Effects of communitywide education on cardiovascular disease risk factors: the Stanford five-city project

Article Abstract:

The effect of community programs aimed at educating people about risk factors for cardiovascular disease (CVD) was assessed in four California cities as part of the Stanford Five-City Multifactor Risk Reduction Project (FCP). Residents in the two treatment cities (Monterey and Salinas) underwent exposure to education regarding reduction of blood cholesterol levels, blood pressure, and cigarette use; weight control; and increasing physical activity. Messages were transmitted via the mass media and by direct education. Each adult was exposed to an estimated 527 educational episodes during a five-year period. Two comparable cities (Modesto, San Luis Obispo), which were isolated from the 'treatment market', functioned as control cities. Surveys were conducted at regular intervals to assess participants' knowledge of CVD risk factors, and their weight, height, body-mass index (an indicator of obesity), blood pressure, and blood cholesterol levels. Risk scores were calculated according to standard methods to determine the risk of death from any cause, as well as the risk of coronary heart disease (disease of the coronary arteries, which supply blood to the heart). Results showed that knowledge regarding CVD risk increased in both groups, but more for the treatment group, at all times studied. Residents of the treatment cities showed reductions in cholesterol levels (2 percent, on average), blood pressure (4 percent), smoking (13 percent), and resting pulse rate (3 percent). Both the estimated all-cause mortality risk (deaths per 1,000 people in 10 years) and the estimated coronary heart disease risk decreased in the treatment cities, by 15 percent and 16 percent, respectively. These figures do not, however, reflect actual changes in disease incidence, but rather in estimated risk, and must be interpreted with caution. On balance, though, they indicate that a low-cost program such as this can have important effects on health risk behaviors in large groups of people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Risk factors, Statistics, Coronary heart disease, California, Health promotion

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The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women

Article Abstract:

Weight loss by restricting calories or by increasing exercise in moderately overweight people is known to increase levels of high-density lipoprotein (HDL) cholesterol in the blood. Higher levels of HDL cholesterol have been associated with a lower incidence of heart disease. However, dietary modifications that include reductions in saturated fats and cholesterol cause these levels to drop. It is possible that these lower HDL levels, which are risk factors for coronary heart disease (disease of the arteries that supply blood to the heart), could offset the health benefits of lowering levels of low-density lipoprotein (LDL) cholesterol. The diet recommended by the National Cholesterol Education Program (NCEP) is a low-saturated-fat, low-cholesterol diet. To learn more about the effects of the NCEP diet in combination with exercise on HDL cholesterol levels in moderately overweight people (between 120 percent and 150 percent of ideal body weight), a study was carried out with men and premenopausal women (132 subjects in each group). Subjects were randomly assigned to a diet-only group, a diet-plus-exercise group, and a control group (no changes in diet or exercise). Results after one year showed that both men and women in the groups with diet-only or diet-plus-exercise lost significant amounts of body weight and fat weight (the primary type of weight loss for women), compared with weight loss among controls. Blood levels of HDL cholesterol were not significantly changed in the diet-only group, but they were higher for men in the diet-plus-exercise group than in the diet-only group. For women, exercise was not associated with higher HDL cholesterol levels, but the levels were higher for the exercise-plus-diet group than for the diet-only group (whose levels were lower than at the start of the study). The results indicate that exercise enhances the health benefits of a diet that is low in saturated fats and cholesterol for both men and women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Low-fat diet, Low fat diet, Low-cholesterol diet, Low cholesterol diet, Blood cholesterol, Lipoproteins, Blood lipoproteins

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Improved cholesterol-related knowledge and behavior and plasma cholesterol levels in adults during the 1980s

Article Abstract:

Widespread public information programs on the relationship of cholesterol and health in the middle to late 1980s resulted in greater knowledge and healthier behavior. Over 4,000 between 25 and 74 years of age were studied from 1979 to 1990 in two California communities. These people showed the greatest increase in health knowledge and decrease in plasma cholesterol levels beginning in 1985. Improvements in health-related behaviors and knowledge were more common in educated women and older non-smokers. Adults with higher educational levels had greater changes in their behavior and changed more quickly. Plasma cholesterol levels were lowest in younger, educated adults. If a one percent decrease in cholesterol level equals a two percent decrease in risk of coronary heart disease, then the risk in these communities dropped by nine to 16%.

Study and teaching, Cholesterol, Social status

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