Promoting Cardiovascular Health

Cardiovascular Health

A nurse with ambition might wish to peruse the latest literature concerning how to assist patients in regards to promoting cardiovascular health. By doing so, the nurse would not only be helping the patients by showing them how to live healthy lives, but would likely be more successful in achieving those ambitions as well. This is certainly true if considered from an administrator's perspective since it seems a foregone conclusion that most administrators are much more likely to promote those individuals who show a caring attitude towards their patients than those who don't. Even if that were not true, many nurses enter the field because they have an ingrained belief that they might be able to help those who are sick and afflicted, and knowing what to do to help those patients would certainly make life (and the job) much more enjoyable.

Cardiovascular disease is prevalent in today's society so it seems highly likely that a person in the nursing field will (at some point) have to interact with a patient suffering from that disease. A nurse who promotes healthy living will likely be seen as someone who cares about the long-term quality of life of the patient(s). Knowing what type of things need to be promoted to attain that healthy lifestyle would be beneficial.

One recent study is a prime example of what an astute nurse could do to help. The study focused on the effect of lifestyle interventions that might be helpful to obese individuals suffering from metabolic coronary heart disease.

"The objective was to determine whether lifestyle intervention improves metabolic coronary heart disease (CHD) risk factors in obese older adults" (Villareal, Miller, Banks, Fontana, Sinacore, Klein, 2006, pg. 1317).

One of the reasons why the study sought such answers was because of the prevalence of CHD in obese older adults. If lifestyle interventions were shown to be successful with these individuals, applying the same scenario to others with these same symptoms would lower future healthcare costs while at the same time improving the quality of life experienced by these individuals and many more like them. The study reports that "many CHD risk factors (eg, high blood glucose concentration, hypertension, abnormal blood lipid concentration, and abdominal obesity) increase in prevalence and severity with age" (Villareal, et al., pg. 1317) and that "the coexistence of multiple metabolic CHD risk factors is more common in older adults than in young and middle-aged adults" (pg. 1317). It made sense, therefore, to have the researchers discover if lifestyle changes might be helpful in any degree for individuals with these characteristics.

The study hypothesized that not only would lifestyle intervention be helpful regarding metabolic coronary disease but that it would also improve the patient's waist circumference, blood pressure, serum lipid profile, insulin sensitivity and plasma glucose amongst other things.

There were 27 obese adults participating in the study. The participation rate was relatively small in number but each individual had many of the same characteristics.

All the subjects were older than 64 years of age and had a body mass index (BMI) greater than or equal to 30. The participants were randomly divided into two groups; a control group of 10 individuals and a non-control group of 17. The control group participants were "instructed to maintain their usual diet and activities during the study period" (pg. 1318). They were also instructed not to participate in any weight loss programs throughout the duration.

The treatment group received much different treatment. "Each participant was prescribed a daily diet to provide an energy deficit equal to or greater than 750 kcal/d" (pg. 1318). The subjects were also required to attend weekly group meetings with a study dietician. There, they were introduced to behavioral strategies such as goal setting, self-monitoring, stimulus control techniques, problem-solving skills, identification of high-risk situations and relapse prevention training. These techniques were taught to them in an effort to modify the participant's eating habits. The subjects were also expected to attend exercise-training sessions every other day. The exercise program focused on improving flexibility, endurance, strength and balance. Each exercise session lasted approximately ninety minutes.

A baseline was established for both groups as the study began. The baseline established the fact that no "significant differences were observed in baseline demographic characteristics or in baseline CHD risk factors between the treatment and the control groups" (pg. 1319).

The treatment group was consistently monitored in an effort to provide verifiable results, while the control group was offered little support and had relatively little contact with the researchers. This was purposeful in that a sedentary lifestyle had already been ascertained regarding the control group participants. What the study sought was to determine what differences would be present when compared to no changes whatsoever, and a lifestyle intervention. By the completion of the study, 3 individuals had dropped out; two subjects that were not compliant with the treatment and one from the control group who did not show for follow-up.

The results were fairly impressive. "Treatment decreased the prevalence of the metabolic syndrome by 59%…improved all criteria of the metabolic syndrome, with the exception of serum HDL-cholesterol concentration, which did not change significantly" (pg. 1319). The study also found that "diet-induced weight loss and exercise training improved almost all of the obesity-related metabolic CHD risk factors simultaneously, including waist circumference, blood pressure, circulating inflammatory markers, oral glucose tolerance, insulin resistance, and plasma glucose, triacylglycerol, and FFA concentrations" (pg. 1320). These findings are especially helpful for anyone interested in pursuing a career in the nursing field. Informing patients, especially those who are caught in the obesity and age trap that many fellow citizens find themselves, of a lifestyle intervention that might have such profound effects on their quality of life, could mean the difference between a life lost and a life gained.

The knowledge is invaluable to those nurses who are not afraid to pursue it. Especially beneficial is the study's statement that "these data demonstrate that long-term CHD risk factors are reversible in obese older adults; lifestyle therapy can improve or normalize the metabolic risks of CHD in older adults, as has been shown in young and middle-aged adults" (pg. 1320). Speaking on these benefits does no harm to the patients, instead it (at the very least) provides the patient(s) with an opportunity to take charge of their own lives and lifestyles.

A separate study provided additional data that would also be beneficial to patients suffering from cardiovascular disease (CVD). This specific study was initiated with the purpose of discovering which macronutrient (protein, carbohydrate or unsaturated fat) works the best at lowering CVD. The study reiterated the belief that dietary recommendations lower blood pressure and improve serum lipids. The reason for lowering these two items is that they are both primary determinants of CVD risk. Each of the macronutrients studied showed signs of lowering the levels of these determinants, what the study wished to ascertain was which macronutrient was actually the most beneficial to the largest number of participants. The setting for the study was to compare the effects that a diet heavily favored to each of the three macronutrients would be introduced. Those three diets focused on three approaches; a high protein diet, a high carbohydrate diet and a high monounsaturated fat diet.

"We conducted a randomized trial to compare the effects on blood pressure and serum lipids of 3 healthful diets, each reduced in saturated fat: a carbohydrate-rich diet, similar to the DASH diet; a diet rich in protein, approximately half from plant sources; and a diet rich in unsaturated fat, predominantly monounsaturated fat" (Appel, Sacks, Carey, Obrazanek, Swain, Miller III, Conlin, Erlinger, Rosner, Laranjo, Charleston, McCarron, Bishop, 2005, pg. 2456).

Participants in the trial were "generally healthy adults, aged 30 years or older, with a systolic blood pressure of 120 to 159 mm Hg or a diastolic blood pressure of 80 to 99 mm Hg" (pg. 2456). Individuals who were excluded from participation included people with diabetes, high cholesterol, high fasting triglycerides, people who weighed over 350 pounds, individuals taking medication for high blood pressure or blood lipid levels, or anyone who drank alcoholic beverages at a rate of higher than 14 drinks per week,

The study was comprehensive in scope and "results should be widely applicable to the U.S. population" (pg. 2463). The reasoning behind this statement is because of the large scope and timeframe of the study. The study took place over a one -year period and included over 160 participants. Secondly the "blood pressure inclusion criteria were broad; more than 50% of U.S. adults have blood pressure in this range" (pg. 2463).

The participants were divided into three separate groups and each group was given a specific diet to follow.

One diet was high in carbohydrates, the next was high in protein, and the third diet was high in monounsaturated fats. Menus were designed so that individuals would easily find the commonly available foods. During the week, each participant would eat a main meal on the study site. The other meals would be eaten off-site. "Participants were instructed to drink no more than 3 caffeinated beverages and no more than 2 alcoholic beverages per day" (pg. 2457).

Two features from this study that stand out when compared to the previous study (as read about earlier) was that this study sought to keep the participants weight relatively stable and that the participants were not obese and old, but were young and healthy. The goal of this study was measurably the same as the pervious study, but was set in entirely different circumstances. This is important to individuals seeking entry to the nursing field because it provides ammunition for lifestyle interventions even before the patient may think it is necessary.

The study's primary interest was to ascertain "the contrasts between the carbohydrate and protein diets and between the carbohydrate and unsaturated fat diets" (pg. 2459). What the study found was that for each diet (when compared to baseline) "systolic and diastolic blood pressure and levels of LDL, total, and HDL cholesterol were lower on each diet" (pg. 2459). However, the diet that showed the most effect on blood pressure and lipids was the protein diet. "Compared with the carbohydrate diet, both the protein and unsaturated fat diets significantly lowered systolic and diastolic blood pressure in all participants and in those who were hypertensive" (pg. 2459).

The protein diet was effective for lowering blood pressure and for lowering lipids. The study determined "the protein diet but not the unsaturated fat diet significantly lowered LDL cholesterol levels compared to the carbohydrate diet…the protein diet significantly reduced HDL cholesterol levels compared with the carbohydrate and the unsaturated fat diets" (pg. 2459).

This data and the study's findings can be invaluable when questioned by a patient seeking information that may help them live longer and healthier lives. A nurse must be knowledgeable in all aspects of health, even when approached by a seemingly healthy, young or vibrant individual. Knowing that a high protein diet has shown more infinity (at least by this study) to lowering blood pressure and cholesterol levels may come in handy as interactions with patients oftentimes takes place.

Especially helpful would be the study's estimated cardiovascular risk component that states, "compared with baseline, the 10-year risk of CHD was lower on each study diet by 16.1 to 21% as estimated from the Framingham risk equation" (pg. 2461). Espousing such data could surely be a risk worth taking.

A final study that might be of interest to the nursing industry was a study that took place between 1994 and 1997 and had over 28,572 volunteers. The participants were all recruited from various regions of Greece and overall enjoyed the Mediterranean diet as their normal food consumption. This is an interesting study due to the large numbers and the fact that it looked to ascertain the effects of a local culture on the local citizenry.

"The Mediterranean diet was first considered…as a diet low in saturated lipids that conveyed protection against coronary heart disease by lowering plasma cholesterol levels" (Trichopoulou, Bamia, Trichopoulos, 2005, pg. 929).

This study is in sharp contrast to the other two studies presented above. The first study was on obese, older adults, many of whom had already experienced some form of high blood pressure, hypertension and other cardiovascular maladies. The second study focused on healthy, young individuals who wished to have relatively small changes to their lifestyles. That study showed how protein, monounsaturated fat, and carbohydrate diets lowered the risk factors of early hypertension and other cardio health symptoms. The Trichopoulou study sought to determine whether an entire culture could be effectively combating cardiovascular disease based on the diet that was consumed.

The researchers state, "we have been able to evaluate the effects of the traditional Mediterranean diet on survival among individuals previously diagnosed as having coronary heart disease" (Trichopoulou, pg. 929). Results from the study show that "in an analysis of a fairly large sample of individuals participating in a general population cohort study who, at enrollment, had already been diagnosed as having coronary heart disease but no cancer, we found that adherence to the traditional Mediterranean diet was significantly associated with a reduced mortality rate" (Trichopoulou, pg. 932).