Are you sitting comfortably? Then I’ll begin. Once upon a time… Telling stories is something that many of us do with our children. But what about with our patients, and what about encouraging patients to tell their stories? In this issue of BJPCN, we share some exciting new research showing that patients with high blood pressure can learn from each others’ stories. And we help you to fill in the gaps so you’ve got a clear story to tell during routine consultations with patients with cardiovascular disease and diabetes.
An ultimate cholesterol-lowering plan is urgently needed!
Coronary heart disease (CHD) remains the UK’s number one killer, affecting over 2.8 million people and causing almost 100,000 deaths a year.1 This is despite an overall reduction since the 1970’s through the introduction of statins, improved screening and treatment and an increase in smoking cessation. Although many risk factors have to be taken into consideration, an elevated serum cholesterol level, which affects two out of every three UK adults, remains the single biggest modifiable risk factor for CHD.1,2 Dietary intervention should always be first-line treatment with or without statin therapy. However, there is clearly a need for a diet renaissance – providing patients with a diet that is not only realistic, but one that delivers impactful cholesterol-lowering results.
Long live the difference? Why women lose out in heart health
In the UK, the last 30 years have seen a significant decline in deaths from coronary heart disease (CHD) in men, but the fall has been less significant in women. This may be because women need a different, more gender-specific approach if they are to benefit fully from recent advances in treatment.
Liraglutide in type 2 diabetes: what NICE recommends?
One in 20 of the UK population—or 2.8 million people—have been diagnosed with type 2 diabetes, according to a recent report based on the Quality and Outcomes Framework (QOF) exception data. Most of these patients will have been identified in primary care, and GPs and practice nurses will be only too well aware of the burden of illness associated with the cardiovascular and microvascular complications of diabetes. The most effective means of reducing the risk of these microvascular complications is to ensure that each patient achieves and maintains their individualised glycaemic target. Recent guidance from the National Institute for Health and Clinical Excellence (NICE) provides recommendations on using liraglutide (Victoza), a new option for patients who do not achieve their target HbA1c using currently available therapies.
Very low energy diets: the key facts
In recent years it seems as if there has been an increase in the popularity of very low energy diets (VLEDs) and new programmes are readily available to our patients on the high street. This article explains the background and theory behind VLEDs so that you can better inform and support your patients if they are considering one of these diets.
How to advise patients on fortifying their diet
Adequate nutrition is an important part of keeping healthy. Some patients – particularly the elderly – may find it difficult to consume an adequate diet to provide all the components to maintain good health. In this case, fortifying the diet may be helpful. Our keep and copy guide over the page provides practical tips for you to photocopy and give to patients and their carers on how to fortify their diet without using oral nutritional supplements.
Whole grain breakfasts for trimmer waists
Central obesity remains a big issue in the UK. The accumulation of adipose tissue in the abdominal region is a particular risk factor for chronic disease and mortality.1 In 2008, 39% of adults in England had a waist circumference indicative of central obesity (above 88 cm for women and 102 cm for men).2,3 Two proven effective dietary strategies for reducing waist circumference are the inclusion of whole grain foods in the diet and the avoidance of meal skipping.4 Advice to start the day with whole grain breakfast cereal and/or whole grain bread combines these two strategies in one simple and feasible practical message.
Back to Basics: Recognising the four types of coronary artery disease
Hearts and hormones: what’s the impact of hormonal contraception and HRT on cardiovascular risk?
The impact of female hormones on cardiovascular risk is a hot issue. Many nurses working in the NHS, including in general practice, are aged 50 or older. This means that there is a strong possibility that some of us may be experiencing menopausal symptoms, along with our patients. In this article, we look at the use of hormonal therapies at the time of the menopause, with particular reference to cardiovascular risk. We will also touch on the use of oral contraception and associated cardiovascular factors.
Helping patients with swallowing problems after a stroke
Swallowing really is a life or death matter. Nearly half of people who have had a stroke will initially experience difficulty swallowing. This is called dysphagia. In this article, we look at the anatomy and physiology of swallowing, what can go wrong in people who have had a stroke, and what can help. Explanations are given clearly, using simple language that you can use with patients and their family members.
Proteinuria: replacing cholesterol as a key risk factor for revealing patients with CVD?
We have all seen paintings of early physicians looking at flasks of urine to give an indication of a person’s health. And most of us can remember days of rows of urine pots lined up to test for new patients in primary care and in hospital outpatient clinics. We may assume that those days have gone in the era of blood testing and CT scans. So why do we have a cluster of urine pots on the cover of this issue of BJPCN and why are we suggesting that urine testing has a central role in finding patients with previously undiagnosed cardiovascular disease?
Take your gin without the tonic: prolonged QTc interval and torsades de pointes
Take your gin without the tonic: prolonged QTc interval and torsades de pointes – David Ripley, Fiona MacCormack, Mark Kinghan, Kate Willmer
Torsades de pointes (TdP) is a life-threatening ventricular arrhythmia associated with prolongation of the QT interval. This case report describes one possible cause of acquired prolongation of the QT interval, and discusses more broadly the topic of antiarrhythmic drug side-effects and interactions.
