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The Effect of Community Care on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis
Jing Zhang1, Ting Luo1, Jiao Wang1
1Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi 'an Medical College, Xi 'an, China.
Insights
Community care effectively reduces cardiovascular disease risk factors like high blood pressure and LDL cholesterol. This strategy shows promise for primary cardiovascular disease prevention, especially in resource-limited settings.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading cause of death globally, with hypertension, dyslipidemia, and smoking as key modifiable risk factors.
- Pharmacological treatments are effective but face accessibility challenges in resource-limited settings.
- Community care offers a scalable non-pharmacological strategy, but evidence on its efficacy is inconsistent.
Purpose of the Study:
- To evaluate the effectiveness of community care interventions in reducing cardiovascular disease risk factors.
- To explore geographical variations in the efficacy of community care for CVD risk reduction.
Main Methods:
- A systematic review and meta-analysis of 15 randomized controlled trials (n=10,749) published up to January 2025.
- Included participants with at least one CVD risk factor receiving community nursing (education, follow-up) versus routine care.
- Analyzed outcomes including systolic blood pressure (SBP), diastolic blood pressure (DBP), HDL, LDL, triglycerides (TG), and smoking persistence using random-effects models.
Main Results:
- Community care significantly reduced SBP, DBP, LDL, and TG levels.
- A significant reduction in smoking persistence was observed.
- No significant improvement in HDL levels was found.
- Stronger TG reduction was noted in developing countries, while smoking cessation efficacy was greater in developed nations.
Conclusions:
- Community care is an effective strategy for lowering blood pressure, LDL, TG, and reducing smoking persistence, supporting its role in primary CVD prevention.
- The limited impact on HDL and observed regional variations highlight the need for tailored interventions.
- Further research is warranted to understand HDL functionality and optimize community care models.
Rationale:
Cardiovascular disease (CVD) remains a leading global cause of morbidity and mortality, with hypertension, dyslipidemia, and smoking as key modifiable risk factors. While pharmacological interventions are effective, their accessibility in resource-limited settings highlights the need for scalable nonpharmacological strategies. Community care has emerged as a potential solution, yet evidence on its efficacy in reducing CVD risk factors remains fragmented and inconsistent due to heterogeneity in intervention designs and population characteristics.
Aim:
To evaluate the effectiveness of community care in reducing CVD risk factors (blood pressure, lipids, smoking) and explore geographical heterogeneity.
Methods:
Fifteen RCTs (n = 10,749) from PubMed, Embase, Cochrane Library, and Web of Science (up to January 2025) were included. Participants had ≥ 1 CVD risk factor and received community nursing (health education, follow-up) versus routine care. Random-effects models in Stata 17.0 analysed outcomes (SBP, DBP, HDL, LDL, TG, smoking). Subgroups assessed sample size, region, duration, and quality.
Results:
Community care significantly reduced SBP (WMD = - 3.54 mmHg, 95% CI: - 4.73 to -2.35; p < 0.001), DBP (WMD = - 1.47 mmHg, -1.94 to -0.99; p < 0.001), LDL ( - 5.11 mg/dL; p < 0.001), and TG ( - 4.21 mg/dL; p = 0.024), with lower smoking persistence (RR = 0.949; p = 0.033). No HDL improvement was observed (WMD = 1.26 mg/dL; p = 0.323). Subgroups showed stronger TG reduction in developing countries (Pinteraction = 0.010) and greater smoking cessation efficacy in developed nations (Pinteraction = 0.085).
Conclusion:
Community care effectively lowers blood pressure, LDL, TG, and smoking persistence, supporting its role in primary CVD prevention. Limited HDL impact and regional variations necessitate tailored interventions and further research on HDL functionality.
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