Primary prevention of cardiovascular disease: implications of lipid-lowering trials

AVAILABLE LIPID-LOWERING TREATMENT: Aggressive cholesterol-lowering with 3-hydroxy-3-methylglutaryl (HMG)-coenzyme A reductase inhibitors has proved to be more effective than drugs available in the past. This treatment is safe and reduces morbidity and mortality from coronary heart disease substantially in all categories of patients at risk. The effect of treatment on clinical events is proportional to the reduction in low-density-lipoprotein cholesterol. FUTURE PROSPECTS: In the future, even more effective drugs will become available that may yield even greater benefit than has been observed in trials until now. At present, this therapy is too expensive for use in mass strategy to prevent coronary heart disease. Therefore, it should be limited to patients with a high risk. When further development brings newer drugs with a lower cost, drug treatment for cholesterol-lowering may become as widespread as antihypertensive treatment is today in order to prevent cardiovascular disease.     

Compliance with cardiovascular disease prevention strategies: a review of the research

The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and, further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.     

Primary prevention of cardiovascular disease risk factors: review and implications for population-based practice

This review analyzed the results of population-based intervention studies targeting primary prevention of cardiovascular disease risk factors among children and adolescents in the United States. In general, the findings indicate that cardiovascular disease risk factors may be amenable to interventions in school-based programs. Although the interventions have small effects on risk factor outcomes, they should be interpreted within the context of population-based approaches that ultimately may have a greater impact on disease prevention than much larger effects among the small proportion of individuals at the highest levels of risk.     

The gynecologist and cardiovascular disease: a window of opportunity for prevention

OBJECTIVE: We present current concepts and assess the quality of information available for the prevention of cardiovascular disease in women. METHODS: This article reviews research bearing on the prevention of cardiovascular disease in women, with particular attention to modifiable risk factors. We describe the magnitude of the problem and assess the quality of the data with respect to the classic risk factors. The concept is emphasized that changes at menopause, states of endocrine aberration, and benefits and risks of hormone substitution and oral contraception must be understood in conjunction with all other potentially modifiable and nonmodifiable risk factors. CONCLUSIONS: Primary care physicians, especially obstetrician/gynecologists, have a pivotal role to play in the reduction of this disease. Behavior modification is the key to integrating prevention into the regular annual visit.     

Primary prevention: Insights for rehabilitation psychology.

Suggests that the gap between the number of persons suffering from mental disorders and the number of professionals available to help them is so large that it may never be bridged. This situation demands intensified efforts at primary prevention of disturbance and disability. Proponents of this position encounter opposition from those who benefit from the status quo featuring this medical model. However, the field appears to be moving inexorably toward a new model of health and illness, a model that demands social change, personal responsibility for health, and the importance of support systems and networks. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tennessee Lives Count: Statewide gatekeeper training for youth suicide prevention.

Youth suicide remains a significant public health problem in the United States. In 2004, the Garrett Lee Smith Memorial Act provided states and tribes with funding to implement and evaluate youth suicide prevention programs. The Tennessee Lives Count project was developed through a collaborative model at the state level and delivers an enhanced version of the Question, Persuade, Refer gatekeeper training program to individuals working with youth across the state. This article describes the development of the project and preliminary outcomes of 416 participants in child welfare, juvenile justice, health, and education systems at pretest, posttest, and 6-month follow-up. The findings suggest the training has an immediate and long-term impact on perceived knowledge of suicide prevention, self-efficacy, and attitudes about the inevitability of suicide. Policy and practice implications are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specialty differences in cardiovascular disease prevention practices

OBJECTIVES: The aim of this study was to examine physician specialty differences in cardiovascular disease prevention practices. BACKGROUND: Despite the importance of cardiovascular disease prevention, little is known about current national practices, particularly physician specialty differences. METHODS: Using a national survey of office visits, we evaluated differences in the propensity of physicians of different specialties to provide prevention services. We analyzed 30,929 adult visits to 1,521 physicians selected by stratified random sampling in the 1995 National Ambulatory Medical Care Survey. Standard and ordinal multiple logistic regression models were employed to estimate the independent effects of physician and patient characteristics. RESULTS: A variety of cardiovascular disease prevention services were provided during an estimated 547 million adult office visits to US physicians in 1995, including blood pressure measurement (50% of visits), cholesterol testing (5%) and counseling for exercise (12%), weight (6%), cholesterol (4%) and smoking (3%). In addition, medication management was reflected by the report of antihypertensives in 12% of visits and lipid-lowering medications in 2%. Across these eight services, propensity to provide services varied consistently with specialty. Controlling for patient and visit characteristics and compared to general internists, the likelihood of providing services was higher for cardiologists (adjusted odds ratio 1.65, 95% confidence interval 1.44 to 1.89) but lower for obstetrician/gynecologists (0.75, 0.68 to 0.82), family physicians (0.69, 0.64 to 0.74), general practitioners (0.58, 0.53 to 0.63), other medical specialists (0.65, 0.59 to 0.72) and surgeons (0.06, 0.05 to 0.06). CONCLUSIONS: Cardiologists have the greatest propensity to provide cardiovascular disease prevention services, while primary care physicians vary substantially in their practices. These findings suggest a need to address variations in cardiovascular disease prevention.     

Primary and secondary prevention strategies among older postmenopausal women

Women may choose to initiate, reinitiate, or discontinue hormone replacement therapy (HRT) at any time beyond the perimenopausal period. HRT, exercise, and nutrition are reviewed in terms of their potential benefits as primary and secondary preventive therapies against coronary heart disease, osteoporosis, breast and genital cancers, and the maintenance of cognitive function among older postmenopausal women. Lifestyle alternatives involving nutrition and exercise that offer many of the same benefits as HRT are discussed. Since both pharmacologic and lifestyle interventions offer significant benefit for primary and secondary prevention of disease and disability, each should be offered to women for consideration as they enter the perimenopausal period. Additionally, each can be recommended for initiation even at much older ages and subsequent to adverse health occurrences, such as the experience of breast or genital cancer or a cardiac event. Each should be sustained over the long term. The decision whether to discontinue these interventions among the most elderly will be influenced by other quality of life considerations.     

Primary and secondary prevention strategies in the older adult

Most causes of death and disability in older people are partially to fully preventable. To achieve maximum benefits from prevention strategies, use an organized system tailored to individual health risks and circumstances.     

Immersion scald burns: strategies for prevention

Tap water scald burns are common injuries to persons with disabilities, young children, and the elderly. A case is reported of an elderly woman with a physical and neurological handicap who while bathing received partial and full thickness (tap water) scald burns covering 20% of her total body surface area. This life-threatening injury could have been prevented with a Shower Safe, Inc. temperature-controlling water valve.     

Computer-assisted strategies for substance abuse prevention: Opportunities and barriers.

This article presents an analysis of the potential role that computer-assisted strategies could play in substance abuse prevention efforts in the future. Four primary areas are addressed. First, substance abuse prevention is discussed within the context of adolescent development. Second, computer-assisted instruction (CAI) is defined in terms of the opportunities it represents for substance abuse prevention. Third, a variety of barriers are described that must be addressed if the potential of CAI for enhancing substance abuse prevention efforts is ever to be realized. Finally, recommendations are made for coordinating research and development efforts, now and in the future, so that the potential of new technology for improving substance abuse prevention efforts will be adequately evaluated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing risk for cardiovascular disease.

The focus of this review article is to examine the importance of psychological and social factors in the development and maintenance of cardiovascular diseases, primarily coronary heart and artery disease, and to provide an overview of the effectiveness of psychosocial risk reduction interventions. First we summarize the prevalence and economic burden of cardiovascular disease, as well as the role of psychosocial factors in disease development and progression. We then examine the primary modifiable risk factors and evaluate the role of psychotherapists in the treatment of heart disease. Finally, we assess the effectiveness of risk factor modification and rehabilitation interventions, describe the potential costs and benefits of these programs, and discuss the role of primary prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for the elaboration of programs for the primary prevention of cardiovascular diseases. The Working Group for Primary Cardiovascular Prevention

This paper, elaborated by consensus between experts from Scientific Societies and the Health Administration, is aimed at providing general guidelines for the elaboration and prompting of cardiovascular disease primary prevention programmes, through individual risk factors screening and control. It is expected to be helpful for primary care professionals. After reviewing the rationale and logistics of the programmes starting in the Spanish context, an outline for the risk screening and assessment of the individuals attending the health services is set out. The strategies for high risk individuals control and the periodic health examination of low risk subjects are developed, emphasizing the multifactorial approach. Lastly operational criteria for the management of each risk factor taking simultaneously into account the whole risk picture, embracing definition criteria and consensus recommendations, are stated.     

Primary prevention: Historical perspectives and a blueprint for action.

Provides a history of primary prevention program development at the National Institute of Mental Health, achievements to date, and the unmet needs and future directions that must be addressed to advance the field of prevention. Specific proposals for action are identified as a blueprint for further program development at the nation, state, and local levels. Specialized perspectives of public service within a federal agency, as well as the opportunities to participate in shaping public policy that such national programs provide, are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS prevention strategies for ethnic-racial minority substance users.

African Americans and Latinos account for 29% and 16%, respectively, of persons with AIDS, yet collectively represent less than 20% of the US population. Although rates of HIV transmission have slowed among gay Anglo men, there is less evidence to indicate that patterns of transmission have been altered among Black and Hispanic drug users. Risk factors for HIV transmission among drug users are described, and sociocultural aspects of these risk behaviors are discussed. The advantages and disadvantages of various approaches to reducing the spread of HIV among drug users and their associates are considered, particularly as they apply to ethnic–racial minorities. Brief examples are provided of how existing theories of behavior change can be applied in Hispanic and African-American communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)