In an environment in which most people have lifestyles that increase risk for initial or recurrent cardiovascular disease (CVD) events, community-based healthy lifestyle initiatives are highly effective in providing programs, education and support to reduce associated CVD risk factors and improve outcomes. Pioneering programs, such as the Stanford Three Community and Five Cities studies, and the North Karelia project in Finland, served as prototypes for current initiatives. These include partnerships with national organizations (e.g., YMCA DPP) and faith-based programs. Training may be provided by healthcare professionals and/or community healthcare workers; initiatives include exercise-based and weight-reduction programs, smoking cessation interventions, dietary counseling and education, and medication adherence. Contemporary technologies and home-based programs provide alternatives to those who might not otherwise have access to center-based programs. Community-based initiatives, particularly those with state or national support, have the potential to enhance the delivery and effectiveness of CVD prevention at low cost. (C) 2017 Elsevier Inc. All rights reserved.