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Study objective-To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD). Design-Quasi-experimental study comparing trends in an intervention area with those in a reference area. Setting-A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510 000 inhabitants) served as the reference area. Conclusions-It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction. (J Epidemiol Community Health 1999;53:243-250) Prospective studies in diVerent populations over the past 30 years have investigated the correlations between cardiovascular disease (CVD) risk factors and CVD morbidity and mortality. Participants-All1 2 Epidemiological studies during recent decades have confirmed the necessity of further eVorts to prevent CVD, especially in populations with a pronounced risk. In the US as well as in Europe, prevention programmes using a population oriented strategy to focus on the main risk factors have aimed to increase the public awareness of life style factors, to encourage changes in life style behaviours, and to shift the risk of the entire population to a lower level. In some of these programmes, high risk people have also been identified and counselled. A major unsolved question is whether the coronary heart disease and stroke incidence rates would improve further if the population wide strategy is combined with a strategy of detecting and treating people at higher risk. Among others, the Population Panel of the National Cholesterol Education Program (NCEP) hypothesised and anticipated a combined and compatible eVect in their report by a simultaneous implementation of the two strategies.

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