Progress, from the Latin progressus, means "moving forward" or "advancing." Yet progress can be a paradoxical concept, and, as has frequently been observed, we often seem to be taking 2 steps backward even as we slowly inch forward. As our world grows richer, some populations become poorer, and many become sicker. As we live longer, too often we become less healthy. And, although we live in a period of increasing economic development and urbanization, as our lives become "better," cardiovascular disease (CVD), the principal cause of death throughout the world, imposes an ever-increasing burden of morbidity and mortality in both high- and low-income countries. In the first of the articles in this supplement, "The Global Burden of Cardiovascular Disease," Deaton and colleagues explain why CVD is, increasingly, a global issue; why it attacks both high and low socioeconomic groups; why, given that it results from the cumulative effects of a finite number of modifiable risk factors, it is nevertheless so difficult to eradicate; why different risk factors are endemic in different societies; and which interventional strategies may have the greatest impact in various locations and cultures.
Although risk for CVD increases with increasing age, the disease process begins very early in life. Because the risk factors that lead to CVD events are influenced over decades by both behavior and environment, intervention at any point to modify or reverse deleterious patterns is likely to be beneficial. In "A Life Course Approach to Cardiovascular Disease Prevention," Hayman et al describe effective interventions and present global risk assessment tools to help determine which populations need to be targeted.
These interventions can best be delivered by professionals who possess the wide range of skills required to change behaviors. In the third article in this supplement, Berra et al discuss "Nurse-Based Models for Cardiovascular Disease Prevention" and provide examples of nurse-led programs that have been successful in modifying multiple risk factors in both primary and secondary prevention populations. These models have the flexibility to be implemented successfully in a variety of settings and the proven potential to reverse unhealthy practices, such as poor diet, sedentary lifestyle, and smoking, and replace them with healthy ones, such as regular exercise and good nutrition. Nurse case managers also have the skills to mobilize family members to motivate and support positive behaviors, including diet, exercise, and adherence to medication regimens. New technologies provide additional opportunities for nurses to extend their reach in working to reduce cardiovascular risk factors in individuals and populations.
Effective strategies to tackle global problems often begin in communities. In the fourth article in this series, Fletcher and colleagues present "Community-Based and Public Health Prevention Initiatives" and explain why they are necessary, and why, with support from policy makers, such initiatives can be highly successful in encouraging and enabling behavior change for groups of people. The authors provide examples of communities that have been mobilized to adopt heart-healthy behaviors and whose environments have been modified so as to make those behaviors possible, for example, safe and attractive locations to walk and exercise. Community-Based Participatory Research is highlighted and illustrates how to involve communities in research efforts. Community participation in genetic research is increasing and is enabling improved understanding of how genes interact with lifestyles to enhance CVD risk. The authors describe the rewards and challenges of such participatory research, including ethical issues that remain to be resolved.
In the fifth article in the supplement, Burke and colleagues discuss ways in which health policy operates at municipal and local as well as national levels. Effective change requires an in-depth understanding of these multilevel policies and how they operate, particularly in poor and developing countries. Health care systems differ throughout the world and can have a significant impact on patient adherence to therapeutic lifestyle change, but so can a number of other factors delineated by the authors, including available therapies and the resources, skills, and beliefs of target populations. The authors present ways of overcoming obstacles to adherence and creating incentives for healthy behaviors.
In the final article in this supplement, the authors argue that, although nurses are the highly trained foot soldiers in the battle against CVD, many also have the potential to be generals-visionary leaders who can innovate, motivate, and inspire. In this article, the authors describe the kinds of programs, including mentorship programs that have been most successful in identifying and training these new leaders.
A sense of urgency permeates this supplement. Just as poverty engenders poor health, poor health also contributes to poverty and to loss of productivity worldwide. The challenge of CVD is enormous and unrelenting, but it is not insurmountable. The risk factors are known, and the skills to modify them are available. Cardiovascular nurses are deeply committed and determined to make authentic progress, to move forward steadily and without losing ground, so as to enable vulnerable populations and individuals throughout the world to avoid initial or recurrent CVD and to have a longer, healthier, and more productive future.
On behalf of the Preventive Cardiovascular Nurses Association (PCNA) International Committee:
Kathy Berra, MSN, RN, ANP, FAHA, FPCNA, FAAN
Barbara J. Fletcher, MSN, RN, FAHA, FPCNA, FAAN
Laura L. Hayman, PhD, RN, FAHA, FPCNA, FAAN
Nancy Houston Miller, BSN, RN, FAHA, FPCNA
Coeditors
The coeditors want to express their gratitude to Dr Ruth Sussman for her invaluable editorial assistance.