Community Education for Cardiovascular Disease Prevention: Morbidity and Mortality Results from the Minnesota Heart Health Program

TLDR

The Minnesota Heart Health Program was a community trial of cardiovascular disease prevention conducted from 1980 to 1990 in three Upper Midwestern communities and matched comparison communities. The study aimed to test whether the incidence of validated fatal and nonfatal coronary heart disease and stroke would decline differentially in the education communities after the health promotion program was introduced. A 5‑ to 6‑year intervention combining community‑wide and individual health education was evaluated using mixed‑model regression that modeled the intervention effect as annual deviations from a linear secular trend after a 2‑year lag. The analysis found no significant intervention effect on morbidity or mortality for coronary heart disease or stroke, with only modest annual declines in CHD incidence (1.8% in men, 3.6% in women) and no significant secular trends for stroke.

Abstract

The Minnesota Heart Health Program was a community trial of cardiovascular disease prevention methods that was conducted from 1980 to 1990 in three Upper Midwestern communities with three matched comparison communities. A 5- to 6-year intervention program used community-wide and individual health education in an attempt to decrease population risk. A major hypothesis was that the incidence of validated fatal and nonfatal coronary heart disease and stroke in 30- to 74-year-old men and women would decline differentially in the education communities after the health promotion program was introduced. This hypothesis was investigated using mixed-model regression. The intervention effect was modeled as a series of annual departures from a linear secular trend after a 2-year lag from the start of the intervention program. In the education communities, 2,394 cases of coronary heart disease and 818 cases of stroke occurred, with 2,526 and 739 cases, respectively, being seen in the comparison communities. The overall decline in coronary heart disease incidence was 1.8 percent per year in men (p = 0.03) and 3.6 percent per year in women (p = 0.007). For stroke, there were no significant secular trends. The authors recently published findings showing minimal effects of sustained intervention on risk factor levels. In the current report, there was no evidence of a significant intervention effect on morbidity or mortality, either for coronary heart disease or for stroke.