Coronary Artery Risk Detection in Appalachian Communities
William A. Neal, M.D.
This demonstration project is designed to test the hypothesis that universal cholesterol screening of children in a high risk rural population is an effective way of identifying not only the child, but also his or her parents at risk of developing premature cardiovascular disease. An interventional stategy targeted at individuals identified as dyslipidemic or hypertensive rather than the population as a whole will be implemented.
The incidence of premature coronary artery disease in West Virginia is among the very highest in the United States, undoubtedly influenced by the high prevalence of cardiovascular disease risk factors such as tobacco use, poor diet, obesity, hypertension and sedentary life style.
Community-based cardiovascular disease intervention projects throughout the U.S. and other developed nations have met with mixed success. Long term affects upon cardiovascular morbidity and mortality and disappointing, especially given the great expense of carrying out these well planned interventional trials. Public health policy now is to concentrate such efforts in high risk communities such as exist in West Virginia and the rest of Appalachia. The communities themselves must be much more directly participatory, even financially, in designing interventional protocols in order to feel a sense of ownership.
West Virginia has the infrastructure in place to launch the first statewide cardiovascular disease risk factor reduction program in the nation. Thirteen strategically located Rural Health Education Partnerships, and a Health Schools Initiative which today serves as a national model, will facilitate the implementation of a cost-effective prevention project which brings together community leaders, public health officials and higher education faculty to address the greatest single cause of death in West Virginia: heart disease.