Prevention of Coronary Heart Disease - Essay Example

Essay on primary prevention on coronary heart disease [name of the author] [Department name and section number of course] [Name of the supervisor and date] [Module title] CONTENT LIST INTRODUCTION 3 Primary preventions 4 Preventive Diet 6 Findings and analysis 8 CONCLUSION 10 REFERENCE 12 ELECTRONIC REFERENCE 12 APPENDIX 13 Introduction The target of my essay is to find out some of the primary preventive measures regarding Coronary Heart Diseases. It is grow among all human beings in a drastically rapid speed and such needs awareness and immediate preventions. As inspected by Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, et al (1999, 353: 1547-1557) Coronary heart disease (CHD) mortality rates in the United Kingdom, though has decreased, yet is still on a higher rate as compared to the patients in rest of the world.1 The only factor that is related to these CHD deaths is the poor cardiovascular risk profiles of the patients of UK, and their ill-maintained unhealthy lifestyles. The reason that has been discovered behind the leading cause of premature death in the UK before the age of 75 is none other than cardiovascular disease (CVD). Half of these CVD are due to the result of lack of prevention from coronary heart disease (CHD) and a quarter from stroke. 2According to the Scandinavian Simvastatin Survival study (1994; 344: 1383-1389), as compared to now the acute myocardial infarction (MI) was 50% at 28 days, and was rated to be 4.5% per year over the following five years3. The prevention of CHD thus needs a strategy for risk reduction in selected high-risk patients. It can be achieved only if to from the very beginning the prevention of myocardial infarction is done. In dealing with the CHD it is very important to keep a track of every new development. This makes the task tougher. However the case can be well handled by the contributions made by efficient nurse. There are various reasons why nurses are ideal to take a greater role in dealing with chronic diseases as well as minor illness diseases. Nurse led management of such conditions allow a distribution of workload within the practice and they are able to take on tasks that have traditionally been under the GP’s remit. Thus it is very important to have well trained and well managed nursing stuff to deal with such sensitive cases. Primary preventions The primary proceedings for the prevention of CHD, lies in a well managed lifestyle. The measures that are needed for the maintenance of a healthy life must be followed by every individual. The provisions need to be made for absolute rather than relative risk reduction in the patient. It paves the way for a better calculative effects led by the imposed lipid-lowering drug treatment. The lipid-lowering drug therapy is actually given the first preference to all those patients who have got the pre-existing cardiovascular disease. It is an absolute measure for the primary prevention of CHD. It gets followed after the speculations over the lifestyle measures of the patients and other appropriate interventions for at least three months. There is no difference made for women in the application of lipid-lowering drug therapy for primary prevention. It is equally applicable to the estimated risk that persists in the patient. General practitioners and primary care teams should identity all people with established cardio- vascular disease and offer them comprehensive advice and appropriate treatment to reduce their risks. The preventive procedure in case of Type 2 diabetics that has got no nephropathy is considered for lipid-lowering drug therapy for primary prevention. This application too is done in consideration to the expected risk. In cases of both Type 1 diabetics and Type 2 diabetics with nephropathy, gets some kind of underestimated risks and thus are suggested for using current scoring methods and intervention. All these methods and interventions should be considered at a lower threshold of the risk that obviously persists. There are many CHD patients, who are engrossed with heterozygous familial hypercholesterolemia (FH). In these types of cases the patients needs to be dealt more seriously. The treatment should be very strictly followed by the dietary advice and lipid lowering therapy in a proportionate and well equilibrium state. These are the patients who are very sensitive and thus needs to be kept under close monitoring and regular follow-ups. The primary preventive measures needs proper assessments and thus all the targeted assessment of CHD, should be in between 35 to 69 years of age. There is every possibility of having the risks at a younger age if the disease in the patient exists with a family history of FH. All the secondary causes of dyslipidaemia need to be get rid of from the patient before the commencing state of lipid-lowering drug therapy. It is a very important step and needs proper supervision and speculative inspection. With the advancement of science there comes up Statin. Stains are the best drugs as has been considered till date for the purpose of lowering lipid for the patient. It is now included in the list of primary prevention for CHD. There is a big role played by all those people who are related to the clinical responsibilities. These are the people who are in charge of curing the disease as well as share the responsibility of preventing it. The process starts from keeping a well maintained record of the personal history as well as family history including heart disease, stroke or diabetes of the patient right from the early diagnosis. As soon as such case comes in it is the primary duty of the clinical stuff to keep a track of every detail. The patient needs to guide through a proper routine of exercises and relaxation courses in order to get rid of hypertension. Smoking habits are big matters of negation. If any patient comes up with such a habit he needs to be made aware of the consequences related to the habit of smoking so that he gets willing enough to quit it. Same inspection and consultation needs to be done for drinking habits. The next very important duty of the clinical stuff is to check the dietary habits of the patients. It is the core to all kinds to preventive measures led towards CHD protection. Proper consultation and suggestions are very important. Added to a proper diet the patient needs to go through a regular routine of developing exercise habits. All these are the part of a full fledged medication a service and thus needs to be taken care of under safe and expert hands. Preventive Diet A properly accumulate diet and a well maintained schedule of it can prevent anybody from CHD. It is the actual source that leads to the CHD in any human being. A high cholesterol diet is sure enough to generate coronary heart disease. It is a particularised condition in which we got to see some kinds of plaque the arteries near the heart. The American Heart Association thus recommends a diet of less than 300mg of cholesterol per day to a normal human being. The Framingham Heart Study gave a detail explanation for the dietary risk factors and risk reduction. This is a well synchronised and is widely followed as a measure to CHD preventions4. The diet as has been recommended by the American Heart Association is termed as AHA-1 Diet5, which has actually got the lists of Mediterranean-style diets, thus at times needs variations as per the advises given by the medical specialists. It is a general diet for the prevention of CHD and thus is very much important to be followed under medical supervision. None other than food is the basic footing for the prevention of CHD. Foods with maximum amount of high cholesterol generate body to make more cholesterol, and as such in the long run leads it towards the heart disease. As a matter of fact Cholesterol is very harmful for CHD, this is because though it is a type of fat that is essential for the body yet the amount intake for it has to be very low. Cells are what a part of it and it comprises the production of vitamin D, some hormones and bile acids. These are no doubt that are the equipments for digestion, but if present in a higher quantity then can be a threat to life. The most appropriate foods are those that contain high amount of fibre, potassium, nitric oxide that is found in green leafy vegetables. The other categories of food that one should prefer are phytic acid, polyunsaturated fat, saponins, carotenoids, flavonoids, lecithin, stanol, sterol, monounsaturated fat, phenolics, antioxidants, or tannins. All these items are highly recommended to prevent CHD as they are lower in margin when it comes to cholesterol levels in the body. There should be a strict rejection towards those food stuffs that are high in trans fat, grease, salt, or saturated fat. Avoidance towards them will undoubtedly raise the possibility of not having CHD. Findings and analysis The comprehensiveness and enough awareness towards the concept of risk factors constitutes for developing strategies for preventing CHD. It is the means to make one conscious enough of the possible pain and risks. There is a very important role played by Framingham Heart Study in defining the contribution of all sorts of risk factors to CHD in the United States. Framingham declares some of the day to day habits of US population that have increased the possibility of having CHD. These are the factors that have emerged out of cigarette smoking and hypertension in almost every walk of life. The other major factors leading to CHD are high serum cholesterol and various cholesterol fractions that are commonly in use. There again the avaibility of low levels of high-density lipoprotein (HDL) cholesterol, and maximum occupation made by diabetes mellitus. Along with the state of advancing age the risk factor for CHD also increases. As stated by the study led by Framingham charts increase in age can make people prone to CHD, the body becomes more fragile to activate a strong immunological state to fight minute tugs against diseases. However there are many preventive solutions for people who are suddenly attacked by any stroke. The new GMS has made a contract, for the provision for high quality of care payments based on outcome in certain key areas, including HbAlc, blood pressure and lipids. The other very common and obvious factors that can increase the possibility of suffering from CHD are obesity, physical inactivity and above all a big contribution is made from family history of premature CHD. The hypertriglyceridemia, increased lipoprotein (a) (Lp[a]), small low-density lipoprotein (LDL) particles, increased serum homocysteine, and abnormalities in several coagulation factors are some of the major aspects to lead towards CHD. All these factors need to be prevented from a very younger age. It is also very important to keep the body and mind well exercising, so that the hindrances can be conquered. As assessed by Wilson PW, Christiansen JC, Anderson KM, Kannel WB (1989;262:41–44.) these are all very important and are considered as the potential factors in paving one’s life towards the attack of CHD6. The great preventive action therefore is none other than preventing oneself from having any dominance of these factors. The simple way is to have thorough check and regular check ups and added to which one needs to add some exercises to his schedule. A broad range of clinical audit criteria is manifested by the NSF that relates to the prevention and treatment of CHD. It intends to inform the development of the information strategy and to be used by professional organisations as they develop new and more effective methods of self regulation and progressive professional development. The primary prevention can start with the motto of making the body more active and getting into the process of not having any kind of obesity and physical inactivity. These are the two such factors that are rooted deeply and are positively associated with risk for CHD. Obesity and physical inactivity exert towards an active and rapid development of CHD through the major risk factors. There are many mechanisms of having a direct participation of obesity and physical inactivity to wards the development of the risks factors of having CHD. Though these are more mysterious mechanisms and are yet to explore the risk imparted by these two factors are independent. These are such factors that anybody can get a hold of and can have the prevention thereby. According to the surveys made by NCEP(1993;269:3015–3023)7 and the AHA(1989:109–129)8 obesity and physical inactivity are important risk factors for CHD. The quantitative risk assessment as done by NCEP and AHA; stands as targets for these two particularised aspect. They are into the promotion of public health and social awareness regarding these two major causes for CHD. It has been forwarded by them that a desirable body weight and regular exercise done are the deserving steps that one can take and can have a high priority in prevention of CHD. concluSION It has been discovered that the Coronary heart diseases are both hereditary and can cause by lack of awareness. Through the value of modern society is in prevention and primary care as well as the contribution of the more specialised service had been recognised. There should be some kinds of active actions taken to help people avoid getting heart disease. On a public platform there should be certain amount of presentation illustrating high quality treatment and care needed for those people who are suffering from CHD. Early diagnosis is the most important ant the most primary step towards the prevention. This needs to be followed by prompt and effective ambulance and emergency services. The provisions are to be made for high quality medical, surgical and nursing care. Special services including heart surgery and rehabilitation to help those people who had a heart attack or heart operations to recover quickly are mandatory. Above all, it is all about making good diet choices is your first line of defence when striving to improve cholesterol levels. Knowing which food to avoid and which to include will not only improve your cholesterol level, but will improve your overall health as well. As a matter of fact, it is very important to have a broad range of clinical audit criteria is manifested by the NSF that relates to the prevention and treatment of CHD. It intends to inform the development of the information strategy and to be used by professional organisations as they develop new and more effective methods of self regulation and progressive professional development. references Kannel WB, Cupples LA. Cardiovascular and noncardiovascular consequences of obesity. In: Stunkard AJ, Baum A, eds. Perspectives in Behavioral Medicine: Eating, Sleeping, and Sex. Hillsdale, NJ: Lawrence Erlbaum Associates Inc; 1989:109–129 Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival study (4S). Lancet 1994; 344: 1383-1389. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA.. 1993;269:3015–3023. Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, et al. 1999, Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet; 353: 1547-1557. Wilson PW, Christiansen JC, Anderson KM, Kannel WB. Impact of national guidelines for cholesterol risk factor screening: the Framingham Offspring Study. JAMA.. 1989;262:41–44. ELECTRONIC REFERENCES Scott M. Grundy, Chair; Gary J. Balady, Michael H. Criqui, et al.; n.d., Primary Prevention of Coronary Heart Disease: Guidance From Framingham, A Statement for Healthcare Professionals From the AHA Task Force on Risk Reduction, [retrieved on 04.06.08] http://circ.ahajournals.org/cgi/content/full/97/18/1876 Step I, Step II and TLC Diets, n.d., [retrieved on 04.06.08] http://www.americanheart.org/presenter.jhtml?identifier=4764 Appendix BP - Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as blood moves through arteries, arterioles, capillaries, and veins; the term blood pressure generally refers to arterial pressure, i.e., the pressure in the larger arteries, arteries being the blood vessels which take blood away from the heart. BHF-- The British Heart Foundation is a charity organisation in the United Kingdom that funds research, education, care and awareness campaigns aimed to prevent heart diseases in humans. Their vision is of a world in which people do not die prematurely of heart disease. Cholesterol - Cholesterol is a type of fat that is essential for the body in small amounts. It is a component of all cells and also involved in the production of some hormones, vitamin D and bile acids; the latter aid digestion. CHD - Coronary disease (or coronary heart disease) refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. CVD- Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments. FH- Familial hypercholesterolemia (abbreviated FH, also spelled familial hypercholesterolaemia) is a genetic disorder characterized by high cholesterol levels, specifically very high low-density lipoprotein (LDL, "bad cholesterol") levels, in the blood and early cardiovascular disease. Many patients have mutations in the LDLR gene that encodes the LDL receptor protein, which normally removes LDL from the circulation, or apolipoprotein B (ApoB), which is the part of LDL that binds with the receptor; mutations in other genes are rare. Patients who have one abnormal copy (are heterozygous) of the LDLR gene may have premature cardiovascular disease at the age of 30 to 40. GMS - General medical services is the name used in the United Kingdom to describe the medical services provided by General Practitioners (GPs or family doctors) who, in effect, run private businesses independently contracting with the government. GP- A general practitioner (GP) is a medical doctor who provides primary care and specializes in family medicine. A GP treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities. MI- A heart attack, known in medicine as an (acute) myocardial infarction (AMI or MI), occurs when the blood supply to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period, can cause damage and/or death (infarction) of heart muscle tissue (myocardium). NSF- National Service Frameworks (NSFs) are policies set by the National Health Service (NHS) in the United Kingdom to define standards of care for major medical issues such as cancer, coronary heart disease, mental health and diabetes. NSFs are also defined for some key patient groups including children and older people. STATIN - The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower cholesterol levels in people with or at risk of cardiovascular disease. They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver stimulates LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream and a decrease in blood cholesterol levels. Read More