1. Hayman, Laura L. PhD, RN, FAAN
  2. Hughes, Suzanne RN, MSN

Article Content

We are delighted and honored to serve as coeditors of Progress in Prevention, a new regular feature of the Journal of Cardiovascular Nursing (JCN). As the title implies, this column will highlight recent advances relevant to prevention of cardiovascular disease (CVD). With emphasis on "putting prevention into practice" on both an individual/patient and population level, we plan to include commentaries on articles appearing in JCN as well as original, peer-reviewed articles. We hope that Progress in Prevention will contribute to your cardiovascular nursing practice across clinical and community-based settings and we welcome your comments and ideas for this column.


The evidence supporting primary and secondary prevention of CVD has burgeoned over the past several decades. Primordial prevention, preventing the development of risk factors in the first place (also referred to as cardiovascular health promotion), has emerged as an important component of CVD prevention. Two recent issues of JCN have focused on prevention including the challenges and opportunities for cardiovascular nurses in facilitating and championing cardiovascular health promotion and risk reduction on both the individual and population level. 1,2


It is particularly timely for JCN to incorporate prevention as a regular feature. Trends in the development, dissemination, and translation of CVD prevention science suggest that the opportunities for nurses and nursing will continue to increase. Research continues to underscore the role of potentially modifiable lifestyle behaviors and environments as important determinants of CVD. Relatedly, lifestyle modification forms the cornerstone of current primary 3 and secondary 4 prevention guidelines and is emphasized in recently revised guidelines issued by both the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) 5 and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). 6 In addition, treatment algorithms advanced in ATP III and JNC 7 target more individuals for intensive therapeutic lifestyle changes. For example, based on accumulated evidence and recognizing the continuous relationship between blood pressure levels and CVD events, JNC 7 introduced the "prehypertension" classification. That is, health-promoting lifestyle modifications are strongly recommended for individuals with a systolic blood pressure of 120 to 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg. Similarly, the development and maintenance of "heart-healthy" patterns of behavior is the critical ingredient of primordial prevention guidelines 7 and a major component of the American Heart Association's recent guide for improving cardiovascular health at the community level. 8


Viewed from the perspective of CVD prevention, the increased attention to health-promoting and therapeutic lifestyle modifications in recent evidence-based guidelines is a positive trend. As emphasized throughout the 2 recent issues of JCN, 1,2 however, prevention is a complex process that extends beyond individuals/patients and providers to systems of health care delivery and social-political factors. Despite the availability and demonstrated efficacy of well-tolerated therapies, trends in compliance on multiple levels suggest minimal-to-modest gains. Armed with the knowledge base and skill sets in behavioral interventions (outlined by Burke and Fair 9), nurses play an integral role in motivating and coaching individual patients with therapeutic lifestyle change. Clearly, the potential for nurse case managers in optimizing cardiovascular risk profiles in patients with and without established CVD has been demonstrated. The population approach to promoting "cardiovascular health for all" will require different but complementary strategies that combine behavioral/lifestyle modification and policy changes necessary to enable heart healthy patterns of behavior. 8 Taken together, trends augur well for pivotal roles for cardiovascular nurses in continuing progress in prevention at the individual/patient and population level.




1. Franklin B, Fletcher B, eds. Emerging issues in prevention. J Cardiovasc Nurs. 2003;18:2. [Context Link]


2. Fair JM, ed. Facilitating cardiovascular risk reduction. J Cardiovasc Nurs. 2003;18:4. [Context Link]


3. Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002;106:388-391. [Context Link]


4. Smith SC, Blair SN, Bonow RO, et al. AHA/ACC guidelines for preventing heart attack and death in patients with atheroclerotic cardiovascular disease: 2001 update. Circulation. 2001;104:1577-1579. [Context Link]


5. National Cholesterol Education Program. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. Available at: [Context Link]


6. Chobanian AV, Bakris GL, Black HR, et al, and the National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-2572. [Context Link]


7. Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health in childhood. Circulation. 2002;106:143-160. [Context Link]


8. Pearson TA, Bazzarre TL, Daniels SR, et al. American Heart Association guide for improving cardiovascular health at the community level. Circulation. 2003;107:645-651. [Context Link]


9. Burke LE, Fair J. Promoting prevention: skill sets and attributes of health care providers who deliver behavioral interventions. J Cardiovasc Nurs. 2003;18:256-266. [Context Link]