Article Content

New Findings From Nutrition Research Reported at AHA Scientific Sessions

PCNA member Jerilyn Allen, RN, ScD, FAAN, reported on her recent study adding to the limited knowledge on the benefits of soy protein. The use of soy protein containing isoflavones, a phytoestrogen or weak form of naturally occurring estrogen, can improve atherogenic lipoprotein profiles in postmenopausal women and effectively reduce two strong, independent indicators of coronary heart disease.


According to a study by Johns Hopkins researchers, both the low-density lipoprotein cholesterol elevation (LDL-C) and the lowdensity lipoprotein particle number (LDL-P) were decreased in healthy postmenopausal women with borderline LDL-C who took a dietary supplement of soy protein each day for six weeks. In the randomized "Beneficial Effects of Soy Trial" (BEST), 216 Caucasian and African American women received a daily dose of either 20 grams of isolated soy protein containing isoflavones or a placebo of 20 grams of protein from casein. In comparison to the women who were given the placebo, those taking the soy protein experienced significantly greater decreases in LDL-C and LDL-P. Differences in age, race, and changes in other lipoproteins, dietary saturated fat intake, and weight had little or no impact on the BEST findings. The study was conducted at the Johns Hopkins University School of Nursing and funded by the National Heart, Lung and Blood Institute. Allen's co-investigators were Diane Becker, RN, ScD, and Pete Kwiterovich, Jr., MD, both of Johns Hopkins University School of Medicine.


Another study provided evidence that substituting carbohydrates with protein (about half from plants) or with unsaturated fat (mostly monounsaturated fat) can lower blood pressure, improve cholesterol levels, and reduce heart disease risk. The National Institutes of Health-funded OmniHeart study studied 164 adults with systolic blood pressure of 120-159 mm Hg or diastolic at 80-99 mm Hg. About half the subjects were African American. Researchers tested three healthy diets. One diet was rich in carbohydrates (55 percent of calories) and is very close to the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH diet has proven to lower blood pressure and emphasizes fruits, vegetables, and low-fat or fat-free dairy products. A second diet shifted 10 percent of its calories to protein, compared to the carbohydrate diet. A third diet shifted 10 percent of its calories to unsaturated fat, predominantly monounsaturated fat. All of the diets were low in saturated fat (6 percent of calories). Researchers provided all of the food during the study. The 164 participants followed each diet for six weeks at a time.


In comparison to baseline levels obtained when participants were eating their own food, all three diets lowered systolic blood pressure by 8.2 mm Hg to 9.5 mm Hg and LDL or "bad cholesterol" by 11.6 mg/dL to 14.2 mg/dL. When compared to the carbohydrate diet, the protein diet further reduced systolic blood pressure by 1.4 mm Hg overall and lowered LDL by 3.3 mg/dL overall. However, high-density lipoptotein (HDL) significantly decreased by about 1.4 mg/dL. The unsaturated fat diet further reduced systolic blood pressure by 1.3 mmHg overall. The unsaturated fat diet had no significant effect on LDL but raised levels of HDL by 1.1 mg/dL. Compared to both baseline and the carbohydrate diet, the protein diet reduced triglycerides by approximately 16 mg/dL, and the unsaturated fat diet lowered triglycerides by about 9 mg/dL. Larry Appel, MD, was the lead investigator from Johns Hopkins University and Frank Sacks, MD, was the lead investigator from Brigham & Women's Hospital, Harvard Medical School.


Karen Olson, RN, Executive Director of the Cardiovascular Research and Education Foundation in Wausau, Wisconsin, reported on the results from the Wausau SCHOOL (School Children Have early Onset Of Leading risk factors for CVD and diabetes) Project. The project included 621 participants who were randomly selected students in the 2nd, 5th, 8th and 11th grades who completed diet and exercise surveys. Twenty-percent of the students (126) indicated that they had eaten out four or more times weekly, not including lunches in the school cafeteria.


Compared with the 495 students who ate out less than four times a week, those who dined out often had significantly higher systolic and diastolic blood pressure; lower levels of HDL, smaller LDL particle size (small, dense LDL particles are associated with atherosclerosis); lower scores on the quantitative insulin-sensitivity check index (QUICKI) which is an early sign of progression toward type-2 diabetes; and significantly overall higher dietary intake of starch, sugar, sodium, fat, and cholesterol. Children who ate out more often also drank almost twice as many sodas and other soft drinks, about six cups a week compared with 3.65 cups a week for the children who ate out less often.


According to researchers, children who ate out more often were also significantly less active than their peers. Not counting school or time spent reading or doing homework at the computer, children who ate out more often spent an average of 3.59 hours a day in sedentary activities such as playing computer games and watching television. Children who ate out less often spent 2.78 hours a day in sedentary activities. The researchers are working on interventions to encourage more physical activity and healthier eating for children. Co-authors were Bryan Hendricks, PhD; Dana Macalalad, RD; Judy Omernik, RD; Patrick Hughes, MD; and David Murdock, MD. Funding was provided in part by the Centers for Disease Control and Prevention, CaRE Foundation and Wausau Heart Institute and Wausau Health Foundation, Aspirus partners.


February and "Love Your Heart"

Even before the last horn has been blown on New Year's Eve, retailers are filling their store shelves with Valentine's Day memorabilia. Cardiovascular nurses likewise need to jump start their February campaigns for promoting awareness for heart health. The American Heart Association, the National Heart Lung and Blood Institute (NHLBI), and PCNA's Web sites are great places to start gathering materials. There are many strategies that can be used to spread the word about heart disease using the designated "Go Red" logos. The scope of activities are numerous as well-small scale month-long projects such as circulating red heart stickers and "Know Red" fact sheets, using payroll stuffers, hanging posters, or sending awareness newsletters and e-mails. Anexcellent site for gathering these materials is

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Another approach is to plan specific activities for the National Wear Red for Women Day on February 3, 2006. This could include hosting a luncheon where women share their stories about how we all can "love and save our hearts" through heart-healthy lifestyle choices and actions. The above AHA Web site offers myriad step-by-step suggestions to make a successful program.


The PCNA Web site also offers awareness materials through their "Tell a Friend" campaign about women and heart disease. Check these out at


The NHLBI provides valuable tool kits for their The Heart Truth campaign. They offer downloadable photos and graphics that can be used in news stories and articles. On an even grander scale, consider checking out the Heart Truth Road Show 2006. This second cross country tour is ready to raise awareness about heart disease and women through display of the famous Red Dress Collection along with its associated free heart screenings in shopping malls in the following cities: Detroit, MI; Jacksonville, FL; Memphis, TN; Pittsburgh, PA; and Washington, DC.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Finally, the Heart Failure Society of America is using February to promote Heart Failure Awareness Week (Feb. 12-18, 2006). They also provide all the necessary materials for a successful program, including a turnkey kit, through their Web site:


PCNA Collaborates in Updating Scope & Standards for CV Nursing

Have you ever wondered what happened to the old Standards of Cardiovascular Nursing Practice first printed in 1975 through the American Nurses Association (ANA) in collaboration with the American Heart Association (AHA)? This piece, revised in 1981, is currently out of print and probably out of touch with today's practice of cardiovascular (CV) nursing.


After months of discussion, it became obvious that a new edition was needed to define the scope and standards of CV nursing practice for this millennium. Spearheaded by the American College of Cardiology Foundation's Working Group on Continuing Nursing Education and under the guidance of the ANA, leaders from more than 14 nursing organizations have joined forces in a unique collaborative effort to create this document. Represented in this group of nursing organizations are: The Preventive Cardiovascular Nurses Association (PCNA), the AHA Council on Cardiovascular Nursing, the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association of Heart Failure Nurses, the Heart Failure Society of America, the American Association of Critical Care Nurses, the American College of Cardiovascular Nursing, the American College of Nurse Practitioners, the National Council of Clinical Nurse Specialists, the Society for Vascular Nursing, and the International Transplant Nurses Society, to name a few. What an awesome group of nurse leaders!


The second group meeting was held this past September in Chicago. Group members were given an overview of the established ANA format for the Scope and Standards documents, along with discussion of "lessons learned" from other specialties that attempted such a project. Much attention was focused on creating a comprehensive "working" definition of Cardiovascular Nursing. Each representative left the meeting with a writing assignment related to further clarification of the definition of CV nursing specialty and its practice environment, an overview of the historic perspective of the development of this specialty, current issues and trends affecting the specialty, or the differences between the generalist and advanced practice CV specialty nurse. This is quite a challenge considering the breadth of practice-from genetics to end-of-life issues, with primary and secondary prevention and acute care in between. Any PCNA member with creative ideas and suggestions, please forward this information to Meg Gulanick (PCNA's representative) at the national PCNA office at [email protected], subject "Scope and Standards."


Stroke and Heart Disease: Moving Toward Common Goals

Stroke and Heart Disease: Moving Toward Common Goals was offered as a pre-sessions nursing conference, prior to the official beginning of the AHA Scientific Sessions in Dallas. Suzanne Hughes, RN, MSN, set the stage with the opening presentation in which she cited the array of commonalities between cardiovascular and cerebrovascular disease. There are parallels in the development of thrombolytic therapies for acute coronary syndrome and for ischemic stroke. The mantra "Time is muscle," associated with the era of thrombolytic therapy for acute MI in the 1980's, was paralleled with "Time lost is brain lost" slogan when thrombolytic therapy was approved for use in ischemic stroke in 1996.


Citing data that 25% of strokes are recurrent, Hughes also alluded to the respective development of secondary prevention quality improvement programs developed by the American Heart Association of the Get With the Guidelines CAD and Get With the Guidelines Stroke. Risk factors and biomarkers, particularly C-reactive protein and Lp-PLA2, common to both diseases, were reviewed.


Anne Wojner-Alexandrov, PhD, CCRN, FAAN, followed with fascinating information about measurement of cerebral flow, and potential therapeutic effects of ultrasound.


Karin Nystrom, MSN, APRN, discussed the assessment of stroke risk in the patient with cardiovascular disease, also covering the subtopic of iatrogenic stroke. Opportunities for risk factor modification, particularly blood pressure management, were stressed. Several of the presenters recalled having begun their clinical practice in the cardiovascular arena before entering the current field of cerebrovascular disease.


Anne Leonard, RN, BSN, MPH, FAHA, delivered an important presentation that included cardioembolic stroke, warfarin therapy for the at-risk patient, and the challenges of careful anticoagulation management.


Janice Hinkle, PhD, RN, CNRN, reviewed new developments in the area of neuroprotection.


Claire Sommargren, RN, MS, in her presentation on cardiac effects during acute ischemic or hemorrhagic stroke, explained the pathophysiologic basis of electrocardiograph abnormalities associated with acute stroke and the significance of each.


The closing presentation, given by Lori Massaro, MSN, RN, CRNP, looked at opportunities for professional and patient education to raise awareness about the symptoms of stroke and the critical need for early recognition and prompt action in the pre-hospital phase, and for hospital processes that support expeditious treatment of stroke in progress.


Although there have been strides in decreasing the morbidity from both heart attack and stroke in the past 25 years, these remain the first and third leading causes of death in the United States. We clearly still have a gap to close to meet the Healthy People 2010 goals. When one examines the gaps by racial and ethnic groups, it is demonstrated that there is a great deal more work to do, particularly in the African American population. The results of a Harris survey commissioned by the American Heart Association were reported October 3, 2005. Only 29% of African American adults reported having discussed stroke risk with their physicians, and the group surveyed includes those with a personal and/or family history of stroke. The program was well-received and represents an important collaboration between nurses working in these closely related areas.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Section Description

The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.