title: Population-level interventions for coronary heart disease prevention: what have we learned since the North Karelia project?
abstract: OBJECTIVE
  The prevalence of coronary heart disease (CHD) risk factors in the population necessitates investment in the design and delivery of effective population-level interventions to prevent and enhance the management of CHD. This review examines the approaches that have been central to the design and delivery of previous, seminal population-level CHD prevention programs; it offers recommendations for the design and evaluation of the next generation of population-level CHD prevention trials.
  
  
  RESULTS
  Almost 50% of the decline in the rates of CHD mortality in the developed world can be attributed to population-level declines in CHD risk factors, including cholesterol, hypertension, and smoking. There is evidence that community-based CHD prevention interventions can have a positive impact on these risk factors within a distinct population. More recent community-based CHD trials have focused on discrete populations including the socioeconomically deprived, ethnic minorities, and rural communities.
  
  
  CONCLUSIONS
  There has been large variability in the success experienced by population-level CHD prevention trials. Best practices have emerged which may be used to inform the design of future trials. These include the need for multisectoral partnerships, coordination of multi-level interventions (programs and policy), and delivering a sufficient intervention dose to targeted populations.
authors.affiliation: Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada. SPapadak@ahsmail.uwaterloo.ca
authors.forename: Sophia
authors.initials: S
authors.lastname: Papadakis
authors.forename: Isabella
authors.initials: I
authors.lastname: Moroz
mesh_terms: D002170:Canada / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D015397:Program Evaluation; D012307:Risk Factors