Scand J Public Health 2001; 29 (suppl 56): 46± 58Objectives: There is a need among healthcare providers to acquire more knowledge about small-scale and low budget community intervention programmes. This paper compares risk factor outcomes in Swedish and US intervention programmes for the prevention of cardiovascular disease (CVD). The aim was to explore how diVerent intervention programme pro® les aVect outcome. Methods: Using a quasi-experimental design, trends in risk factors and estimated CVD risk in two intervention areas (Norsjo È , Sweden and Otsego± Schoharie County, New York state) are compared with those in reference areas (Northern Sweden region and Herkimer County, New York state) using serial cross-sectional studies and panel studies. Results: The programmes were able to achieve signi® cant changes in CVD risk factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US population. For the Swedish cross-sectional follow-up study cholesterol reduction was 12 % , compared to 5 % in the reference population ( p for trend diVerences < 0.000). The signi® cantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of the Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-sectional and panel studies showed a > 10 % decline in smoking prevalence in the intervention population, while it increased slightly in the reference population. When pooling the serial cross-sectional studies the estimated risk reduction (using the Framingham risk equation) was signi® cantly greater in the intervention populations compared to the reference populations. Conclusions: The overall pattern of risk reduction is consistent and suggests that the two diVerent models of rural county intervention can contribute to signi® cant risk reduction. The Swedish programme had its greatest eVect on reduction of serum cholesterol levels whereas the US programme had its greatest eVect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in these rural areas bene® ted as much or more from the interventions as those with greater social resources.