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
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.
On the beat: Controlling heart rate in angina and heart failure
Controlling heart rate is a key element of good care of patients with angina or heart failure. In this article we explore the benefit of effective heart rate control to reduce hospitalisation and alleviate symptoms. Measuring heart rate is simple, and can provide valuable benefits for many patients.
Editorial 2 – If I had one wish for improving the management of liver disease…
Editorial 1 – Putting chronic liver disease on the primary care agenda
Chronic liver disease is a problem for all of us. It develops silently, often taking many years to cause sufficient damage to be detectable or cause signs or symptoms for which a patient would seek attention. Primary care has a central role in improving the prevention and early detection of chronic liver disease. This special issue of the British Journal of Primary Care Nursing (BJPCN) and Primary Care Cardiovascular Journal on chronic liver disease is full of step-by-step guides and informative articles to give you the key information and tools to get to grips with this important condition.
Fat: separating the facts from the fiction
Fat is an important part of the diet, providing fat-soluble vitamins and essential fatty acids, as well as a valuable source of energy or calories. Fat also increases the palatability and carries the flavour of many of our foods. The problem is, despite decades of public health campaigns, most of us still eat too much of the wrong fat. Understanding the different types of fat can help us to advise our patients on ways to optimise their diets.
