T.A. Pearson

A core group of concepts and recommendations form the theoretical, scientific, and policy basis for programs in cardiovascular disease (CVD) prevention and control. Atherosclerosis is one of the few truly mass diseases. CVD control programs have relied on the "risk factor" paradigm, recognizing that there are physiologic and behavioral risk factors. The former must be measured and treated clinically, the latter are modifiable by both individual and population-wide interventions. The high risk approach seeks to identify and treat persons at highest risk. Examples of this are the Primary Prevention and the Secondary Prevention Guidelines of the American Heart Association. The problem with reliance only on the high risk approach is that most cases of heart attack and stroke come from persons at average or moderately increased risk. The population approach then seeks to shift the entire population to a lower risk level. To reduce the CVD burden, there are 10 essential public health services, including surveillance, education and media, provision of personal health services, and policy development/legislation. These might then be applied to major risk behaviors (diet, sedentary lifestyle, tobacco, detection and treatment of hypertension/hyperlipidemia and early recognition of symptomatic diseases) and implemented in specific community settings (whole communities, schools, religious organizations, healthcare facilities, and worksites). There is a modest evidence base to support these approaches. In addition, the policy basis for population-based heart health include the Victoria, Catalonia, and Singapore Declarations. These concepts and recommendation can then be formulated into a comprehensive set of recommendations to improve cardiovascular health at the community level.