Regional-dwelling adults have higher levels of cardiovascular disease (CVD) risk.To determine the potential benefits of a nurse-led, self-management intervention program to reduce CVD and diabetes risk.A six-month pre/post observational study was conducted in a high risk, under-serviced regional community. A nurse-led heart health clinic was established and 530 self-selected adult individuals (mean age 54±14 years, 62% female) were subject to standardized screening. Individual targets and multidisciplinary strategies to reduce risk factors were individually tailored according to the Green Amber Red Delineation of rIsk And Need (GARDIAN) system. Changes in participants' CVD risk factors and lifestyle behaviors were compared and independent correlates of improvements in blood pressure (BP), total cholesterol, weight and absolute CVD risk were evaluated. Baseline risk factors for CVD were highly prevalent. Participants required low (43%), moderate (34%) or high (23%) levels of surveillance and management according to GARDIAN criteria. Clinically significant changes in 326 (76%) participants were observed. Average BP decreased by 4 mmHg (systolic) and 1 mmHg (diastolic), weight by almost 1 kg, total cholesterol by 0.6 mmol/l and body mass index (BMI) by 0.3 kg/m(2). A change in absolute CVD risk scores of -0.4% was observed. Primary physician attendance independently predicted improvements in BP (odds ratio (OR) 1.67; 95% confidence interval (CI) 1.08-2.58, p=0.022) whereas GARDIAN status, age, physical activity and nurse guidance positively influenced cholesterol, absolute CVD risk and weight outcomes.The feasibility and short-term benefits of a dedicated "heart health" service for high risk regional-dwelling individuals was shown.