The Effect of Community Care on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis

Abstract

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.