Primary Prevention of Coronary Heart Disease versus Health Promotion — a Contradiction?

Abstract

The German Cardiovascular Prevention Study is a multicentre community-based intervention study with the primary goal of reducing cardiovascular mortality by primary prevention measures. The intervention strategy comprises improving people's life styles as well as health promotion so as to modify cardiovascular risk factors (hypercholesterolemia, cigarette smoking, arterial hypertension, physical inactivity and overweight). Design elements of the German Cardiovascular Prevention Study, now in its fifth year, were adopted from well known community intervention studies, including monitoring of mortality and morbidity, health examination surveys to assess distribution of cardiovascular risk factors, health attitudes and health behaviour in the community and use of formative and process evaluation to monitor the effects of intervention policies in the community.

To identify risk factor profiles a cluster analysis was carried out from survey data. Four clusters were identified: a) people with none or few risk factors; b) those with high prevalence of smoking; c) those with high prevalence of hypercholesterolemia and hypertension; d) high risk factor exposure individuals. The clusters are different along social indicators like age, sex and social status. Process evaluation data show that special strategies like interventive blood pressure screenings reached a relatively high proportion of people from lower socioeconomic status. But they also indicate that there is a long way to go from publicity of intervention programs to lasting changes in behaviour.

Key Words:

• community study
• coronary disease
• process evaluation
• participant analysis.