Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme

Abstract

Background The effect of primary prevention of cardiovascular disease is debated. The Västerbotten Intervention Programme (VIP) is an individual and community-based public health programme that comprises the whole county of Västerbotten (VB). In the neighbouring county of Norrbotten (NB), no programmes have been implemented. Method Between 1994 and 2014, five surveys were performed in the two counties on persons aged 40 to 75 years within the Northern Sweden MONICA Study. The number of subjects participating was 6600 (75.4%). We compared time trends in risk factors between the two counties using regression models including age, county and year of survey. To test whether time trends differed between counties, the interaction between county and year was included in the models. Results Systolic blood pressure declined in both counties, and the decline was faster in Västerbotten than in Norrbotten ( p = 0.043 for interaction county*year). Diastolic blood pressure declined in VB but increased in NB ( p < 0.001). Cholesterol levels declined at a similar rate in both counties whereas body mass index increased in both counties. Fasting glucose decreased in VB ( p = 0.003) and increased in NB. The prevalence of regular smokers decreased faster in VB than in NB ( p = 0.01). Trend in waist and hip circumference, known diabetes, having an academic degree, being physically inactive or 10 year cardiovascular mortality according to SCORE did not differ. Conclusion Blood pressure, glucose and smoking improved at a faster rate in the county with a community and primary care-based intervention than in the county without such an intervention.

The impact of community based prevention on quality of life – the necessity to control for general health trends. The Northern Sweden MONICA Study in 2014

“…We found no significant differences in health-related QoL between the population of VB, with the health intervention program, and NB, without any similar program. The only previous research where VB is compared to another county, also based on the 2014 MONICA population survey and using similar methods as in this report, reported a faster decline in blood pressure and smoking in Västerbotten but similar trends for diabetes, cholesterol and obesity (8). However, the results are different from a previous evaluation of the impact of the program on self-reported health, in which a significant and positive effect was reported (7).…”

“…Still, several studies have evaluated the effects of the Västerbotten program on intermediate outcomes and report improvement on lifestyle parameters such as reducing smoking (5), increasing physical activity (6) and that self-reported health has improved (7), in particular in those with initial poor and fair health. A study of time trends in cardiovascular risk factors in VB, using the MONICA Study, showed a faster improvement in blood pressure and smoking but no difference in the prevalence of diabetes, cholesterol levels or BMI compared to the neighbouring county of NB (8).…”

The impact of community-based health promotion on quality of life: The need to control for general health trends. The Northern Sweden MONICA Study in 2014

“…We found no significant differences in health-related QoL between the populations of VB (which had been subjected to the VIP) and NB (which had not). The only other research that compares VB with NB, that also uses the 2014 MONICA Study data, and that employs similar methods to those in this report, found a faster decline in blood pressure and smoking in VB when the two counties in question were compared, but found similar trends when the two were compared with respect to diabetes, cholesterol and obesity (8). However, the results of our study differ from a previous evaluation of the VIP's impact on self-reported health, which found the intervention had had a significant and positive effect in VB (7).…”

“…These studies report that certain lifestyle parameters have been enhanced by, among other things, a reduction in smoking (5), an increase in physical activity (6) and an improvement in self-reported health particularly among those whose initial state of health was poor or fair (7). In addition, a study of trends over time in respect of cardiovascular risk factors in VB, using the World Health Organization's Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Study, showed a faster improvement in blood pressure and smoking but no difference in the prevalence of diabetes, cholesterol levels or BMI compared to the neighbouring county of NB (8).…”

Editor’s presentation: ‘You say you love your children above all else, and yet you are stealing their future in front of their very eyes’

“…Editor's presentation: 'You say you love your children above all else, and yet you are stealing their future in front of their very eyes' Massimo F Piepoli 1,2 Intergenerational associations of ideal health behaviours…”