Community-based prevention of cardiovascular disease in low- and middle-income countries: Strategies and implementation models

ABSTRACT Cardiovascular disease (CVD) remains the leading cause of death globally, with approximately 18 million deaths annually, over 80% occurring in low- and middle-income countries (LMICs). This narrative review synthesizes evidence on community-based CVD prevention strategies in LMICs, including community health worker programs, peer-led interventions, faith-based partnerships, school-based initiatives, and policy-level interventions. A systematic literature search across PubMed, MEDLINE, and the World Health Organization Institutional Repository for Information Sharing database was conducted to identify relevant studies published between 2000 and 2024. Included studies demonstrate that well-designed community-based programs can achieve 12%–25% reductions in blood pressure, 15%–25% improvements in medication adherence, and 10%–25% improvements in healthy dietary choices, with incremental cost-effectiveness ratios ranging from US$10 to US$150 per disability-adjusted life year averted – well within established cost-effectiveness thresholds for LMICs. Successful programs share common characteristics, including strong community engagement, multicomponent design, cultural adaptation, health system integration, and sustained implementation. Recommendations are stratified into three implementation tiers: essential interventions for all LMICs, context-dependent strategies, and aspirational long-term goals, each linked to evidence strength and feasibility. This review provides evidence-based guidance for policymakers and program implementers designing community-based CVD prevention adapted to local contexts and resource constraints.