Optimising lipid levels: looking beyond LDL-cholesterol
Treatment with statins is undoubtedly making a major contribution to reducing high-risk patients’ chance of a heart attack or another coronary event. However, their risk remains high, since over half of patients included in statin clinical trials suffered a further coronary event within five years. There is growing evidence that we need to move beyond simply lowering low-density lipoprotein cholesterol (LDL-C) and optimise the whole lipid profile.
Non-statin strategies for modifying lipids
Raised cholesterol is the commonest risk factor for CHD. Reducing cholesterol can be an effective way to help lower a patient’s risk of heart disease, particularly when cholesterol levels are already high. Dr Rubin Minhas looks at how to help patients to lower their cholesterol levels without drug treatment. He will discuss other lipid modifying drugs in future issues.
Ezetimibe: a new type of lipid-lowering therapy
Only half of patients being treated for elevated cholesterol levels are currently reaching targets, according to recent research. So what can we do to improve things? One option is to add a new type of lipid-lowering drug – ezetimibe – to a statin. This article reviews how ezetimibe works and its place in primary care management of raised lipids.
Optimising treatment of type 2 diabetes with metformin
There is good evidence that tight glycaemic control significantly improves outcomes in patients with type 2 diabetes. All practice nurses will be looking to achieve the new General Medical Services contract (GMS2) targets for HbA1c reduction in diabetes (see box). Practices will be developing prescribing strategies to achieve this reduction, in accordance with good clinical practice. Metformin offers an important first-line therapy for type 2 diabetes. The introduction of a new, sustained-release formulation – Glucophage SR – should improve patient compliance with metformin and so improve glycaemic control.
Optimising the treatment of type 2 diabetes with newer insulins
Primary care nurses play a central role in the management of type 2 diabetes in the community. This includes helping patients to use their drug treatment correctly. Although many patients with type 2 diabetes initially respond well to weight loss and exercise, most require oral hypoglycaemics and half of all patients eventually require insulin to control their glucose levels in order to prevent the devastating long-term complications of inadequately controlled diabetes. Linda Goldie gives an up-to-date review of the newer insulins – including the insulin analogues, insulin lispro, insulin aspart and insulin glargine – that have been introduced.
Disposing of used syringes and other sharp clinical waste
More and more is being expected of practices in improving the management of diabetes – with initiatives such as the National Service Framework (NSF) for Diabetes and NICE guidance setting increasingly ambitious targets. The National Diabetes Support Team (NDST) has been set up to help support local services throughout the NHS and in meeting these challenges. In this issue, they share latest advice for practices and patients on disposing of used syringes and other sharps.
Diabetes care: maintaining glycaemic control during fasting for Ramadan
Fasting during Ramadan – lasting from 15th October to 12th November this year – is one of the five pillars of Islam. The experience of fasting is intended to teach Muslims self-discipline and self-restraint, and to help them understand a little of the plight of the less privileged. But what are the implications of fasting for patients with type 2 diabetes?
Beta blockers
Beta blockers are well established drugs in the treatment of cardiovascular disease, after first being introduced 20 years ago. Today, they are used to treat patients with a range of cardiovascular conditions – hypertension, myocardial infarction, angina, heart failure and abnormal heart rhythms (arrhythmias). There is good evidence for beneficial effects with beta blockers and their use is recommended in many guidelines, including the recent British Hypertension Society guidelines. Prescribing of beta blockers in patients with heart disease is further encouraged as a ‘quality marker’ in the new GMS contract.
Getting it right – how to measure BP in the surgery
It’s something that we do so often, but are we always doing it the best way? Check out how to measure blood pressure (BP) correctly, with latest advice from the National Institute for Clinical Excellence and the British Hypertension Society.
Making sense of heart failure and its treatment
Heart failure is a high priority in primary care, with the National Service Framework for Coronary Heart Disease, the NICE Heart Failure Guidance, and the new General Medical Services contract quality indicators all setting clear standards for improving the management of patients with this increasingly common condition. This four-page pull-out supplement provides you with a need-to-know, need-to-keep guide.
Disease Focus on… Sleep Apnoea
Sleep apnoea is far more than just snoring associated with brief periods of suspended breathing while asleep. It is an important risk factor for cardiovascular disease and diabetes, so it is well worth asking patients whether they suffer breathing problems during the night and then following up those who do. More than one-third of people with sleep apnoea have hypertension, so measuring blood pressure is important in assessing risk factors and then establishing appropriate preventive treatment.
