title: Effectiveness of multifactorial interventions in primary health care settings for primary prevention of cardiovascular disease: A systematic review of systematic reviews.
abstract: OBJECTIVE
  To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients.
  
  
  METHODS
  Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool.
  
  
  RESULTS
  Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness.
  
  
  CONCLUSIONS
  Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity.
authors.affiliation: Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain. Electronic address: Celia.Alvarezbueno@uclm.es.
authors.forename: Celia
authors.initials: C
authors.lastname: Álvarez-Bueno
authors.affiliation: Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain. Electronic address: icaveror@yahoo.es.
authors.forename: Iván
authors.initials: I
authors.lastname: Cavero-Redondo
authors.affiliation: Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain. Electronic address: Maria.Martinezandres@uclm.es.
authors.forename: María
authors.initials: M
authors.lastname: Martínez-Andrés
authors.affiliation: Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain. Electronic address: Natalia.Arias@uclm.es.
authors.forename: Natalia
authors.initials: N
authors.lastname: Arias-Palencia
authors.affiliation: Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) and Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain. Electronic address: rramos.girona.ics@gencat.cat.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramos-Blanes
authors.affiliation: Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain; Health Centre Cuenca I, Health Service of Castilla-La Mancha (SESCAM), Cuenca, Spain. Electronic address: fsalcedo@sescam.org.
authors.forename: Fernando
authors.initials: F
authors.lastname: Salcedo-Aguilar
mesh_terms: D000488:Allied Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D011320:Primary Health Care; D011322:Primary Prevention; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Cardiovascular disease; Preventive health; Review; Risk factors