A Letter from the President-Joanna Sikkema
It is an honor to be the 2007-2008 PCNA President and I look forward to a year of innovation as we move forward with a new 10-year strategic plan. In January 2007, the PCNA Board of Directors, with the assistance of BigPicture Consulting, developed a new direction for the organization and its dynamic membership. I invite each and every one of you to join us on this journey.
We acknowledge that the healthcare environment is rapidly changing, and the science and technology associated with cardiovascular disease prevention is also in evolution. These changes, coupled with the expanding role of nurses in many different specialties and practice sites, have energized the PCNA to re-evaluate the organization's direction and outreach as a leader in cardiovascular disease prevention. Data collected from the 2006 membership survey and the Annual Symposium evaluation reflect that our membership is changing in diversity and role responsibility. As a result, we will be directing the PCNA Annual Symposium, education strategies, and tools to meet these needs.
The vision at the core of the PCNA 10-year strategic plan includes a bold and potentially radical expansion of the organization, its responsibilities, and actions. This vision has 11 having an organization with substantially more diverse members; expanding to a global reach and presence; developing an enlarged and more active leadership core; creating a greater visibility and broader audience (both within nursing and with the public); expanding the use of new technologies; increasing cooperation and partnership with other organizations; nurturing an active local membership base; and the vision to dare to be the leading organization in the world in prevention policy and practice.
It is with the support and involvement of our members and corporate partners that we will reach these goals. To this end, as President, I hope to hear from you as we move in this new direction. I have established an e-mail address for you to keep me informed about your thoughts and I welcome all comments. My address is: [email protected].
I look forward to working closely with the PCNA membership over the next year.
Sincerely,
Joanna D. Sikkema,
MSN, APRN-BC, FAHA
PCNA Hosts 13th Annual Symposium
PCNA's 2007 Annual Symposium, "Cardiovascular Risk Reduction: Leading the Way in Prevention," held April 26-28 in Minneapolis, Minnesota was a huge success. The program began with a public health approach exploring the effects of race, ethnicity, culture, and low literacy on the prevention of cardiovascular disease (CVD). Focus then shifted to gender issues with a review of lessons learned and implications for practice from the Women's Health Initiative, and the Women's Ischemia Syndrome Evaluation (WISE) study. Later talks focused on the challenges of managing individual risk factors, how to use motivational interviewing with the patient to make change, identifying and managing peripheral arterial disease, preventing heart failure, diabetes prevention, and the powerful connection between kidney disease and CVD. Seven breakout sessions provided "something for every one's learning." The following are just a few highlights from this powerful program:
Vera Bittner, MS, MSPH, Professor of Medicine, University of Alabama at Birmingham presented Exploring Better Ways to Diagnose Heart Disease in Women, based on the WISE study. She reviewed outcomes over 6 years for 936 women who presented with suspected myocardial ischemia and underwent coronary angiography coupled with state-of-the-art diagnostic testing. Some key points included:
* Symptom assessment is more complex than in men, in part related to women's advanced age and presence of diabetes.
* Lack of obstructive coronary artery disease should not be equated with lack of ischemia, nor does it equate with a good prognosis.
* Traditional treatment approaches are often not successful in women.
* The economic burden of angina among women is substantial.
Randal Thomas, MD, Director, Cardiovascular Health Clinic, Mayo Clinic, explored Traditional vs. Emerging Risk Factors: Which is Better for Quantifying Risk? He clarified that although a variety of factors help to estimate cardiovascular (CV) risk, it is a handful of these that explain the majority of a person's risk for future CV events. The impact of the newer "novel" measurements has shown mixed results. Although much focus goes into determining "the best estimates of risk," the bottom line is that basic preventive therapies already known to reduce morbidity and mortality continue to be underutilized. He posed several important areas for future investigation and clarification:
* Is "high tech" more effective than "low tech" preventive cardiology?
* What about the cost effectiveness of screening for novel risk indicators?
* Should we simply assume every one is at increased CV risk and work through community-wide models of prevention?
* How might we estimate risk for given patients after preventive therapies have already been applied?
Lisa Young, PhD, RD, Adjunct Asst. Professor, Dept. of Nutrition, Food Studies and Public Health, New York University, challenged the audience with her topic, The Diet Dilemma: Reducing Risk with Nutritional Management. As clinicians, we are all very concerned about the best ways to guide clients in weight management, yet the real world continues to work against these efforts. Dr Young's research in marketplace food portions has documented how portion sizes have continued to expand in parallel with increasing body weights. This poses a huge public health effort as most marketplace portions exceed 2 to 8 times the federal guidelines for standard serving sizes. Bottom line-we need to counsel patients not only on selection of healthy food choices but also on the appropriate serving size that meets caloric needs.
Patricia McCarley, MSN, ACNP, Nephrology Nurse Practitioner, Oakland, CA presented, Kidney Disease and CVD: A Powerful Connection. She discussed several large prospective studies that have reported CVD as a risk independently associated with elevated serum creatinine and low glomerular filtration rate. Although patients with chronic kidney disease (CKD) have many of the traditional risk factors for CVD, they also have other unique renal-related risk factors, including anemia, disturbances of mineral metabolism, proteinuria, extracellular volume overload, malnutrition, inflammation, elevated homocysteine, and C-reactive protein. Patients with CKD should be considered at highest risk for CVD and its associated mortality. Strategies to slow progression of CKD and CVD were highlighted.
The PCNA Planning Committee is already working on an exciting program for 2008. Save the date-April 24-26 in Orlando, Florida!
May is National Stroke Awareness Month
The goal of the National Stroke Association's (NSA) annual campaign is to raise public awareness about stroke risk factors, prevention, symptom recognition, and acting fast to treat stroke. Because women are uniquely affected by stroke, this year's campaign will focus on women and the impact of stroke on our mothers, sisters, wives, and daughters. It is also the goal of the NSA to engage men to learn more about stroke by asking them to think about the personal impact it can have on the women in their lives.
Twice as many women die of stroke than breast cancer every year. Despite this startling statistic, women are more worried about their risk of getting breast cancer than their stroke risk. What's more, women think stroke is a man's disease. However, more women than men will die from stroke. These are some of the reasons why the NSA developed "Women in Your Life," to teach both men and women about stroke prevention and the importance of recognizing stroke symptoms in each other.
Stroke symptoms include:
* Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.
* Sudden confusion, trouble speaking, or understanding.
* Sudden trouble seeing in one or both eyes.
* Sudden trouble walking, dizziness, loss of balance or coordination.
* Sudden severe headache with no known cause.
To order a free "Women in Your Life" booklet, call 1-800-STROKES.
The good news is that 80% of strokes are preventable. For persons with 1 or more stroke risk factors, it is even more important that they learn about the lifestyle and medical changes they can make to prevent a stroke. National Stroke Awareness Month is an opportunity to educate our patients, friends, family, and community about stroke. Do you have your Stroke Awareness Month event planned already? If not, visit the NSA for some helpful ideas: http://www.stroke.org/.
Heart Health for Women
Mother's Day is Sunday, May 13. Your mom has taken good care of you, now is the perfect time to encourage her to take good care of herself. In fact, why not encourage all of the special women in your life to make heart health a priority this month?
Although significant progress has been made in increasing awareness among American women that heart disease is their leading killer, 45% are still unaware of their own risk of heart disease.
PCNA's Tell a Friend about Women and Heart Disease campaign will arm you with information and tools to share with your mother, sisters, friends, and colleagues. This program will help you to: (1) Raise awareness that heart disease is the leading cause of death among women, (2) Raise awareness about the symptoms of heart disease and how these may differ in women when compared to men, (3) Raise awareness about the importance of knowing key numbers for cholesterol, body mass index, and blood pressure. Learn more about Tell a Friend at http://www.pcna.net.
Another resource is the National Heart Lung and Blood Institute's Heart Truth Speakers Kit. The updated and expanded kit contains everything necessary to conduct a 1-hour session on women and heart disease with patients, friends, family, neighbors, or club members. The kit includes a speaker's guide along with a 10-minute video featuring real women telling their stories of heart disease. You can order a kit, for a small fee, at http://www.nhlbi.nih.gov/health/hearttruth/.
While you are gearing up to spread the word about women and heart disease this month, it is worthwhile to review a new women's heart risk predictor, the Reynolds Risk Score. This risk tool is based on the study, "Development and Validation of Improved Algorithms for the Assessment of Global CV Risk in Women," published in JAMA on February 14, 2007. The Reynolds Risk Score includes age, systolic blood pressure, total and high-density lipoprotein cholesterol levels, smoking status, levels of high sensitivity C-reactive protein, and parental history of myocardial infarction before the age of 60. According to the study, 40% to 50% of women classified as having an intermediate risk actually had a higher or a lower risk based on the Reynolds Risk Score.
The latest Evidence-Based Guidelines for CVD Prevention in Women: 2007 Update (see next) emphasizes that healthy lifestyles continue to be the top priority for women in the prevention of heart disease. Mother's Day is an opportunity to encourage lifestyle changes by treating the women in your life to a heart-healthy brunch, a walk (or bike ride) in the park, a fitness center membership, or a gift certificate for a new pair of walking shoes. Finally, it's important to remember to take good care of yourself in order to be able to take care of others! Happy Mother's Day.
Reference:
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007;297:611-619.
Evidence-Based Guidelines for CVD Prevention in Women: 2007 Update
The 2007 Updated Prevention Guidelines for Women continue to highlight that lifestyle changes can both decrease cardiovascular (CV) risk factors and prevent cardiovascular disease (CVD) and coronary heart disease (CHD). They further emphasize that the intensity of the intervention should match the woman's level of risk. The new risk classification for women-either high risk, at risk, or optimal risk-places many women in the "At Risk" category by acknowledging the importance of single or multiple risk factors without clinically evident coronary artery disease.
* High Risk is defined as a woman with established CHD, cerebrovascular disease, peripheral artery disease (PAD), abdominal aortic aneurysm, end-stage or chronic renal disease, diabetes mellitus, or a Framingham risk score of > 20% (or at high risk based on another population-adapted global risk tool).
* At Risk is defined as a woman with >=1 major risk factor for CVD, including cigarette smoking, poor diet, physical inactivity, obesity (especially central adiposity), family history of premature CVD, hypertension, dyslipidemia, evidence of subclinical disease (eg. coronary calcification), poor exercise capacity on test, and/or abnormal heart rate recovery after stopping exercise.
* Optimal Risk is defined as a woman with a Framingham global risk lower than 10% with a healthy lifestyle and no risk factors.
The new classification emphasizes the importance of prevention for all women, given their high average lifetime risk, with almost 1 of 2 women developing CVD. The 2007 Guideline is also aligned with the evidence that most clinical trials involved either high-risk women (those with known CVD) or apparently healthy women. It further reflected the increased appreciation of the limitations of the traditionally used Framingham Risk Score, with its narrow focus on 10-year risk, its lack of inclusion of family history, and an underestimation or overestimation of risk in many non-white populations. Further, subclinical disease has been documented among many women who score "low-risk" on the Framingham Risk Score.
The 2007 Guideline emphasizes lifestyle as the fundamental approach to the care of all women. Smoking cessation, a heart-healthy eating pattern, regular physical activity, and weight management remain critical to our efforts in both primary and secondary preventions. Other recommendations include:
* Expanded indications for cardiac rehabilitation to include women with a recent acute coronary syndrome or coronary intervention, new-onset or chronic angina, recent cerebrovascular event, PAD, or current or prior symptoms of heart failure and a left ventricular ejection fraction below 40%.
* Optimal levels of lipids and lipoproteins are defined as a low-density lipoprotein cholesterol (LDL-C) <100 mg/dL, high-density lipoprotein cholesterol (HDL-C) >50 mg/dL, and triglycerides <150 mg/dL, initially encouraged through lifestyle approaches. For high-risk women, LDL-C-lowering drug therapy should be initiated simultaneously with lifestyle interventions; newly noted is that LDL-C reduction to <70 mg/dL may be reasonable in very high-risk women with CHD and may require an LDL-lowering drug combination.
* Aspirin recommendations reflect results of the recently published Women's Health Study, identifying 75-325 mg of aspirin daily in all high-risk women unless contraindicated, with clopidogrel substituted if aspirin intolerance is present. Eighty-one milligrams daily or 100 mg every other day of aspirin in women 65 years or older should be considered if the blood pressure is controlled and the benefit for ischemic stroke and myocardial infarction prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke. Aspirin should be considered for women younger than 65 years when the benefit for ischemia stroke prevention is likely to outweigh the adverse effect of therapy. By contrast, the routine use of aspirin in healthy women younger than 65 years is not recommended to prevent myocardial infarction.
* Menopausal hormone therapy is identified as an intervention that is not useful/effective and may be harmful; neither hormone therapy nor selective estrogen receptor modulators are recommended for the primary or secondary prevention of CVD.
* Antioxidant vitamin supplements such as vitamins E, C, and beta carotene should not be used for the primary and secondary prevention of CVD.
* Folic acid with or without vitamin B6 and B12 supplementation should not be used for the primary or secondary prevention of CVD.
* A simple algorithm is provided based on risk status to help guide clinical decision making, which can be shared with women as a basis for their preventive cardiovascular care.
As nurses and healthcare providers committed to CVD prevention throughout the lifespan, these new Guidelines provide us with scientific evidence to support our educational, lifestyle, and medical recommendations for women across the lifespan. Our ability to reach large numbers of women through our educational programs and clinical care holds promise that we can also reach their families and communities. A strong message of prevention through healthy lifestyles for women must be continued.
Reference:
Mosca L, Banka CL, Benjamin EJ. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. February 19, 2007.
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.