community-based screening and intervention program in primary care was associated with significantly lower all-cause and CVD mortality over 13 years.
May support primary care CVD prevention programs; leaves open causality and selection bias in this observational cohort.
OBJECTIVE: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN: A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. SETTING: A public health care centre in the town of Harjavalta, Finland. SUBJECTS: All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES: All-cause and CVD mortality. RESULTS: Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS: Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.
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Kuneinen et al. (2021) conducted a cohort in Cardiovascular disease prevention (n=2,843). Community-based screening and targeted primary prevention program vs. No intervention (non-respondents, no risk factors, or declined intervention) was evaluated on All-cause mortality (HR 0.44, 95% CI 0.36-0.54). A community-based primary prevention program combining screening and lifestyle counselling reduced all-cause mortality risk by 56% (HR 0.44) over 13 years compared to no intervention.
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