Community-Wide Health Program Slows Creep Toward Heart Disease

A five-year push to blanket a Dutch community with healthy heart programs and education curtailed three major risk factors for heart disease: body mass index, waist circumference and blood pressure.

The cardiovascular disease prevention plan targeted residents of Limburg, a province on the southern edge of the Netherlands. The campaign, dubbed Hartslag Limburg — Dutch for Heartbeat Limburg — included nearly 800 programs from bicycling clubs and supermarket education tours to pamphlet distribution, a stop-smoking effort and commercials on local media outlets.

“This program was capable of actually, not so much improving the health status, but preventing the age- and time-related worsening of health status of this population,” said lead researcher Albertine J. Schuit, Ph.D.

The study reports on health indicators for more than 2,400 people between the ages of 25 to 70. About 750 residents from another Dutch region were also tracked between 1998 and 2003, but the second community was not exposed to the programs encouraging residents to become more active, reduce their fat intake and stop smoking.

The study appears in the current issue of the American Journal of Preventive Medicine.

As people age their risk for heart disease typically spikes with each passing year. For BMI, waist circumference and blood pressure, the worsening over time was less pronounced among the Limburg residents in the study.

The average waist circumference of the men in the Limburg group decreased by 0.4 centimeters, while men in the other Dutch community gained an average of 2.7 centimeters over five years — a more than six-fold difference.

The average BMI of the Limburg women increased by 0.38 kg/m2, while their counterparts put on 0.63 kg/m2.

Systolic blood pressure (the top number) was significantly lower for both Limburg men and women, with differences of 7.8 mm/Hg and 5.5 mm/Hg respectively.

The researchers also monitored changes in total cholesterol and blood glucose concentration, but the differences between the two communities were not significant overall.

Schuit, a public health scientist with the Netherlands’ National Institute of Public Health, was project director for the study. Most of the trial interventions were directed at increasing physical activity and a healthy diet, particularly less fat, she said, while only about five percent of the efforts discouraged smoking.

Michael E. Farkouh, a cardiologist who was not involved in the Dutch research, said the study results are no surprise.

“If you bombard a community with interventions that that have all been shown on in individual patient data to make a difference, then it makes sense that you will have a difference in the population,” said Farkouh, an associate professor at the Mount Sinai School of Medicine.

Schuit said Hartslag Limburg is a considered a “jewel” in the Netherlands, but cautions that the study design was not a randomized trial, the gold standard for research.

“Because we didn’t randomize, you can never know for sure if the changes we
find are solely the result of the intervention,” Schuit said.

Farkouh said the large number and wide-ranging type of interventions make the Limburg study difficult to replicate, or apply, elsewhere.

“Would this community-based program work in other settings and other health care systems and other populations and ethnic populations, and minority populations? That needs to be further evaluated,” he said.

“So I think this raises more questions than it answers. But the promising finding is that interventions – not patient centered, but community centered – do show significant public health endpoint difference,” Farkouh said.