Retinal artery occlusion (RAO) is a frequent cause of sudden, painless, monocular visual loss.Many patients with symptomatic RAO also have systemic vascular diseases that may increasethe risk of future ipsilateral hemispheric cerebral vascular events. For healthcare professionalswho assess patients with RAO, knowledge of the possible ocular and systemic causes may notonly improve the patient’s visual prognosis, but may also reduce its associated mortality andmorbidity by encouraging prompt and appropriate referrals.
Cardiovascular risk management: 8 Pharmacotherapy – improving the lipid profile
Epidemiological and clinical research has determined that lipids contribute substantially to cardiovascular disease (CVD) and that modifying the lipid profile has a significant impact on coronary events. These findings are reflected in continuously updated CVD management guidelines, which focus on low-density lipoprotein cholesterol (LDL-C) as the primary therapeutic target. The guidelines have further defined LDL-C levels to which patients should be treated. An individual’s eligibility for treatment, and their LDL-C treatment goal and intensity of therapy is determined by their absolute CVD risk. Lipid abnormalities can be partly modified by lifestyle changes, which are integral to reducing risk for all patients. However, as lipid goals are progressively lowered, many patients will not be able to achieve them using lifestyle changes alone and these patients usually require treatment with lipid-modifying drugs. This article aims to provide practitioners with a concise guide to managing lipids with pharmacotherapy, based on recommendations from six of the most up-to-date clinical practice guidelines for prevention of cardiovascular disease.
The importance of counselling in patients initiated on potentially nephrotoxic drugs
Measurement of renal function in patients starting on angiotensin-converting enzyme (ACE) inhibitors within one week after commencement of treatment or dose adjustment is compulsory, and failure to do so would be negligent.
Pharmacy-based health checks – acceptable and feasible
Pharmacists in the ethnically diverse city of Leicester piloted Healthy Life Checks in inner-city pharmacies, forpeople aged 40-74. Pharmacists conducted checks including blood pressure, weight and glucose measurementand gave lifestyle advice. We present here the findings from semi-structured telephone interviews conductedwith pharmacists and service users.
Cardiovascular risk management: 7 Lifestyle changes to reduce cardiovascular risk
Epidemiological research has clearly established that many risk factors contribute to cardiovascular disease(CVD). Some of them are modifiable, and treatment decisions are based on the level of risk determined by risk assessment. Positive lifestyle changes are crucial to the prevention and management of CVD, and can result in substantial risk reduction. These changes can include smoking cessation interventions, acardioprotective dietary pattern and increased physical activity. However, lifestyle changes are challenging forboth the healthcare professional and the patient, and behavioural counselling and regular follow-ups are often required to overcome barriers, encourage adherence and assist in the achievement of long-term lifestyle goals.This article aims to provide practitioners with a concise guide to the role and impact of lifestyle changesbased on recommendations from six of the most up-to-date clinical practice guidelines for prevention ofcardiovascular disease.
Dietary change post-MI – the key aspect of lifestyle change
Recent research suggests that post-MI patients are not being optimally managed. Awareness and implementation of guideline recommendations could improve outcomes in this patient group.
National GPwSI in cardiology survey 2010
The first general practitioners with a special interest (GPwSI) in cardiology services were set up more than 10 years ago but there is little information available on the national level about service provision. The authors invited all GPwSIs in cardiology to complete a survey detailing their qualifications and experience, range of services provided, capacity and clinical governance. The results are presented here.
A primary care service for cardiovascular risk reduction in first-degree relatives of patients with premature coronary heart disease
Cardiovascular disease continues to be the leading cause of premature morbidity and mortality in the UK.1 Primary prevention not only is cost-effective but is endorsed as a priority by healthcare systems in the UK, and indeed globally. We describe here a targeted prevention service, which showed that the modifiable risk factors of obesity and overweight, smoking and low levels of high-density lipoprotein cholesterol were highly prevalent in first-degree relatives of patients with premature coronary heart disease.
It is astonishing with how little reading a doctor can practise medicine
“It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it.-(William Osler, Aequanimitas, Books and Men)
Left atrial myxoma presenting as worsening dyspnoea with a distinct positional relief of symptoms
Worsening dyspnoea is a very common presenting complaint in the community; the causes varyhugely. We present a case of a patient with worsening dyspnoea and a positional change in hissymptoms who was found to have a left atrial myxoma.
Managing low HDL cholesterol: need for newer options!
High-density lipoprotein (HDL) particles constitute a heterogeneous family of circulatinglipoproteins composed of amphipathic apoproteins complexed to a monolayer of phospholipidswith a central core of free cholesterol, cholesterol esters (CE) and/or triglycerides. Analyses of theprotein components have identified up to 75 different subpopulations of these particles.However, there are 2 major sub-categories: 1: a dense CE-depleted, protein-rich HDL3 particle (pre-β HDL) and 2: a large CE-enriched HDL2 particle (α- HDL).Apart from its role in reverse cholesterol transfer (RCT) which involves the transport of cholesterol from lipid-laden foam cells(macrophages) in the arterial endothelium or peripheral cells to the liver for excretion orrecycling, the HDL particle has been shown to have a wide range of properties which includeanti-thrombogenic, anti-inflammatory, anti-oxidative, anti-platelet and vasodilatory functions.HDL may also stimulate insulin synthesis in pancreatic β cells.
HOT TOPIC | Commissioning in the new NHS: what are the implications for cardiovascular and diabetes services?
The new coalition government of the United Kingdom (UK) has announced plans to change the NHS radically in England. The Department of Health has published two important documents Equity and excellence: liberating the NHS and Liberating the NHS: commissioning for patients. The implications for primary and secondary care, and for local authorities, mental health services and community providers, will be enormous. The changes are taking place at a rapid pace and every manager and clinician in the NHS will need to keep abreast of developments as they will affect the way in which we all deliver services in the future.
