Chronic kidney disease mineral and bone disorders (CKD-MBD) is a slowly progressive complication of CKD occurring over many years. The kidneys are unable to maintain normal levels of calcium and phosphate and respond to the hormones needed to maintain healthy bones. CKD–MBD is a common problem in people with stage 3 CKD onwards and affects almost all patients receiving dialysis. This article explains why renal bone disease occurs, the problems it can cause for patients affected and provides practical tips on how to identify people at risk and management options.
Moving stroke prevention up the healthcare agenda
“There are lots of really powerful examples around o f things we can do to improve quality while improving productivity”
This statement from Sir David Nicholson, the NHS Chief Executive, appears on the NHS Evidence website, where the recognition and optimal treatment of atrial fibrillation (AF) is given as one of the top six Quality, Innovation, Productivity and Prevention (QIPP) examples from across the entire NHS.
Feeling the pinch: the impact of weight loss surgery on cardiovascular risk
Weight loss (bariatric) surgery is becoming increasingly common as the obesity epidemic continues to flourish, and recent NICE guidelines have supported this approach. In this article, we review the procedures used in bariatric surgery, the impact on patients’ cardiovascular risk and type 2 diabetes, what the guidelines recommend and the long-term care of patients who have undergone this type of surgery.
Transient ischaemic attack: act fast to reduce the risk of stroke
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010; recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s. This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
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?
Editorial
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.
