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.
Back to Basics: A BJPCN Guide – Erectile dysfunction
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.
New year’s resolutions: take one small step at a time
It’s that time of year again. New Year – time for resolutions, many of which are associated with health. Personal New Year’s resolutions are often about losing weight, getting fit or eating more healthily. All good news for cardiovascular health, the focus of BJPCN. But, as primary care nurses, we could have broader new year’s resolutions, affecting our clinical practice and efforts to improve the health of our patients. Persuading anyone – including ourselves – to change behaviour in an effort to improve health can be challenging at the best of times. The answer seems to be to just take one small step at a time – one that you know you can repeat with ease. Don’t attempt a revolution. In this issue, we offer a range of ideas that you could adopt as ‘new year resolutions’ for your practice – or even yourself!
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.
Raising the issue of obesity with patients who need to lose weight
You know the scenario only too well. Your patient is sat in front of you, taking up more space than he or she used to, and you are discussing the increase in their blood glucose levels. How do you raise the issue of their weight, without offending them or making what seems to them a personal comment?
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.
Talking to Practices
Rosemary Evans, practice nurse at a Docklands practice, London, talks to BJPCN about why and how she set up her smoking cessation service
Disease Focus on… Angina
Angina is a common problem in primary care, affecting around one in every six patients aged 65 years and over. It ispredominantly chest pain due to transient myocardial ischaemia caused by coronary artery disease. Episodes of angina are typically caused by exertion or emotion, and are relieved by rest. Treatment with drugs and/or surgery that improves blood flow to the heart and lifestyle changes can significantly improve patients’ quality of life and survival.
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.
Tackling the burning issue of smoking cessation
The number of people who smoke has fallen over the past 30 years under a barrage of tobacco control measures, including increasing the price of cigarettes, advertising bans, and health education campaigns. But, one in four premature deaths in the UK (adults aged 35–65 years) are still caused by smoking, and a study published recently warned that today’s smokers puff their way through more cigarettes and start at an earlier age than smokers of fifty years ago. This means that, on average, men who smoke now die ten years earlier than men who don’t smoke. Can primary care make an impact on this ongoing problem? The good news is yes – and the new GMS contract is finally offering us incentives to include smoking in our health promotion activities. In this article, we give you the ammunition to put smoking cessation on your agenda – with the health and economic reasons why it makes sense to help patients quit. Practice nurse Rosemary Evans then explains how she does it in her Docklands practice.
Stop the clot: achieving effective anticoagulation in patients with heart disease
Thromboembolism is a common complication of heart disease – particularly in patients with atrial fibrillation (AF). Decisions to prescribe an anticoagulant are based on assessment of an individual patient’s risk of clotting and the side-effects of treatment. With growing numbers of patients with heart disease, the number of patients on anticoagulants is increasing and there is a shift to primary care-based anticoagulation clinics. Practice nurses have a central role in educating patients about anticoagulation therapy and in monitoring their ongoing care.
