In June, results from the EUROACTION trial were published in The Lancet. In this project, a multidisciplinary, nurse-coordinated, family-based program improved lifestyles and reduced cardiovascular disease (CVD) risk among patients and their families in hospital and general-practice settings (2008;371:1999-2012). This highlights the importance and effectiveness of primary-care prevention in clinical practice.
As a nurse practitioner in cardiology, I have always believed in taking an active role in preventing heart disease and the metabolic syndrome and in promoting healthy behaviors. It’s not enough for a primary-care clinician to simply tell patients what they need to do to prevent disease—eat less sodium, lose 10 pounds, stop smoking, exercise 30 minutes three to five times a week, and modify their diet. Great practitioners will also routinely monitor for and address other modifiable risk factors, such as hypertension, diabetes, and hypercholesterolemia. Studies like the EUROACTION trial show that a well-organized multidisciplinary approach yields positive results for reducing CVD risk. The Nigerian proverb “It takes a village to raise a child” can be applied: Tackling heart disease requires a multidisciplinary approach to primary prevention.
EUROACTION was a randomized controlled trial involving thousands of people in eight European countries. All participants had coronary heart disease or were at high risk for the condition. A nurse-led intervention involving family practitioners, cardiologists, dietitians, and physiotherapists was more effective than usual care in reducing CVD risk and helping patients and their families increase their intake of recommended fruits, vegetables, and fish; consume less saturated fat; become more physically active; improve their BP and total cholesterol levels, and quit smoking.
Thanks to greater research efforts and scientific innovations, heart disease-related morbidity and mortality have declined. However, as health-care professionals, we must continue to research ways to promote primary prevention of CVD. Family practices, hospitals, and endocrinology or cardiology offices are perfect places to make a real difference in the lives of patients as well as their families. It has been found that atherosclerotic processes start in early childhood and are influenced by familial risk factors, potentially modifiable risk factors, and other outside exposures (Circulation. 2007;116:344-357). That’s an excellent reason to get the entire family actively involved in primary prevention.
In the future I would love to see multidisciplinary approaches in the form of prevention programs to aggressively target high-risk patients. For now, I challenge every health-care professional to at least follow the recommendations of the American Heart Association:
- Begin risk factor assessment in adults at age 20.
- Regularly update the patient’s family history of coronary heart disease.
- Assess the patient’s smoking status, diet, alcohol intake, and level of physical activity at every routine evaluation.
- Record the patient’s BP, BMI, waist circumference, and pulse (to screen for atrial fibrillation and other arrhythmias) at each visit (at least every two years).
- Assess the fasting serum lipoprotein panel (or total and HDL cholesterol levels if fasting is unavailable) and fasting blood glucose according to the patient’s risk for hyperlipidemia and diabetes, respectively (at least every five years or every two years if risk factors are present).