PCNA Honors Excellence With Cardiovascular Disease Prevention Award
Congratulations to the winners of the first PCNA Cardiovascular Disease Prevention Award. Nominees were students graduating from a Masters or Doctoral Program in nursing who have demonstrated a significant contribution to cardiovascular disease prevention through a practice initiative, publication, research, community project, or other prevention leadership effort. They likewise have the potential to contribute to cardiovascular disease prevention in their future career.
Each winner will receive a 1-year PCNA membership, educational materials, a subscription to the Journal of Cardiovascular Nursing, and a complimentary registration for the PCNA Annual Symposium. Congratulations to the following winners: Lola Coke (Rush University, Chicago), Rona Corral (Johns Hopkins University), Maureen Gardner (Loyola University, Chicago), Elizabeth Owens (New York University), Ruth Taylor-Piliae (University of California, San Francisco), and Laura Triola (University of North Florida).
September is Healthy Aging Month
Healthy aging, once an oxymoron, is the focus of preventive care efforts to emphasize the positive aspects of growing older. Healthy habits, such as regular exercise and good nutrition, can be learned at any age and can benefit a person at any age. Exercise helps older adults stay healthy and independent by maintaining healthy bones and joints, contributing to weight control, improving mood and sense of wellbeing, decreasing the risk of falls, and strengthening muscles, including the heart. Most older people do not get enough physical activity. Here are some reasons why they should:
* Older exercisers are more likely to live to an advanced age and are more likely than their sedentary counterparts to remain independent until the end of life.
* Exercise and diet reduce the risk of diabetes in high-risk older people. Lifestyle changes led to a 71% decrease in diabetes among people aged 60 years and older.
* Moderate exercise is effective at reducing stress and sleep problems in older women caring for a family member with dementia.
* Older people who exercise are able to fall asleep quickly, sleep for longer periods, and get better quality of sleep after moderate exercise.
* Exercise, which can improve balance, along with other interventions, reduces falls among older people by 44%.
* Walking and strength-building exercises done by people with knee osteoarthritis can help to reduce pain and maintain function and quality of life.
As is the case for most of us, older people may know that exercise benefits their health, but they may lack the motivation or encouragement to do it. Guide your clients by asking them about their daily activities and whether they participate in any kind of regular exercise. There are several ways to encourage older clients to exercise. First, whenever appropriate, let clients know that it is fine to exercise, regardless of age. Help clients set realistic goals and develop an exercise plan, write an exercise prescription, and follow up to see how the patient is doing. You might refer clients to community resources, such as mall-walking clubs, where they can join group activities to promote and reinforce exercise.
Advise clients that exercise should not hurt or make them feel really tired. Although they might feel some soreness, a little discomfort, or a bit weary, they should not feel pain. In fact, in many ways, being physically active will probably make them feel better. Here are some safety tips you can provide to make sure that your older clients are exercising safely:
* Encourage your clients to start physical activity at a low level with a slow, incremental increase in the duration and intensity of their activities. Doing too much, too soon, can result in injury.
* Remind them not to hold their breath while straining. Instead they should breathe out while their muscle is working and breathe in when it relaxes.
* If clients are taking any medications or have any illnesses that alter their heart rate (eg, beta-blockers), provide education so that they understand that their target heart rate is not an appropriate method of determining the desired intensity of exercise. For these clients, another method for estimating the intensity of their physical activity is the Borg Category Rating Scale. The scale can be found at http://www.niapublications.org/exercisebook/chapter4.htm#how_hard. The numbers on this scale help clients to describe how hard they feel they are working.
* Remind them to use safety equipment (eg, a helmet for bike riding or the right shoes for walking or jogging) to avoid injury.
* Unless clients have been recommended to limit fluids for medical reasons, encourage them to drink plenty of fluids during physical activities that make them sweat. Many older people tend to be low on fluid much of the time, even when not exercising.
* Teach clients to always bend forward from the hips, not the waist. If they can keep their back straight, then they are probably bending the correct way. If their back arches, then injury could result.
* Encourage them to warm up their muscles with 5 to 10 minutes of easy biking or walking and light arm pumping before they stretch.
The National Institute on Aging (NIA) offers a free booklet, which is available in both English and Spanish, showing older adults how to start and stick with a safe, effective program of stretching, balance, and strength-training exercises. The NIA also has produced an exercise video based on the book. The recommended exercises were developed and chosen based on evidence from research studies. The exercise guide is available on the NIA Web site at http://www.nia.nih.gov/HealthInformation or by calling 1-800-222-2225.
Nurses who want to enhance their geriatric competence and improve the quality of healthcare provided to older adults can visit the Nurse Competency in Aging Web-based Comprehensive Geriatric Resource Center, http://www.geronurseonline.org, for information. You can earn Continuing Education Contact hours for geriatric topics.
Consider hosting one of the Healthy Aging Month Events (http://www.healthyaging.net/) suggested below to promote healthy aging:
* Stage an event and have an elected official proclaim the national month-generating publicity for your event.
* Create a Healthy Aging(R) Open House.
* Create an Intergenerational Program.
* Set up a Healthy Aging(R) Walk-a-Thon.
* Sponsor a senior athletic event, such as a mall-walk, 5-km run, or family fun bicycle ride.
* Give away free Healthy Aging(R) materials.
National Lipid Association Releases a Special Report on Statin Safety
A landmark publication, A Symposium: Report of the National Lipid Association's Statin Safety Task Force, was recently released as a supplement to the American Journal of Cardiology (Am J Cardiol. 2006:97 (Suppl)). This report provides a rigorous and thorough review of the most up-to-date scientific evidence regarding the safety of statins.
Following are several key recommendations related to the liver and muscle.
* Because routine monitoring of liver function is not likely to identify the rare patient who develops serious liver dysfunction, the current recommendation for monitoring needs to be reconsidered by the Food and Drug Administration.
* Patients with chronic liver disease, nonalcoholic fatty liver disease, or nonalcoholic steatohepatitis may safely receive statin therapy.
* Whenever muscle symptoms or an increased creatinine kinase (CK) level occurs in a patient receiving statin therapy, clinicians should attempt to rule out other etiologies because these are most likely to explain the findings.
* It is not necessary to measure CK levels in an asymptomatic patient during the course of statin therapy.
* Patients receiving statin therapy should be counseled about the increased risk of muscle aches/weakness, particularly if the initiation of vigorous, sustained endurance exercise or a surgical operation is being contemplated.
* CK levels should be obtained in symptomatic patients to help gauge the severity of muscle damage and facilitate a decision as to whether or not to continue therapy or alter doses.
* Symptomatic patients should have an evaluation of thyroid function because hypothyroidism can decrease statin catabolism. Clinicians should search for effects of concomitant medications that reduce statin metabolism, as well as over-the-counter herbal remedies such as red rice fungus and grapefruit juice consumption, which impedes statin catabolism.
* In patients who develop intolerable muscle symptoms, with or without a CK elevation, and in whom other etiologies have been ruled out, the statin should be discontinued. Once asymptomatic, the same or different statin at the same or lower dose can be restarted to test the reproducibility of symptoms. Recurrence of symptoms with multiple statins and doses requires the initiation of other lipid-altering therapy.
* In patients who develop tolerable muscle complaints or are asymptomatic with a CK <10 times the upper limit of normal, statin therapy may be continued at the same or reduced doses and symptoms may be used as the clinical guide to stop or continue therapy.
The Symposium also addresses the neurological effects of statins, assisting healthcare providers in confidently responding to patient's questions and concerns regarding statin safety.
In the News: Two Popular Statins Go Generic This Summer
Several popular statins are going generic this summer. Pravachol lost its patent protection in April, whereas Zocor lost its protection in late June. Companies are now competing to make generic versions of these popular cholesterol-lowering medications. Insurance companies, in search of cost savings, will recommend, if not require, a switch from the brand-name statins to the generic version.
Generic drugs are the same as the brand-name version in all but looks, inactive ingredients, and price. By law, a generic drug must:
* contain the same active ingredients as the brand-name drug;
* be identical in strength, dosage form, and administration;
* work the same way in the body (bioequivalent);
* meet the same standards for identity, strength, purity, and quality; and
* be made by the same rules the Food and Drug Administration has set for the brand-name drug.
Last year, the average price of a generic prescription drug was $29, whereas the average for a brand-name prescription drug was $95. The generic pravastatin and simvastatin have not seen that much of a discount yet. The average savings for switching to a generic statin has been 30% to 40% for most consumers. These discounts will only increase over time. Lipitor will go generic in a few years, allowing consumers even more cost-effective options for lowering their cholesterol.
American Heart Association Updates Lifestyle Recommendations
Keeping pace with the latest scientific evidence requires vigilant updating of current guidelines. Diet and Lifestyle Recommendations Revision 2006 (available at http://www.circulationaha.org) provides a comprehensive plan for reducing cardiovascular risk in a format that highlights the key role of an "overall healthy lifestyle." This piece reinforces most of the lifestyle goals familiar to healthcare professionals using both a public health and clinical approach. It individualizes recommendations for special groups, highlights the challenges of eating healthy foods prepared outside the home, and addresses the powerful influence the environment poses on the achievement of healthy amounts of foods and physical activity. It identifies the key roles played by health professionals, schools, restaurants, the food industry, and local policies in the attainment of these recommendations. These recommendations also discuss the latest evidence related to dietary factors with unproven or uncertain effects on cardiovascular disease risk (including antioxidant supplements, soy protein, folate, and phytochemicals).
A few of the key points are highlighted:
* Diet and lifestyle interventions remain the foundation of cardiovascular risk reduction.
* Emphasis should be on the overall healthy diet rather than focus on single dietary components or supplements.
* Actual weight at age 18 and subsequent weight gain are associated with the risk of developing cardiovascular disease and diabetes.
* Rather than presenting a structured diet "plan," 2 examples of eating patterns at 2,000 calories per day using the Dietary Approaches to Stop Hypertension and Therapeutic Lifestyle Changes plans are provided.
* Although 30 minutes of physical activity is considered the minimum level, at least 60 minutes most days of the week is recommended for children, whereas addressing weight loss and maintenance issues is recommended for adults.
* A goal of <1% trans-fatty acids is recommended.
* Recognizing the growing pattern of consuming food "away from home," the emphasis of making wise food choices in all settings is necessary.
* High-priority recommendations are provided for several target groups to facilitate the adoption of these recommendations.
September is National Cholesterol Month
Ten great ideas for promoting National Cholesterol Education Month
1. Encourage your family, friends, and coworkers to have their cholesterol checked.
2. Contact your worksite health and fitness center and/or local congregation and ask them to co-sponsor a cholesterol screening fair
3. Increase awareness by distributing a cardiovascular risk factor checklist and/or the 10-year risk calculator (http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub).
4. Each week send out a different broadcast e-mail to all employees to raise awareness, such as: "Did you know[horizontal ellipsis] With each 1% drop in cholesterol value-you decrease your risk of heart disease by 2%?"
5. Sponsor a heart healthy recipe contest. Award a restaurant or grocery store gift certificate to the top winners in each category- salad, entree, and dessert.
6. Coordinate with a dietitian to give a grocery store tour demonstrating how to read food labels and choose heart healthy foods.
7. Organize a group walk at work, school, and home. Set aside 30 minutes at least 1 day a week during Cholesterol Month to do this.
8. Find a local sporting good store to co-sponsor a pedometer giveaway. Coordinate this with a "lunch and learn" program such as "Steps to Heart Health."
9. Decorate a bulletin board using the theme "Know Your Cholesterol Numbers, Know Your Risk." Post various resources and educational flyers.
10. Write an article about Cholesterol Month for your hospital, school, or organization's newsletter. Use the ATP III Update as a resource (Circulation. 2004;110:227-239).
Section Description
The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.