Coronary heart disease prevention in women: focus on lipids.

Coronary heart disease (CHD) remains an urgent and leading threat to women's health and well-being. Clinical trials have demonstrated a clear cut benefit of low density lipoprotein cholesterol (LDL-C) lowering in both women as well as men with coronary disease. While the case for primary prevention of CHD with LDL-C lowering is less secure in both men and women, there is little doubt that patients at high risk of CHD, even without a prior history of vascular events, will in the long run benefit from LDL-C lowering. Thus, all available evidence indicates that lipid interventions should be pursued aggressively in both women and men at risk of CHD.

Enhancing drug compliance in lipid-lowering treatment.

Hyperlipidemia and the atherosclerotic conditions that result from it are well recognized as major contributors to coronary heart disease (CHD). Fortunately, several large-scale clinical trials have shown that there are effective treatments that can substantially lower atherogenic lipid levels and thereby reduce the risk of CHD mortality and morbidity. However, duplication of these dramatic trial results can be negatively affected in "real life" clinical practice by an important issue: compliance. No medications will work if patients do not take them. Unfortunately, patients who need lipid-lowering therapy are likely to need it long-term, perhaps for a lifetime. Yet, many do not adhere to the prescribed medication regimen. This article reviews some major studies of compliance for lipid-lowering drugs. The reasons why patients do not take them as prescribed vary: poor education, lack of understanding, cost, provider indifference, and others. Achieving compliance requires a multifaceted approach. It can be enhanced by encouraging patients to talk openly about their medication habits and by convincing them of the long-term benefits of reaching and maintaining target low-density lipoprotein cholesterol levels. Although more studies focusing on compliance specifically regarding CHD are needed, the current literature does provide some guidance. Arch Fam Med. 2000;9:1169-1175

Office of Research on Women's Health. National Institutes of Health and the women's health agenda.

The historical precedent underway in women's health research in the 1990s provides the basis for more equitable health promotion and disease prevention and treatment of women in the second millennium. The success of this enterprise rests on the collaboration and cooperation of all concerned--the scientific community, health care providers, and the women themselves. The goal is improved health and prevented disease for all women. Thucydides avowed that "history is philosophy learned from examples." We can do no less.

Women's health: science and politics.

The scientific community, in particular the NIH, as well as the political communities of governments and advocates, have formidable goals to achieve in integrating women's health research firmly within the context of biomedical science, securing rights for women to be included in clinical studies and fostering the development and advancement of women in biomedical sciences. No one group or organization can accomplish such a task alone, nor should they. This effort requires the cooperation and collaboration of many individuals and organizations if we are to meet our ultimate goal--health for all our citizens.

An update from the National Cholesterol Education Program: implications for nurses.

The article presents an update of activities from the National Cholesterol Education Program, including information about the recently released documents addressing laboratory standardization for cholesterol evaluation, public screening for cholesterol, the panel report of dietary recommendations for the nation, and a description of the American Heart Association Cholesterol Education Program for Nurses. Implications for nursing are discussed in light of these releases.

Executive women and health: perceptions and practices.

The purpose of this study was to obtain a socioeconomic/health profile of a select group of executive women, to understand more about their personal and professional lives, and to examine how these factors relate to their overall health. The data were obtained from a self-administered 73-item questionnaire that was mailed during spring 1987 to the 1,000 members of a professional executive women's organization with 15 chapters across the United States. Findings suggest that the women in executive positions do not necessarily compromise their health. In comparison with a group of age/gender/education matched working women, the overall wellness and risk assessment scores were remarkably similar. The study group, however, reported greater life satisfaction, stronger social support, and excellent health status; the overwhelming majority was satisfied with their personal and professional lives and believed that they were in control of both. This perception, coupled with the relatively high wellness scores, suggests that on average this group of executives may be in better health than had been predicted as women rose to executive positions within organizations.

Considerations for a national heart attack alert program.

Coronary heart disease (CHD) remains the leading cause of death in the United States--in women as well as men. In 1987, CHD was responsible for 512,138 deaths, of which 253,542 deaths were attributed to acute myocardial infarction (AMI) and accounted for over $43 billion in direct and indirect costs. The disease spares no one. Primary prevention is clearly important, but for those in whom primary prevention has not been applied or has failed, acting to minimize the effect of a heart attack is of paramount importance. Many of its victims do not obtain appropriate medical care, or obtain it too late for the latest lifesaving technologies to be effective. The goal of treatment is to prevent death and to salvage as much heart tissue as possible. To achieve this goal, it is essential to minimize the time from the first symptoms and signs to treatment. Opportunities exist at each phase of an evolving AMI to intervene promptly and appropriately to prevent sudden death and to preserve cardiac muscle and thereby reduce CHD morbidity and mortality. Yet, formidable problems also exist. These and other issues are presently being studied by the National Heart, Lung, and Blood Institute staff and advisors in consideration of whether to establish a national educational program aimed at reducing CHD morbidity and mortality through the rapid identification and treatment of those with AMI.

Elevated blood cholesterol. A risk factor for coronary heart disease.

1. The Report of the Adult Treatment Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults is designed to provide guidance to healthcare professionals in the detection, evaluation, and treatment of adult hypercholesterolemic patients. 2. Dietary intervention, an essential part of every treatment plan, is highlighted followed by the introduction of drug treatment if the dietary intervention fails to achieve the desired results. 3. Guidelines for intervention at the worksite, including those using community resources, are discussed.

Nursing practice and the National Cholesterol Education Program guidelines for detecting, evaluating, and treating high blood cholesterol in adults.

Recently published guidelines, The Report of the Adult Treatment Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, have tremendous implications for the practice of nursing. This paper presents key elements from that report and discusses how these guidelines can be used to enhance clinical practice among nurses treating and counseling patients with elevated blood cholesterol levels. In addition to discussing the major treatment modalities of diet and drugs, this paper considers implications for nurses working with Black patients.