PCNA Participates in the 2nd Asian Preventive Cardiology and Cardiac Rehabilitation Conference and 7th Certificate Course in Cardiac Rehabilitation
Preventive Cardiovascular Nurses Association (PCNA) joined the Hong Kong College of Cardiology as a supporting organization for their biannual 2nd Asian Preventive Cardiology Conference and 7th Certificate Course in Cardiac Rehabilitation in Hong Kong. Dr Suet-ting Lau and Prof Chu-pak Lau, conference cochairs, invited a multinational faculty from China, Iran, Korea, Japan, Malaysia, Thailand, Italy, the Netherlands, the United Kingdom, Canada, and the United States. The PCNA was honored to be invited and awarded the conference cochairs with honorary memberships in PCNA.
As a supporting organization, PCNA was able to meet with the nursing leadership in China and support its plans to develop a Cardiovascular Prevention Society. Two $500 scholarships to attend PCNA's Annual Symposium will be awarded at the Inaugural Chinese Cardiovascular Prevention Society. Professor Sophia S. C. Chan, PhD, MPH, MEd, FAAN, Assistant Dean of External Affairs, Professor of Nursing and head of the Department of Nursing Studies, the University of Hong Kong, Li Ka Shing, Faculty of Medicine; and Sek-Ying Chair, RN, MBA, PhD, Associate Professor, the Nethersole School of Nursing and Faculty of Medicine, the Chinese University of Hong Kong; and Ms Winnie Hung, General Manager of Nursing, Grantham Hospital, and incoming President of the new Prevention Society all attended our meeting to discuss future international collaboration.
The PCNA board members Nancy Houston Miller BSN, FAHA, and Kathy Berra, MSN, ANP-C, FAAN, had the privilege of presenting a variety of important subjects including diabetes, metabolic syndrome, angina, hypertension, and behavioral counseling. Sue Koob, CEO of PCNA, met with the attendees and provided information about PCNA. Samples of our educational materials, including The Journal of Cardiovascular Nursing, were distributed throughout the meeting. The PCNA was warmly welcomed, and we highly value our new liaisons with the nursing and medical leadership in China.
Vitamin D Deficiency and Cardiovascular Disease Risk
Low vitamin D levels have long been associated with bone diseases such as rickets in children and osteomalacia and osteoporosis in adults. More recently, evidence points to its relationship with cardiovascular disease (CVD). Vitamin D deficiency seems to be related to hypertension, diabetes mellitus, metabolic syndrome, left ventricular hypertrophy, heart failure, peripheral arterial disease, and chronic vascular inflammation. Prospective epidemiological studies have linked low vitamin D levels with increased risk of myocardial infarction in men and have noted a relationship between rates of CVD, diabetes mellitus, and hypertension and vitamin D deficiency, with distance from the equator.
Vitamin D deficiency is a highly prevalent condition, present in approximately 30% to 50% of the general population. Early symptoms of deficiency include muscle weakness, generalized fatigue, myalgia, and joint pain. Preventive cardiovascular practitioners have long associated these symptoms with statin intolerance. Evaluating vitamin D levels as part of a workup for secondary causes of myalgia in statin-treated patients may be helpful. Serum 25(OH [hydroxy])D level is the recommended laboratory test to assess for vitamin D deficiency. Optimal levels are between 30 and 100 ng/mL. Levels less than 30 ng/mL are considered deficient; more than 100 ng/mL, excessive; and more than 150 ng/mL indicates toxicity.
Recommendations for repletion of levels less than 30 ng/mL are prescription vitamin D2 (ergocalciferol) 50,000 IU once weekly for 8 weeks. If levels are still low, repeat the same prescription for an additional 8 weeks. Once sufficient serum levels are reached, a maintenance dose of over-the-counter vitamin (cholecalciferol) D3 1,000 to 2,000 IU daily is generally required. In many cases, muscular/skeletal symptoms of vitamin D deficiency improve shortly after levels have normalized.
Individuals get limited vitamin D from food sources such as fortified milk or orange juice (each contains 400 IU vitamin D per quart) and fatty ocean fish (salmon, albacore tuna, sardines, and mackerel have an estimated 100-500 IU per serving). Fish oil capsules generally do not contain vitamin D.
An excellent source of vitamin D is the sun, giving vitamin D its name as the "sunshine vitamin." In latitudes greater than 35 degrees north (in the US, this is north of Atlanta, Georgia), we absorb no vitamin D from the sun; however, during the summer months in the north and throughout the year in areas closer to the equator, the amount of vitamin D absorbed by 20 minutes of skin exposure can be as much as 20,000 IU. Sunscreen (SPF 30 or higher) blocks vitamin D absorption. The benefit of sunshine must be carefully weighed with the risk of sun exposure, especially for those with a history of, or who are at high risk for, skin cancer. Tanning beds with UVB lights can yield 2,000 to 4,000 IU of vitamin D, but need to be used with caution as well.
The Endocrine Society is currently writing a clinical practice guideline entitled "Vitamin D and Bone." This guideline is to be released in 2009. Other good resources regarding vitamin D are the National Institutes of Health Office of Dietary Supplements (http://ods.od.nih.gov/factsheets/vitamind.asp) and the Vitamin D Council (http://www.vitamindcouncil.org). Future research is needed to better explain the relationship between vitamin D and CVD risk as well as to determine whether supplementation reduces morbidity and mortality.
Reference
1. Lee JH, O'Keefe JH, Bell D, Hensrud DD, Holick MF. "Vitamin D Deficiency. An important, common, and easily treatable cardiovascular risk factor?" JACC. 2008;52:24.
Enhance Your Practice-Become a Clinical Lipid Specialist
The Accreditation Council for Clinical Lipidology (ACCL) invites nurses engaged in the management of lipid disorders to become clinical lipid specialists (CLSs). The ACCL's aim is to establish and maintain a board examination process for medical professionals to demonstrate clinical competence in lipidology. The examination process also encourages professional growth in the practice of lipidology and enhances practice behavior to improve the quality of patient care.
The CLS credential validates a clinician's expertise in lipid management and prevention of cardiovascular disease for patients and professional colleagues. Clinical lipid specialist candidates must be US or Canadian residents and be a licensed pharmacist or physician assistant, registered or advanced practice nurse, dietitian, or American College of Sports Medicine-certified exercise specialist, clinical exercise physiologist, or American Council on Exercise advanced health fitness specialist. Individuals who hold a BS/BA degree must also have at least 3,000 contact hours in the clinical management of lipids, and those with a master's degree or higher in health science must have at least 2,000 contact hours in the management of patients with lipid disorders.
This year, ACCL will host 2 on-site examination dates: Friday, May 1, and Saturday, May 2, in Miami Beach, Florida, in conjunction with the National Lipid Association's Scientific Sessions and on Saturday, September 29, in Cincinnati, Ohio, in conjunction with the Midwest Lipid Association's annual conference. Computer-based examinations will also be available at various assessment centers throughout the country for 2 months following each of the above examination dates. Please visit the CLS Web site http://www.lipidspecialist.org for more details regarding the application process and to download the 2009 credentialing guide and examination application.
Kick Butts in 2009!
Each year since 1995, the Campaign for Tobacco-Free Kids, also known as the National Center for Tobacco-Free Kids, has held Kick Butts Day in an effort to empower youth to stand out, speak up, and seize control against Big Tobacco with fun, educational activities, and events.
In 2008, more than 1,000 events were held across the United States. Teachers, youth leaders, and advocates organized events and mobilized kids to raise awareness about the problems of tobacco use in their schools and communities.
Kick Butts Day will be held on March 25, 2009. The Campaign for Tobacco-Free Kids offers many resources to use in planning an event. New Kick Butts Day event organizers can visit http://www.kickbuttsday.org/getting_started/ for tips on how to get started. Returning organizers can visit http://www.kickbuttsday.org to order or download a free copy of the 2009 Kick Butts Day Guide, get activity ideas, download activity and promotional materials, purchase Kick Butts Day Gear, and register events.
The PCNA supports the efforts of the Campaign for Tobacco-Free Kids! Please let us know what creative activities you have planned for Kick Butts Day 2009 by e-mailing [email protected].
Did you know?
* More than 5 million children alive today will die prematurely from smoking-related illnesses.
* Adult male smokers lose an average of 13 years of life.
* Almost 90% of adults who have ever been regular smokers began smoking by the time they were 18 years old.
Heart Attack Risk Assessment Tool-Now Compatible With Google Health
The American Heart Association has enhanced its risk assessment tool to allow consumers to import and export data into their Google Health portal account. Google Health lets you store and manage all your health information in one safe, secure location. The American Heart Association is the first nonprofit organization to team with Google to encourage Americans to create and maintain a Personal Health Record and one of only several companies that had an interoperable health tool at launch. Visit http://www.americanheart.org/riskassessment.
Depression Screening-A Must for Heart Patients
New guidelines from the American Heart Association (AHA) recommend that heart patients should be screened for depression and treated if necessary, because they are at much higher risk for depression and it can severely affect prognosis of their heart condition and their quality of life.
The AHA's first scientific statement on depression and coronary heart disease is published in the September 29, 2008, issue of Circulation: Journal of the American Heart Association.
There is no routine depression screening among heart patients, but studies show that depression is approximately 3 times more common in patients following a heart attack than in the general community.
Depression can impact cardiovascular care because depressed patients are less likely to follow medication instructions or other advice such as improving their diets, exercise, and attending cardiac rehabilitation.
Screening entails asking the patient these 2 questions, and then if depression is suspected, asking them an additional 7 questions:
"Over the past 2 weeks, how often have you been bothered by any of the following problems: (1) little interest or pleasure in doing things, or (2) feeling down, depressed, or hopeless." If the answer is yes to either question, then screen with the 7 remaining questions in the Patient Health Questionnaire 9. The guidelines as well as the screening questions are available at http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.190769v2.pdf.
The statement recommends the following:
* Patients presenting with symptoms of depression should be evaluated by a professional qualified in diagnosing and managing depression.
* They should also be screened for other psychiatric disorders, such as anxiety.
* Treatments considered should include cognitive behavioral therapy, physical activity, cardiac rehabilitation, antidepressants, and combinations of these.
* Selective serotonin reuptake inhibitor treatment may be effective for treating depression soon after a heart attack and is considered safe and relatively inexpensive.
* To avoid missing the opportunity to effectively treat depression in heart patients and improve physical health outcomes, screening for depression should be routinely performed in a range of settings, including hospitals, cardiologist and thoracic surgeons' offices, clinics, and cardiac rehabilitation centers.
* Coordination of care between health providers is essential for patients with both medical and psychiatric diagnoses.
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.