title: Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program.
abstract: BACKGROUND
  This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area.
  
  
  METHODS
  IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 - 2001) and after (2007) this program were used to compare differences in the intervention area  and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress.
  
  
  RESULTS
  The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P < 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus.  In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001).
  
  
  CONCLUSIONS
  A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.
authors.affiliation: Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. nsarrafzadegan@gmail.com
authors.forename: Nizal
authors.initials: N
authors.lastname: Sarrafzadegan
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.forename: Gholamhossein
authors.initials: G
authors.lastname: Sadri
authors.forename: Hossein
authors.initials: H
authors.lastname: Malekafzali
authors.forename: Masoud
authors.initials: M
authors.lastname: Pourmoghaddas
authors.forename: Kamal
authors.initials: K
authors.lastname: Heidari
authors.forename: Shahin
authors.initials: S
authors.lastname: Shirani
authors.forename: Ahmad
authors.initials: A
authors.lastname: Bahonar
authors.forename: Maryam
authors.initials: M
authors.lastname: Boshtam
authors.forename: Sedigheh
authors.initials: S
authors.lastname: Asgary
authors.forename: Noushin
authors.initials: N
authors.lastname: Mohammadifard
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sadeghi
authors.forename: Babak
authors.initials: B
authors.lastname: Eshrati
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hadipour
authors.forename: Ahmad
authors.initials: A
authors.lastname: Esmaillzadeh
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: O'Loughlin
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D007492:Iran; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000209:etiology / Q000517:prevention & control*; D011314:Preventive Health Services / Q000379:methods*; D012307:Risk Factors; D016540:Smoking Cessation; D013315:Stress, Psychological / Q000517:prevention & control