Cardiovascular disease prevention is one of the main challenges facing primary care today. In order to reduce the burden of disease, national guidelines recommend that asymptomatic patients who are at high risk of cardiovascular disease should be offered preventive medications. This article discusses cardiovascular disease risk assessment, communication of this risk to patients and attitudes of both general practitioners and patients to preventive medications.
Statin prescribing in Europe: a comparison of differences and potential impact on health outcomes
The benefit of treatment with HMG-CoA reductase inhibitors (statins) is unquestioned, with multiple studies over the last 20 years having shown that statins improve cardiovascular (CV) outcomes.1 Although all statins reduce low-density lipoprotein cholesterol (LDL-C), their potencies differ. The decreasing order of potency (per milligram) for LDL-C reduction is: rosuvastatin, atorvastatin, simvastatin and pravastatin.
Integration of cardiac services
Prominent consequences of the Health and Social Care Act which has now passed into law will be the increased commissioning of cardiac services and changes in how they are delivered. This Act, although establishing an NHS Commissioning Board to provide commissioning guidance, intends to increase markedly GPs’ power to commission services. Monitor, the non-departmental public body, will be developed into an economic regulator to oversee access and competition within the NHS
In the balance: Testosterone deficiency and cardiovascular health
Male hypogonadism—also known as testosterone deficiency syndrome—occurs when the testes no longer produce enough testosterone. Testosterone deficiency may be an important factor in increasing a man’s cardiovascular risk. However, the symptoms are often overlooked in older men, both by primary healthcare professionals and by patients themselves.
After stroke: discharge is just the beginning
Like falling off a cliff’ or ‘falling into a black hole’. This is how stroke survivors and their carers often describe discharge from hospital back to their own home. Recognising this issue, the National Stroke Strategy recommended planned reviews to identify unmet needs for health and social care, and secondary prevention. This article discusses tools designed to help professionals to review the evolving needs of stroke survivors and their families.
Making sense of liver function tests
The liver has many functions, and therefore diseases of the liver have numerous consequences. These can be detected and monitored with blood tests. This article provides a review of liver function tests, or LFTs, and how they relate to the key functions of the liver and some of the most common liver diseases.
Reducing alcohol misuse and using audit tools in primary care
Excessive alcohol consumption has joined smoking and obesity as one of today’s major threats to public health. It is a major cause of liver disease, as well as a range of cancers, cardiovascular disease and mental illness. What’s the solution? We look at how primary care can identify patients who are drinking too much and what interventions can help.
Editorial
As practice nurses, our day at the surgery ends well when everything has gone smoothly and patients and colleagues have gone home happy. But we often feel the greatest sense of achievement when we have had to go beyond our usual routine to try a new approach to a problem, or do something that we never thought we could do.
Recognising the risk of familial hypercholesterolaemia
Familial hypercholesterolaemia (FH)—an inherited genetic defect that causes high blood cholesterol—often goes unrecognised. It is therefore under-diagnosed and poorly managed. This can have devastating repercussions for affected families, since premature deaths from heart disease can occur in people in their 40s or even younger. This article looks at the causes of FH, how to recognise those at risk and how to implement National Institute for Health and Clinical Excellence (NICE) guidance in practice.
Time to start insulin in general practice
General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
Starting insulin treatment for type 2 diabetes
Chronic kidney disease: the no tears review
Many drugs are cleared from the body by the kidneys, so careful medicines management is especially important in people with chronic kidney disease (CKD). This article explains how to ensure CKD patients receive recommended therapies designed to protect their kidneys and reduce their risk of a heart attack or stroke.
