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National Diabetes Month

Although diabetes remains a threat to adult health worldwide, one of the main focuses in diabetes care is to halt the emerging epidemic of diabetes in our youth. According to the Centers for Disease Control, 1 in 3 children born in the year 2000 will develop type 2 diabetes (T2DM)-a staggering statistic. Without immediate action, this epidemic in youth promises to be costly in terms of early health complications and healthcare expenditures within the decade. Before 1900, only 5% of children or adolescents diagnosed with diabetes were classified as T2DM. But the tide has turned. Several clinical-based studies report 30% to 50% of new cases in youth as T2DM. With the corresponding tripling in the rate of overweight adolescents in the past 20 years, diabetes in youth is considered the first consequence of the epidemic of childhood obesity.

 

Nurses play a vital role in teaching prevention strategies to parents of at-risk youth and helping with early identification and aggressive management of T2DM in children and adolescents. In addition, nurses as community advocates and educators can actively support social change that promotes healthy food choices and daily exercise for children as a national priority. Check out the American Diabetes Association Web site at http://www.diabetes.org/ for further information on educational programs such as the "Choose to Live, Your Diabetes Survival Guide." Preventive Cardiovascular Nurses Association's "Diabetes-CVD Tool Kit" has excellent resources for providing education; the publication entitled Reducing Cardiovascular Risk in the Insulin Resistant Patient offers excellent information on both T2DM and insulin resistance and their relationship to metabolic syndrome and cardiovascular disease (CVD).

  
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Several new medications are now available and worth knowing about:

 

* Inhaled insulin (Exhubera) was released July 2005. This fast-acting insulin is in powdered form and delivered through an inhaler. Studies show that it is as effective as injected insulin at lowering blood glucose levels, and patient satisfaction is higher than with injections. Exhubera is inhaled before meals, with dosing based on weight. It can be used as monotherapy or combined with oral medications or a long-acting insulin. Because lung disease can affect efficacy, it is not recommended for smokers or persons with asthma or chronic obstructive pulmonary disease.

 

* Exenatide (Byetta), an incretin mimetic, is for people with T2DM who take metformin, a sulfonyurea, or both. Given by subcutaneous injection twice a day, it enhances insulin secretion, suppresses glucagen secretion, slows gastric emptying, and reduces appetite.

 

* Pramlintide (Symlin) is a synthetic hormone that resembles amylin, the human hormone that the pancreas secretes after meals to help the body regulate blood glucose. Pramlintide is an injection taken before meals in addition to insulin for people with type 1 and type 2 diabetes. The insulin dose should be reduced by about 50% when starting pramlintide.

 

  

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PCNA Chapters in the News

What a surprise to the many nonmembers attending the Preventive Cardiovascular Nurses Association's (PCNA) Chicagoland Chapter Meeting in July 2006. Dr Alan S. Brown, Cardiologist, Midwest Heart Associates, presented "Optimizing Treatment of Dyslipidemia in Patients With Type 2 Diabetes" to more than 75 healthcare professionals. In closing his presentation, Dr Brown offered to "pay the membership dues for any new members who signed up that evening." To his surprise and pleasure, 37 nurses took him up on his offer! Thank you to Dr Brown for his dedication to excellence in nursing!

 

Preventive Cardiovascular Nurses Association would like to welcome the following new Chapters and their leadership:

 

* California Central Valley-Kim Newlin

 

* New Jersey-Laura Mansfield, Joel Jacalan, and Roberto Chiu

 

* Central Virginia-Suzanne Fuhrmeister

 

 

If you would like more information on how to form a new Chapter, contact PCNA Membership Coordinator Kristie Kasbohm at kkasbohm@pcna.net.

 

For more information about PCNA Chapter events around the United States and in Montreal, please visit: http://www.pcna.net/chapters/.

 

Health Benefits of Omega-3 Fatty Acids and Walnuts

Preventive Cardiovascular Nurses Association (PCNA) is pleased to announce the release of "Health Benefits of Omega-3 Fatty Acids and Walnuts." This free online continuing education program outlines the health benefits of omega-3 fatty acids in general, walnuts in particular. This program reviews the recommendations for relaying this information to patients, who typically do not understand that certain types of dietary fat, particularly polyunsaturated omega-3 fatty acids, can be beneficial.

 

In recent years, the number of studies describing the healthpromoting benefits of omega-3 fatty acids has increased substantially. Some of the reported activities attributed to omega-3 fatty acids include improving serum triglyceride profiles, stabilizing dysrhythmias, reducing inflammation, regulating endothelial cell function, improving insulin sensitivity in patients with type 2 diabetes, and enhancing the immune response.

 

Evidence-based reviews of the scientific data linking the intake of omega-3 fatty acids to specific health benefits have prompted several government agencies and professional organizations to recommend increasing omega-3 and other healthy fats in the diet while limiting the intake of foods high in harmful saturated fat and trans-fatty acids.

 

Unfortunately, most adults in the United States do not consume enough omega-3 fatty acids in their diet to reap the health benefits. Part of the reason for the inadequate intake of these fatty acids is a lack of knowledge on the part of consumers. Another major factor is individual dietary tastes and preferences. Because of the high levels of omega-3 fatty acids found in fatty fish, the popular media and many health professionals emphasize increasing marine food sources to enhance their intake. However, a large percentage of the population is apparently unwilling or unable to incorporate fish into their diets in sufficient amounts or take fish oil supplements on a regular basis. For many consumers, adding plant-based sources of omega-3 fatty acids, including walnuts, flaxseed, and canola oil, can be a more pleasant and feasible way to increase their intake. As with fish, the challenge is to find convenient, pleasant, and familiar ways to add or increase plant sources of omega-3 fatty acids in the average American diet. Walnuts, the only tree nut that contains significant amounts of omega-3 fatty acids, are particularly attractive because they can be added to a variety of familiar foods, such as cereals, salads, baked goods, and desserts, or they can be eaten by themselves as snacks.

  
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This program, "Health Benefits of Omega-3 Fatty Acids and Walnuts," offers 1 credit of continuing education and can be found at http://www.pcna.net. Preventive Cardiovascular Nurses Association is approved as a provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners.

 

Popular Resource Gets an Update

The Preventive Cardiovascular Nurses Association (PCNA) Forms Guide entitled "Practical Information for Your Cardiovascular Risk Reduction Clinic" has recently been updated. This online resource includes a wide variety of medical evaluation forms, assessment tools, and educational materials used in the day-to-day operations of a clinical practice. This resource provides copies of forms in an electronic format, allowing the users to customize the form with their practice name and logo.

 

Based on feedback from PCNA members, the revised online Forms Guide includes all cardiovascular risk factors, with new expanded sections related to the management of diabetes and obesity. The medication fact sheets now include an entire chapter on diabetic agents and a chapter on anti-hypertensive and lipid-lowering medications. Stress management tools are also included along with many new nutrition assessment and teaching tools. For more information about the Forms Guide and other PCNA publications, please visit http://www.pcna.net.

 

National Depression Month

In the wake of October as National Depression Month, it is still important for nurses to review the latest scientific and clinical information on depression and to expand their skills in screening for this independent risk factor for coronary heart disease. Major depressive disorder, as well as the presence of subthreshold "depression," is a relatively strong predictor of cardiovascular disease in healthy adults, as well as recurrent events in patients with coronary heart disease.

 

Depression is an independent predictor of cardiac mortality over 6 to 18 months after a myocardial infarction. Patients who survive myocardial infarction but suffer from major depression are 3 to 4 times more likely to die within 6 months than survivors without depression. Readers are referred to an excellent article by Whooley recently published in JAMA that highlights some key facts.

 

1. In the recent INTERHEART study that involved 52 countries, psychosocial factors were stronger risk factors for occurrence of myocardial infarction than were smoking, diabetes, hypertension, and obesity (based on a multivariable model).

 

2. Depression occurs in 1 of 5 outpatients with coronary heart disease who remain at a higher level of cardiovascular risk until remission or dissipation of these symptoms. It has been found to predict mortality after acute myocardial infarction, with even minor depressive symptoms being used as the marker of depression.

 

3. Depression often complicates cardiovascular events such as coronary bypass graft surgery.

 

4. Depression occurs in 1 out of 3 outpatients with heart failure and is associated with adverse outcomes.

 

5. Pharmacotherapy with serotonin selective reuptake inhibitors and cognitive behavioral therapy are safe and effective treatments for patients with coronary heart disease. Two commonly used medications are citalopram and sertraline.

 

6. At this time, there are no randomized control studies demonstrating that treating depression will prevent cardiac events, although observational studies support such treatment.

 

7. The Sertraline Antidepressant Heart Attack Randomized Trial is one trial that documented the safety of serotonin selective reuptake inhibitors in treating depression in cardiac patients. There was a trend toward reduced cardiac mortality with sertraline, but further study with a larger sample is needed to demonstrate the benefits of this treatment on cardiac outcomes.

 

8. The Enhancing Recovery in Coronary Heart Disease trial did show the effectiveness of cognitive behavioral therapy in treating depression, but there was no significant improvement in primary or secondary cardiac end points. Ongoing subgroup analysis may provide explanations for these findings.

 

 

Screening for depression is vital to early intervention and risk reduction. Several tools are available, each with its own individual strengths and weaknesses. For example, the Geriatric Depression Inventory is commonly used in primary care settings. The 9-item Patient Health Questionnaire Depression Screening Instrument, available from Pfizer, Inc., has a high specificity and predictive value, although its sensitivity is low. Whooley suggests the use of a 2-item tool with high sensitivity but low specificity: (1) "In the past month, have you felt 'down,' depressed, or hopeless?" and (2) "In the past month, have you had little pleasure or interest in doing things?" A positive response to both questions must be followed up with a clinical interview. In addition, the Beck Depression Inventory, the Profile of Mood States, and the Center for Epidemiologic Studies Depression Inventory can be used to assess for depression.

 

Nurses are the first line of attack for depression screening. Early recognition of signs and symptoms can lead to prompt intervention and, hopefully, an improvement in quality of life and a reduction in future cardiac events. Please visit the Preventive Cardiovascular Nurses Association Web site at http://www.pcna.net/ for information about their free online continuing education program entitled "Depression and Cardiovascular Disease."

 

Wholley, M. Depression and cardiovascular disease. JAMA. 2006;295:2874-2881.

  
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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.