Search

A Harris Interactive survey of 1548 hypertensive persons aged 44 and older confirms the findings of previous studies that showed suboptimal rates of adherence to medication and lifestyle regimens to lower blood pressure, despite a high level of awareness of the health consequences of uncontrolled blood pressure. When the study population was analyzed by age group (baby boomers, ages 44 to 62 years, and seniors, ages >or=63 years), nonadherence was greater in the baby boomer cohort, which nevertheless had a higher level of concern than the seniors. Poor communication between patients and health care providers contributes to nonadherence to treatment regimens. Patients' age plays an important role in their attitudes and behaviors regarding illness and treatment as well as their preferences as to the types of educational materials they would find helpful and the ways those materials can best be delivered. Because of the growing population of baby boomers further studies are warranted to evaluate attitudes, knowledge, and behaviors concerning the identification and treatment of hypertension. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Combination therapy is increasingly recommended for patients with multiple lipid disorders, especially those at high risk for coronary events. We investigated the long-term safety and effectiveness of a new drug formulation containing once-daily extended-release niacin and lovastatin. A total of 814 men and women (mean age 59 years) with dyslipidemia were enrolled in a 52-week multicenter, open-label study. We used 4 escalating doses (niacin/lovastatin in milligrams): 500/10 for the first month, 1,000/20 for the second, 1,500/30 for the third, and 2,000/40 for the fourth month through week 52. Dose-dependent effects were observed for all major lipid parameters. At week 16, mean low-density lipoprotein (LDL) cholesterol and triglycerides were reduced by 47% and 41%, respectively; mean high-density lipoprotein (HDL) cholesterol was increased by 30% (all p <0.001). LDL/HDL cholesterol and total/HDL cholesterol ratios were also decreased by 58% and 48%, respectively. These effects persisted through week 52, except for the mean increase in HDL cholesterol, which had increased to 41% at 1 year. Lipoprotein (a) and C-reactive protein also decreased in a dose-related manner (by 25% and 24%, respectively, on 2,000/40 mg; p <0.01 vs baseline). Treatment was generally well tolerated. The most common adverse event was flushing, which caused 10% of patients to withdraw. Other adverse events included gastrointestinal upset, pruritus, rash, and headache. Drug-induced myopathy did not occur in any patient. The incidence of elevated liver enzymes to >3 times the upper limit of normal was 0.5%. Once-daily niacin/lovastatin exhibits substantial effects on multiple lipid risk factors and represents a significant new treatment option in the management of dyslipidemia. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors have demonstrated associations with both prognosis of patients with cardiovascular disease (CVD) as well as the development of CVD. Psychosocial distress may influence health behaviors (such as eating behavior) that increase cardiovascular risk.Method: The purpose of this research was to evaluate the role of psychosocial distress on intake of high-fat snacks and fruits and vegetables in 740 men and women, identified as high risk for cardiovascular disease, who took part in a 1-year cardiovascular risk factor reduction program.Results: Participants who were more successful at decreasing or staying at an optimal level of high-fat food intake had lower levels of baseline total psychosocial distress and worry and decreases in total psychosocial distress. A greater success rate at increasing fruit and vegetable intake or staying at an optimal level of fruit and vegetable intake was associated with changes in Type A and competing behaviors.Conclusions: Results from these analyses suggest that baseline levels and changes in psychosocial variables, particularly decreased psychosocial distress, were associated with improvements in healthful eating behaviors. Further work may provide information that could be useful in tailoring health behavior interventions to specific subgroups based on psychosocial characteristics, initial health behaviors, and demographic characteristics. [ABSTRACT FROM AUTHOR]