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Given the high co-occurrence of age and hypercholesterolemia, there is a critical need for age-appropriate evidence for achieving normal cholesterol levels. The purpose of the current review was to map recent evidence (i.e., past 5 years) on hypercholesterolemia management in older adults and identify gaps in the evidence. Electronic searches in PubMed, CINAHL, and Scopus were conducted. Inclusion criteria were age 65 or older and lipid panel outcome. Exclusion criteria were a mixed age sample and familial hypercholesterolemia. An initial pool of 3,176 unique records resulted in 26 articles that met inclusion criteria. Arksey and O'Malley's scoping study framework was used. Sample sizes ranged from 12 to 1,010 (N = 8,509) adults ages 65 to 96. Evidence supports the use of exercise, diet, and statins in older adults. Laboratory, intervention, and methodological gaps were identified. Much remains to be examined in safely managing older adults with hypercholesterolemia, including determining time to behavior change in nonpharmacological interventions and contextual factors influencing adherence. [Journal of Gerontological Nursing, 45(3), 31-42.]., (Copyright 2019, SLACK Incorporated.)

Background: Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes., Objectives: To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia., Methods: The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia., Results: Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia., Conclusions: Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Rationale, Aims and Objectives: In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH., Methods: Utilizing clinical decision support software (Audit+) we developed an FH Audit Tool and implemented a systematic audit of electronic medical records within GP practices, first identifying all patients diagnosed with FH or possible FH and next electronically flagging patients with a recorded total cholesterol of >7.5 mmol L(-1) or LDL-C > 4.9 mmol L(-1) (in adults), for further assessment. After a 2-year period, a nurse-led clinic was introduced to screen more intensely for new FH index cases. We evaluated if these interventions increased the prevalence of FH closer to the expected prevalence from epidemiological studies., Results: The baseline prevalence of FH within Medway CCG was 0.13% (1 in 750 persons). After 2 years, the recorded prevalence of diagnosed FH increased by 0.09% to 0.22% (1 in 450 persons). The nurse advisor programme ran for 9 months (October 2013-July 2014) and during this time, the recorded prevalence of patients diagnosed with FH increased to 0.28% (1 in 357 persons) and the prevalence of patients 'at risk and unscreened' reduced from 0.58% to 0.14%., Conclusions: Our study shows that two simple interventions increased the detection of FH. This systematic yet simple electronic case-finding programme with nurse-led review allowed the identification of new index cases, more than doubling the recorded prevalence of detected disease to 1 in 357 (0.28%). This study shows that primary care has an important role in identifying patients with this condition., (© 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.)

Purpose: Guidelines for the prevention and treatment of cardiovascular disease (CVD) have recently changed. Goals of these guidelines have shifted to the promotion of health and control of risk rather than solely on treatment of CVD. This article summarizes the six new cardiovascular screening, prevention, and treatment guidelines for use in practice., Data Sources: Published and peer-reviewed guidelines published jointly and in collaboration with the National Heart Lung and Blood Institute by the American Heart Association and the American College of Cardiology constitute the evidence base for this article., Conclusions: The potential for making lifestyle changes a way of life instead of a diet or program is an important point to make in clinical visits. If nurse practitioners (NPs) could promote a way-of-life lifestyle change to individuals in America, even change at a modest level, we could improve the health of the nation., Implications for Practice: NPs need to be aware of new guidelines and best practices to improve the cardiovascular health of their patients. We summarized these new guidelines into an easy-to-interpret format for use in practice., (©2015 American Association of Nurse Practitioners.)

The National Institute for Health and Care Excellence issued its final guidance in July on lipid modification, making millions more adults eligible for statin treatment. However, community nurses may encounter many patients for whom statin use is not appropriate for a variety of reasons. This article provides advice for community nurses on methods for improving patients' cholesterol levels and reducing the risk of developing cardiovascular disease if statins are not to be used. The article explains the current situation in the UK in relation to cholesterol, then gives dietary and lifestyle modifications that may help to lower cholesterol levels and help maintain good heart and circulatory health.

Background: Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal., Objective: The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers., Methods: A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes., Results: The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol., Conclusions: The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.

Background: Lowering low-density lipoprotein (LDL) cholesterol in patients with diabetes mellitus (DM) and cardiovascular disease (CVD) is critical to lowering morbidity and mortality. To increase the percentage of patients with DM and CVD at target LDL (<100 mg/dL), we launched an expanded team-based quality improvement programme in which centralised registered nurses (RNs) followed a detailed protocol to adjust cholesterol-lowering medications. Despite the growing use of team-based approaches to improve quality of care, little remains known about how best to implement them., Program Evaluation: To share our experiences and lessons from operating a team-based programme, we conducted a retrospective observational analysis of administrative and clinical data on programme performance. We measured: primary care physician (PCP) and patient acceptance of the programme, number of medication adjustments, change in LDL, per cent of patients achieving target, time to LDL target and the efforts required to achieve these goals., Results: Using administrative data, we initially identified 374 potential patients for enrolment. Chart review revealed that 203 (54%) were clinically eligible. PCPs agreed to enrol 74% (150/203) of these patients. Thirty-six per cent of PCP-approved patients (54/150) could not be reached via phone and 5.3% (8/150) declined enrolment. Of patients enrolled (n=64), 50% did not complete the programme. Of those enrolled, median LDL decreased by 21 mg/dL and 52% (33/64) achieved the LDL target. Programme RNs spent 12 023 min on programme activities, of which 44.4% (5539) was related to non-enrolled patients., Conclusions: Our adoption of a centralised expanded team-based programme for the management of LDL cholesterol uncovered many barriers to efficiency and success. Even though expanded team programmes may be supported by PCPs, the administrative efforts required to identify, enrol and continually engage eligible patients raise many concerns regarding efficiency and highlight infrastructure changes needed for successful team-based approaches.

Aim: This study aimed to explore and identify the relationship between health-related quality of life (HRQoL) and perceived social support among Chinese patients with coronary heart disease (CHD) in mainland China., Methods: A descriptive correlational study was conducted with a convenience sample of 200 Chinese patients with CHD recruited from the cardiac outpatient departments of two university-affiliated hospitals in Xi'an, China. The Chinese Mandarin versions of the Short-form 36-item health survey (CM:SF-36) and the Medical Outcomes Study Social Support Survey (CM:MOS-SSS) were administered to assess HRQoL and perceived social support., Results: The results indicated that Chinese patients with CHD reported a poorer HRQoL and lower social support compared with their Western and Hong Kong counterparts. Multiple regression analyses identified four significant predictors of deteriorated physical health (increasing age, co-morbidity with heart failure or hypertension, and smoking status) and two significant predictors of poor mental health (co-morbidity with heart failure and perceived social support)., Conclusions: Health status and social support in Chinese people with CHD should be routinely assessed and, where feasible, addressed through appropriate individually tailored interventions.

Addressing cardiovascular disease (CVD) is a priority for all involved in health promotion. Identifying those at risk and implementing strategies to reduce the incidence of CVD are important issues for government and healthcare providers. This article discusses risk assessment and medical intervention, and provides a detailed analysis of the role of diet in cholesterol reduction. The nurse's role in assisting patients to make dietary changes is examined and practical information on empowering patients to manage their health is provided.

Objective: To evaluate spousal involvement in a nurse-led intervention for patients with high cholesterol in which patients set health goals and spouses learned support strategies., Methods: Qualitative interviews were conducted with 29 patients and 26 spouses who received the intervention during a trial. Interviews were stratified by patient LDL-C change (better, same, worse). Coded text was content analyzed, and organized into thematic matrices, with columns indicating individuals (spouse or patient) and rows indicating dyads., Results: Patients and spouses reported no drawbacks to spousal involvement; some patients whose LDL-C did not improve wanted more focus on spouse health. Spouses said that the nurse's expertise and interest were helpful and they were better able to communicate with patients about health. Although the program helped couples work together, spouses with better or same LDL-C talked more about functioning as a unit, whereas those whose partners had worse LDL-C talked more about functioning as individuals., Conclusion: Although the spousal role was accepted, there were variations in level of involvement. More active spousal involvement might relate to better patient outcomes. For less involved spouses, more focus on their health may improve commitment or involvement., Practice Implications: These findings can inform ways to generate spousal support in future trials., (Published by Elsevier Ireland Ltd.)

The purpose of this study was to evaluate the effectiveness of a community-based health promotion program targeting people with hypertension and high cholesterol. A pre-experimental study was conducted. A total of 60 residents were recruited to participate. Participants were assessed at baseline and at a 6 month follow up at a regional hospital in northern Taiwan. The questionnaires used for data collection consisted of an assessment of self-efficacy, self-care activities, health outcomes, and physical fitness. Several teaching resources were used, including a DVD, a self-care booklet, group support (exercise and counseling sessions), and telephone follow up. A significant decrease in waist circumference (t = 2.20, P = 0.03) and high density lipoprotein-cholesterol level (t = 4.71, P < 0.00) was found at follow up. Moreover, the level of physical fitness activity, and sit-ups specifically (t = 3.10, P < 0.00), was increased. Participants also showed significant increases between baseline and 6 month follow up in their efficacy expectation score (t = -5.81, P < 0.00), outcome expectation scores (t = -4.76, P < 0.00) and self-care behavior scores (t = -2.78, P = 0.007). The community-based health promotion program is an effective means of helping people with hypertension and high cholesterol and should be instituted regularly and evaluated in clinical practice., (© 2012 Blackwell Publishing Asia Pty Ltd.)

Purpose: This study aims to examine known determinants of cardiovascular risk in Italian patients with functional psychoses., Design and Methods: A cross-sectional study design was used to examine cardiovascular risk factors and lifestyle behaviors of 123 individuals with functional psychosis and compare clinically relevant data with those of the general Italian population., Findings: A significant proportion of patients manifested frank hypertension (6.9%), hypercholesterolemia (20.5%), diabetes (6.5%), or a body mass index of more than 30 (20.3%). Many also smoked (63.0%) or ingested alcohol every day (26.0%), did not eat fruits or vegetables (8.0%), or did not exercise on a daily basis (34.0%)., Practice Implications: Patients with psychosis manifest significant rates of potentially reversible risk factors for cardiovascular diseases. Mental health nurses should advocate for and implement well-resourced counseling programs to reduce the prevalence of smoking and metabolic syndrome in mental health populations.

Aims and Objectives: Community awareness of the importance of hypercholesterolemia and the need for appropriate therapy is an important part of global efforts to reduce the population burden of cardiovascular disease. The aim of this study was to assess the knowledge and attitudes about cholesterol and to determine adherence to taking cholesterol-lowering medication among patients at high risk for cardiovascular events., Background: In spite of the availability of lifestyle and medical treatments for lipid management, an estimated 50% of adult Australians (6.4 million) remain at risk for a cardiovascular-related event because they have total blood cholesterol levels which exceed recommended limits. It is within this context that a significant gap remains in meeting cholesterol goals, despite easy to meet targets with readily available therapeutic options., Design: A two-page national self-report postal survey was conducted from August-October 2006., Methods: A total of 508 Australian adults previously treated for hypercholesterolemia were surveyed to determine their understanding about cholesterol and their adherence to treatment. The mean age of participants was 67 (SD 10) years (72% male). Many participants (72%) were at risk of a cardiovascular event based on a prior history and 18% had type II diabetes., Results: Participants had been prescribed lipid-lowering therapy (94% statin therapy) for an average of 10 years and visited their general practitioner on average three times per year. For those who knew their most recent cholesterol reading (67%), the total cholesterol was on average 4.5 (SD 1.1) mmol/l. This level was above the recommended limits for 40% of participants. Overall, 85% of participants reported knowing that there was high- and low-density lipoprotein forms of cholesterol, but only 56% and 38%, respectively, said that they understood or showed signs of clearly understanding the different types of cholesterol when their knowledge was assessed further. On the whole, therefore, participants had a limited understanding about cholesterol and its potential impact on cardiovascular events. Moreover, 25% of participants admitted to being non-compliant in taking their medication and only 51% correctly identified modifiable risk factors as most important for heart disease. Encouragingly, despite 85% of participants finding lifestyle changes challenging, most still identified their potential benefits., Conclusions: This study highlights that there are many unresolved issues in relation to educating high-risk patients who regularly visit their general practitioner to learn about and optimise their cholesterol levels via appropriate treatment and monitoring., Relevance to Clinical Practice: There is a need for urgent public education and management by individuals and the health community. Strategies to address 'cholesterol complacency', in the sense of a willingness to accept sub-optimal standards of cholesterol control at both the patient and healthcare system levels (general practitioners in particular), are urgently needed to truncate an anticipated rising tide of cardiovascular disease in Australia.

Purpose: Progression of metabolic illness in a patient with schizophrenia who was stabilized on an atypical antipsychotic is described using a case study framework. Risks and benefits of staying on current treatment versus switching to another agent and switching strategies are described., Conclusions: Switching an antipsychotic with more favorable side effects may improve metabolic parameters if other weight loss strategies have failed. Switching or stopping medications too quickly may exacerbate psychiatric symptoms. There is little evidence to support which is the best switching strategy., Practice Implications: The psychiatric mental health nurse practitioner carries a significant responsibility of discussing risks and benefits of switching and closely monitoring the patient during a switch of medications. Ensuring that the patient decides and agrees upon the treatment plan will improve the overall outcome.

Objective: To identify the effectiveness of case management for community elderly with hypertension (HT), diabetes mellitus, and hypercholesterolemia (HC) (the so-called three highs)., Design and Setting: Secondary data of the first and 3-month-after visiting records were extracted from 33 Public Health Centers in Taiwan., Participants: Seven hundred and sixty-six clients were selected who were at least 65 years old and had been diagnosed twice on the Case Management Record with at least one of the three highs., Results: This sample had a mean age of 72.6 years, 59.7% were female. Approximately 74% of the clients had HT, 55% had diabetes, and 15% had HC. Each elderly revealed 1.4 highs of the three highs. The elderly with HT, and diabetes, their blood pressures (BP) and blood sugars significantly decreased after being managed by public health nurses. Males and the elderly living in urban areas had more decrease in systolic BP. Females had more decrease in fasting blood sugar., Conclusions: The study found that the case management of the three highs presented effectiveness on reducing the values of the three highs of the elderly in community.

Purpose: To evaluate the cost-effectiveness of case management by a nurse practitioner (NP) to lower blood lipids in patients with coronary heart disease (CHD) from a managed care perspective., Data Sources: A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention from an NP for 1 year after discharge in addition to their usual care (NURS) or to receive usual care (EUC) enhanced with feedback on lipids to their primary provider and/or cardiologist. A cost-effectiveness ratio was calculated using incremental costs of the NURS group per unit change and percent change in low-density lipoprotein cholesterol (LDL-C) for 1 year at 2004 values., Conclusions: The annual incremental cost-effectiveness of NP case management was 26.03 dollars per mg/dL and 39.05 dollars per percent reduction in LDL-C. When costs of NURS care for the second 6 months of management were compared to the first 6 months of management, nursing salary costs were lower as patients were established on cholesterol management regimens, but the reduction in costs was offset by the increase in incremental costs of drug treatment as the NP titrated the patient to higher drug dosages that were more costly., Implications for Practice: The findings suggest that case management by an NP is a cost-effective approach for a managed care organization to consider in improving the care of patients with cardiovascular disease.

Less than 50% of US adults follow dietary recommendations. Despite these figures, little research has focused on improving adherence to a therapeutic eating plan. The research utilizing self-efficacy theory has shown promise for improving behavior change and treatment adherence. This study evaluated the efficacy of a telephone-delivered, self-efficacy based intervention designed to improve adherence to a cholesterol-lowering diet among those self-reporting nonadherence. Sixty-five men and women diagnosed with hypercholesterolemia were randomized to usual care or treatment, which consisted of six intervention sessions delivered every 2 weeks by telephone and focused on how to manage eating behavior in challenging situations. There were significant between group differences post intervention in the consumption of saturated fat (P < .001) and cholesterol (P = .040) with the intervention group improving their dietary adherence. Significant change (P = .013) occurred over time in low-density lipoprotein-cholesterol (LDL-C) in the intervention group. No changes were observed in self-efficacy between groups, suggesting that self-efficacy was not a mediator of the improved adherence. The study's findings confirm that the telephone is a useful tool to deliver adherence-enhancing interventions.

Healthwise II, a nurse-led audit programme in primary care during 1999-2002, assessed the uptake of secondary preventative measures for coronary heart disease (CHD). Risk factors, cardiovascular medications and blood cholesterol were recorded; 'at risk' patients were invited for a review after 6 months. Of 17,570 patients assessed, CHD was clinically present in 12,045 (69%); in these, aspirin usage was high (78%) but fewer patients were on a beta-blocker (40%), angiotensin-converting enzyme inhibitor (27%) or statin (49%). Blood pressure (BP) was controlled (<140/90) in only 41% of patients. Total cholesterol was >5 mmol/l in 49% of all CHD patients, half of whom were taking a statin. In the statin users, total cholesterol was uncontrolled (>5 mmol/l) in 38%. At follow-up, BP control remained at 42%, statin use increased to 57% and cholesterol remained elevated in 46%. Simple assessment in an audit programme fails to trigger change, and risk-factor modification for CHD remains inadequate.

Statins are a lipid-lowering medication. They are increasingly being used for the primary and secondary prevention of cardiovascular disease, as a growing body of research shows that they reduce mortality rates. Carol McLoughlin explains how they work, discusses contraindications, and offers advice on educating patients in their use.

Coronary heart disease (CHD) is the UK's biggest killer. While recommending that all patients can benefit from lifestyle interventions, the current guidelines focus pharmacological management on those at high risk. An over the counter (OTC) statin would enable people with moderate (10-15 per cent) CHD risk to take preventive action. Pharmacists would be able to recommend OTC simvastatin to those at moderate risk by following a simple pharmacy protocol to assess a person's risk. A regime of 10 mg simvastatin daily would have a significant impact on both the low-density lipoprotein cholesterol (LDL-C) level and the CHD risk of those at moderate risk. Cholesterol testing would not be mandatory but would be available in pharmacy to enable people to monitor their progress.

Purpose: To review clinical and laboratory findings that will enhance nurse practitioner (NP) recognition of the metabolic syndrome and to increase awareness of recent treatment guidelines and treatment options., Data Sources: Professional association practice guidelines, government documents, original research articles, and journal articles., Conclusions: The metabolic syndrome is a prevalent condition characterized by a cluster of lipid and nonlipid abnormalities, including atherogenic dyslipidemia, elevated fasting blood glucose, hypertension, and abdominal obesity. Many persons with this syndrome are also insulin resistant. Prompt recognition and treatment of the metabolic syndrome can prevent or delay the development of type 2 diabetes and coronary heart disease. Clinical guidelines recommend treating the metabolic syndrome as a secondary target of lipid-lowering therapy after addressing the primary target, low-density lipoprotein cholesterol., Implications for Practice: NPs are in an instrumental position to manage treatment for patients with the metabolic syndrome by (a) evaluating risk factors, including abdominal obesity, physical inactivity, atherogenic dyslipidemia, hypertension, and elevated fasting blood glucose; (b) assisting in the modification of lifestyle factors such as diet and exercise; (c) implementing pharmacological therapy when needed; and (d) providing psychosocial support to encourage therapeutic adherence.

Purpose: To update nurse practitioners (NPs) on the latest National Cholesterol Education Program (NCEP) guidelines for the management of high blood cholesterol in adults., Data Sources: The 2001 NCEP Adult Treatment Panel (ATP) III guidelines and supporting scientific reviews and reports of clinical trials related to the evidence upon which the guidelines are based., Conclusions: The many new features of the ATP III guidelines include an increased emphasis on the patient with multiple risk factors in order to identify appropriate candidates for primary prevention and on more stringent classifications of elevated lipid/lipoprotein levels. However, elevated levels of low-density lipoprotein (LDL) cholesterol continue to be the focus for both primary and secondary prevention, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are clearly the drugs of choice for decreasing LDL cholesterol in most patients., Implications for Practice: Because NPs play key roles in optimizing treatment management, it is important that they become familiar with, and be prepared to help implement, these latest guidelines. By embracing the global risk assessment approach of ATP III and aggressively treating all at-risk patients, NPs can take a proactive role in helping to halt the progression of coronary heart disease and its consequences.

Background: Many rural residents do not have access to high-quality nutrition counseling for high blood cholesterol. The objective of this study was to assess the effectiveness of an intervention program designed to facilitate dietary counseling for hypercholesterolemia by rural public health nurses., Methods: Eight health departments (216 participants) were randomized to give the special intervention (SI) and nine (252 participants) to give the minimal intervention (MI). The SI consisted of three individual diet counseling sessions given by a public health nurse, using a structured dietary intervention (Food for Heart Program), referral to a nutritionist if lipid goals were not achieved at 3-month follow-up, and a reinforcement phone call and newsletters. Diet was assessed by the Dietary Risk Assessment (DRA), a validated food frequency questionnaire, at baseline, 3-, and 12-month follow-up; blood lipids and weight were assessed at baseline, 3-, 6-, and 12-month follow-up., Results: Participants were largely female (71%), older (mean age 55), and white (80%). At 3-month follow-up, the average reduction (indicating dietary improvement) in total Dietary Risk Assessment score was 3.7 units greater in the SI group (95% confidence interval [CI] 1.9 to 5.5, P = 0.0006), while both groups experienced a similar reduction in blood cholesterol, 14.1 mg/dL (0.37 mmol/L) for SI and 14.5 mg/dL (0.38 mmol/L) for minimal intervention group (difference -0.4 mg/dL [-0.010 mmol/L], 95% CI -12.5 to 11.7 [-0.32 to 0.30], P = 0.9). At 12-month follow-up, the reduction in total Dietary Risk Assessment score was 2.1 units greater in the SI group (95% CI 0.8 to 3.5, P = 0.005), while the reduction in blood cholesterol was similar in both groups, 18.4 mg/dL (0.48 mmol/L) for SI and 15.6 mg/dL (0.40 mmol/L) for minimal intervention group (difference 2.8 mg/dL [0.07 mmol/L], 95% CI -7.5 to 13.1 [-0.19 to 0.34], P = 0.6). During follow-up, weight loss was greater in the SI group; the difference between groups was statistically significant at 3 (1.9 lb [0.86 kg], 95% CI 0.3 to 3.4 [0.14 to 1.55], P = 0.022) and 6 months (2.1 lb [0.95 kg], 95% CI 0.1 to 4.1 [0.04 to 1.86], P = 0.04). At 12 months, the difference was not significant (1.6 lb [0.73 kg], 95% CI -0.05 to 3.7 [-0.02 to 1.68], P = 0.13)., Conclusions: Improvement in self-reported dietary intake was significantly greater in the SI group, while reduction in blood cholesterol was similar in both groups.

Background: Despite the large body of evidence confirming the effectiveness of lipid lowering for the secondary prevention of coronary heart disease (CHD) events, undertreatment of hyperlipidemia is common. This study tested the effectiveness of a nurse case management program to lower blood lipids in patients with CHD., Methods: A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention, from a nurse practitioner for 1 year after discharge in addition to their usual care (NURS), or to usual care enhanced with feedback on lipids to their primary provider and/or cardiologist (EUC)., Results: Significantly more patients in the NURS group than in the EUC group achieved low-density lipoprotein cholesterol (LDL-C) levels <2.59 mmol/dL (100 mg/dL, 65% vs 35%, P =.0001). Favorable changes in lipids and lipoproteins were accompanied by significant improvements in dietary and exercise patterns in the NURS group. In a multivariate analysis adjusting for other covariates, being assigned to the NURS group (P =.0001) and being on a lipid-lowering medication (P =.001) were significant independent predictors of LDL-C level., Conclusions: Control of hypercholesterolemia in patients who have undergone coronary revascularization can be improved by a nurse case-management program. Because the National Cholesterol Education Program Adult Treatment Panel III guidelines have broadened the definition of high-risk populations that warrant aggressive treatment, nurse case-management programs may offer key opportunities to enhance appropriate application of new treatment paradigms.

Reap the benefits of an effective cholesterol management program. Only a small number of patients who could benefit from cholesterol-lowering therapy are actually receiving optimal treatment. However, a systemized approach to the management of such patients can deliver better control and lower costs down the road by preventing cardiac events. Find out the components of a successful cholesterol-lowering DM program, and get advice on how to implement your own program on a large or small scale.

There is compelling scientific evidence that the modification of cardiovascular risk factors, including hypercholesterolemia, can reduce the incidence of myocardial infarction, effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with and without known cardiovascular disease. Unfortunately, neither the publication of results from clinical trials of cholesterol lowering alone nor the 1993 National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPII) updated guidelines for the treatment of hypercholesterolemia have resulted in widespread changes in cholesterol management and control. Systematic nurse case management of dyslipidemias in patients with or at high risk for the development of coronary heart disease has the potential to improve compliance with NCEP-ATPII guidelines. In cooperation with physicians, nurses have the opportunity to address a major public health problem with the potential to eventually affect the more than 11 million people with coronary heart disease.

Residents of the rural South are at high risk for heart disease and are frequently identified as having high blood cholesterol, but sources for nutrition counseling in rural areas are often limited. To increase the availability of high quality nutrition counseling, the Food for Heart Program was developed for public health nurses and is designed to circumvent many of the obstacles common to dietary counseling. We conducted a randomized trial to assess the effectiveness of this program to lower blood cholesterol. In this report, we describe the study design, intervention program, and baseline characteristics of participants. Nurses at 17 health departments screened 781 subjects to enroll 468 with high blood cholesterol: three-quarters of the subjects were female, the mean age was 55, and 80% were white. Participants were at high risk for heart disease: 60% had two or more risk factors for coronary disease, the majority were overweight with a mean BMI of 29, and the mean cholesterol was 257 mg/dL. Reported baseline dietary intake included relatively modest consumption of high fat meats and snack foods, excessive consumption of sweets, modest intake of complex carbohydrates, and inadequate consumption of fruits and vegetables.

Background: Siblings of individuals with premature coronary heart disease have a high prevalence of low-density lipoprotein cholesterol (LDL-C) levels requiring treatment., Objective: To evaluate management strategies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior to age 60 years., Methods: In a 2-year trial of care provided by either a nurse trained in lipid management (NURS) or enhanced primary care (EPC), in which physicians received recommendations based on national guidelines, 156 siblings with LDL-C levels of 4.14 mmol/L (160 mg/dL) were randomized by family. The LDL-C goal levels below 3.36 mmol/L (130 mg/dL) were compared between and within intervention groups. Multiple logistic regression analyses were applied to predict 2-year achievement of the goal., Results: The NURS group achieved a significantly greater percentage of goal LDL-C levels than the EPC group (26% vs 10%; P=.008). The NURS LDL-C levels decreased an average of 0.91 mmol/L (35 mg/dL) while EPC levels decreased by 0.52 mmol/L (24 mg/dL) (P=.09). In the final multivariate model, siblings taking lipid-lowering drug treatment were 6.02 times more likely (95% confidence interval, 2.24-16.18) than those not receiving pharmacotherapy to achieve LDL-C goals; nurse management (P=.09) was marginally significant. Pharmacotherapy was instituted in 45.2% of NURS and 16.7% of EPC siblings (P=.001)., Conclusions: High LDL-C levels in siblings were more effectively treated by a trained nurse, probably related to greater adherence to the application of national guidelines. Nonetheless, the majority of siblings with high LDL-C levels did not meet goal levels 2 years after an index case coronary heart disease event.

In this study we examined the effect of a nurse-managed cholesterol screening program on the preventive health behaviours (e.g., diet changes, weight loss, medical surveillance) of 534 Hutterites. Hutterites are the largest single rural ethnic group in Canada and they have been found to be at high risk for heart disease. Eighty-one percent of the participants engaged in at least one preventive behaviour. Ongoing cholesterol surveillance was reported by 34.5% of the participants. Weight loss and dietary fat reduction were reported by 31% and 62% of the respondents, respectively. Seven percent of the respondents began lipid-lowering pharmacologic therapy. Screening cholesterol levels and age were significantly related to all of the outcomes except weight loss. This study provides evidence that community-based screening accompanied by counselling and referral by nurses can positively affect preventive behaviours.

The possibility of making scientifically objective statements about health risks is part of a new complex of ideas pervading our Western social institutions. The concept of prevention includes an assessment of risk and dangers which lay persons have difficulties in comprehending. Advances in medical technology have made it possible to detect a growing number of anomalies in the human body and thereby to define more and more people as being at risk of various diseases. Even if it seems desirable for society to be able to detect the risks menacing its members, it calls for delicate management of the test procedures and of the preventive intervention. This article presents some perspectives on preventive work in connection with a directed health survey. The primary aim of the survey in question was to diagnose particular risk factors, for instance a high level of blood cholesterol, and inform the patient about how to prevent or reduce the risk of cardiovascular disease. The preventive measures are commonly undertaken by a nurse; her encounters with the patients--to obtain test samples, communicate the results and provide information about health risks--raise complex issues. These and other dilemmas in preventive work are discussed and analyzed.

Universal versus targeted screening for hypercholesterolemia in children is currently a debatable practice issue. Nurse practitioners must decide which screening methods to incorporate into practice. Recommendations on evaluation and management of hyperlipidemia in children can aid nurse practitioners facing this decision.

A total of 507 men and 686 women were opportunistically screened for hypercholesterolaemia and reinvited for a follow-up visit with the nurse after 2 years. Seven-hundred and thirty three (62%) re-attended (group A), while 226 (19%) did not, but saw the nurse at one or more pre-scheduled 6 month check-ups (group B). Two-hundred and thirty-three (20%) did not attend at all (group C). There was no difference between the groups in the number of parallel physician consultations during follow-up. Both groups B and C had higher proportions of smokers than group A. Group C were younger, had lower cholesterol and lower blood pressure (after adjustment for age) than group B, which in turn, had higher cholesterol and blood pressure than group A. The prevalence of hypertension and hypercholesterolaemia declined during the 2 years in group A. Of 189 smokers at baseline, 26 (14%) quit during follow-up. Of the 544 non-smokers, however, 31 (6%) commenced, to out-balance the quitters. Only five of the 43 patients in group A who had a persistent cholesterol of > or = 7.9 mmol/l received medication. It is likely that drop-out from a follow-up programme of this kind is to some extent justified because of the parallel organizations for care.

Nurse practitioners and other health care providers play vital roles in the health education of their clients. A health professional should be able to understand the interplay of diet, education, and exercise in a healthy existence. This article reviews the recommendations offered by the National Cholesterol Education Program (1991) on testing and managing cholesterol levels in children and adolescents. The program recommends a strategy combining two complementary approaches: a population approach and an individual approach. By evaluating these approaches, the timing and rationale for lowering fat and cholesterol are discussed and recommendations are made to health care providers about identifying children at risk. Health care providers should work to promote a physically conscious generation that is well-versed in health maintenance, to identify "high-risk" individuals, and to update their own knowledge of national recommendations for managing fat and cholesterol levels in their clients' diets.

Judging from your response to our September feature on cholesterol testing providing dietary advice has become of paramount importance to OHNs. The Flora Project for Heart Disease Prevention offers information on the risk factors of high cholesterol and has become a major noninstitutional authority on coronary heart disease. With Yuletide in sight The Flora Project offers advice on a cholesterol-clear Christmas.

Successful management of elevated cholesterol requires a change of behaviors that raise cholesterol and adherence to behaviors that lower it. A partnership between patient and provider that is characterized by mutual trust enhances implementation of an effective treatment plan. Educational and behavioral strategies can be individualized subsequent to a comprehensive assessment. Monitoring efforts and results provide feedback about goal attainment and adjustment of the plan.

Studies are reviewed that describe a nurse-managed clinic for treating hypercholesterolemia and two large drug trials that demonstrated a lowered risk of coronary artery disease associated with antilipid therapy.

The article presents an update of activities from the National Cholesterol Education Program, including information about the recently released documents addressing laboratory standardization for cholesterol evaluation, public screening for cholesterol, the panel report of dietary recommendations for the nation, and a description of the American Heart Association Cholesterol Education Program for Nurses. Implications for nursing are discussed in light of these releases.

The new guidelines of the National Cholesterol Education Program (NCEP) for the treatment of adults with hypercholesterolemia provide a standard treatment algorithm for treating patients with cholesterol-lowering medications. These guidelines provide physicians, nurses, and patients with important answers to questions about beginning drug therapy, choice of an appropriate medication, and the proper follow-up for long-term therapy. The article provides highlights of the NCEP guidelines for pharmacotherapy for hypercholesterolemia; the available medications, their effects on blood lipids, side effects, and requirements for follow-up; and the important role that nurses play in medication and compliance counseling.