
Review Quality Rating: 8 (strong) Details on the methodological quality are available here.
Considerations for Public Health Practice

Conclusions from Health Evidence
General Implications This is a well done review of primary studies of moderate and poor quality trials. • smoking prevalence Based on this review, public health should support counselling or education among healthy adults to reduce:
• systolic and diastolic blood pressure, blood cholesterol, and smoking prevalence;
and, among adults with hypertension/diabetes to reduce:
• total mortality, stroke mortality, blood cholesterol, fatal/non-fatal cardiovascular events, systolic and diastolic blood pressure Public health should not promote counselling or education to impact:
• Total mortality, CHD mortality, stroke mortality or fatal/non-fatal cardiovascular events among healthy adults • Smoking prevalence among adults with hypertension/diabetes Overall, education or counselling targeting multiple risk factors has little or no impact on the risk of coronary heart disease mortality/morbidity for the general population. Due to risk of bias in some of the studies, programs/policies should be re-evaluated once additional trials become available.
Evidence and Implications
What's the evidence? Implications for practice and policy 1. Total and CHD Mortality (14 RCTs) Adults with hypertension and/or diabetes
• Reduced odds of total mortality (OR 0.78, 95%CI 0.68 to 0.89) compared to controls. No impact on total mortality for healthy adults, and CHD mortality for any adults.
Total and CHD Mortality
• Public health decision makers should support counselling/education among those with hypertension/diabetes to reduce total mortality; • But, it should not be used to reduce total mortality for healthy adults or CHD mortality among any adults.
Fatal Stroke (7 RCTs)
Adults with hypertension and/or diabetes
Fatal Stroke
• Public health decision makers should support Date this evidence summary was written:
February 2012
• Reduced odds of fatal stroke (OR 0.54, 95%CI 0.36 to 0.83) compared to controls. No impact on healthy adults. counselling/education among those with hypertension/diabetes to reduce stroke mortality, but not among healthy adults.
Fatal or Non-fatal Cardiovascular Events (9 RCTs) Healthy Adults
• Close to no impact on odds of having any cardiovascular event (OR 0.94, 95%CI 0.90 to 0.99).
Adults with hypertension and/or diabetes
• Reduced odds of a cardiovascular event (OR 0.71, 95%CI 0.61 to 0.83).
• Reduced systolic blood pressure (WMD -2.81 mmHg, 95%CI -3.23 to -2.38) and diastolic blood pressure (WMD -2.51 mmHg, 95%CI -2.73 to -2.29).
• Small decrease in blood cholesterol (WMD -0.06 mmol/L, 95%CI -0.08 to -0.03).
Fatal or Non-fatal Cardiovascular Events
• Public health decision makers should focus counselling/education interventions on those with existing diabetes/hypertension, but not on healthy adults, to reduce fatal or non-fatal cardiovascular events.
Blood Pressure (53 studies) Healthy Adults
• Reduced systolic blood pressure (WMD -3.70 mmHg, 95%CI -4.01 to -3.38), and diastolic (WMD -2.33 mmHg, 95%CI -2.52 to -2.13) blood pressure.
Blood Pressure
• Public health decision makers should promote counselling/education to reduce both systolic and diastolic blood pressure among healthy adults and those with hypertension/diabetes.
Blood Cholesterol (50 RCTs)
Healthy Adults • Small decrease in blood cholesterol (WMD -0.08 mmol/L, 95%CI -0.09 to -0.06).
Blood Cholesterol
• Public health decision makers should promote counselling/education to reduce blood cholesterol among healthy adults and those with hypertension/diabetes.
Smoking Prevalence (15 RCTs) Healthy Adults
• Reduced odds of smoking prevalence (OR 0.79, 95%CI 0.75 to 0.82). No impact on adults with hypertension and/or diabetes.
Smoking Prevalence
• Public health decision makers should promote counselling/education to reduce smoking prevalence among healthy adults.
Legend: P -Population; I -Intervention; C -Comparison group; O -Outcomes; CI -Confidence Interval; OR -Odds Ratio; RR -Relative Risk; WMD -

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