Healthy heart programs do work and may cut the risk of heart disease by as much as 1 percent, a review of large community-based programs concludes.

The benefits may sound small “but across a population, that’s quite a large effect,” study co-author Tom Marshall of the University of Birmingham, in England, told Reuters Health.

For every one million people, lead author Dr. Mary Pennant told Reuters Health, the authors estimate that, on average, the programs prevented about 650 heart attacks or strokes per year.

Heart disease prevention programs “appear to have generally achieved favorable changes” but they must be kept up to date, the authors conclude in the American Journal of Epidemiology.

Even though community healthy heart programs have been around for more than 40 years, there have been few scientific reviews of their effects in reducing heart disease, the leading cause of death in the U.S.

Marshall and colleagues looked at 36 programs from around the world that tackled behaviors associated with heart disease such as smoking, poor diet, low physical activity, and high alcohol consumption as well as high blood pressure, high blood cholesterol levels, obesity/overweight, and diabetes.

The specific programs varied widely in how they got their messages out, screened participants, counseled them or changed their environments. To be included in the review, however, they had to meet minimum requirements of targeting several heart disease risks and offering ways to prevent at least two of them.

The researchers calculated changes in heart disease risk factors and, in seven of the studies where the data were available, deaths before and after the program among participants and a group of people not in the programs.

While “favorable” changes in heart disease related deaths were seen, only one study found a “significant reduction” and that was only for men. Changes in heart disease risk factors was “mixed but generally showed a trend towards a positive program effect,” the authors determined.

Overall, the authors estimate that community heart disease prevention programs cut risks by 0.65% over 10 years. Crunched another way, the data showed that treating 154 people over 10 years would result in one less case of heart disease.

The review did not shed light on whether one approach was better than another, however. It only “aimed to broadly say whether these types of programs work or not,” Pennant said.

Some of the programs date back to the 1970s when the dangers of smoking, obesity, and poor diet weren’t as widely communicated as they are today. In addition, obesity is a bigger problem than it was 30 years ago.

As a result, programs that worked in the past need to be updated and “revised approaches should be reevaluated before widespread implementation,” the researchers write.

Barry Franklin, an exercise physiologist at William Beaumont Hospital in Royal Oak, Michigan, and a spokesperson for the American Heart Association, is “very enthusiastic” about community heart health programs. Too often surgery is viewed as the first line treatment even though heart disease is largely preventable, he told Reuters Health.

“Community programs, which can be everything from very detailed, very aggressive to as little as handing out literature on risk factors, can have a significant impact over time,” he said.

Franklin points out in the last 30 years, heart disease deaths have gone down 70 percent “largely because of lifestyle changes and drug therapies, not the more expensive angioplasties or by-pass surgeries.”

The AHA’s worksite wellness Start! program is popular with employers. More than 1000 companies have signed up to - in part - reduce employee healthcare costs, Franklin said.

The Centers for Disease Control and Prevention estimates heart disease will cost the U.S. more than $316 billion this year. More than a third of adults have two or more of the risk factors for heart disease and in 2006, heart disease caused more than one in four deaths in the United States.

The study did not look at the cost of the community programs “because they were conducted at such a wide variety of places and at different times,” co-author Marshall said. “It’s kind of hard to put a figure on the cost.”

SOURCE:  American Journal of Epidemiology, online July 28, 2010.