4 Heart Disease Risk Factors Clinicians Can Tackle

Cardiovascular disease (CVD) continues to pose a serious health problem in the United States, but retail clinicians may be well placed to help patients reduce their risk for it.

According to the US Centers for Disease Control and Prevention (CDC), CVD is theleading causeof death in the United States, claiming approximately 610,000 lives—or nearly 25% of all deaths—each year.

While these figures may be alarming, retail-based nurse practitioners and physician assistants can help their patients prevent CVD by managing its known risk factors, which include the following.

1. High Cholesterol

High cholesterol is among the most well-known and problematic risk factors of heart disease, as patients with elevated low-density lipoprotein cholesterol (LDLC) levels are almost twice as likely to develop CVD as those with normal LDLC levels.

Although the CDCrecommendsthat adults get their cholesterol levels checked every 5 years, data from 2009 to 2010 indicate that less than 70% of Americans aged 20 years and older do so.

Kristene Diggins, FAANP, DNP, MBA, DCC, CNE, NEA-BC, manager of professional practice for MinuteClinic,previously toldContemporary Clinicthat retail clinicians should not only screen their patients for high cholesterol, but also educate them on the association between cholesterol and CVD, as well as inform them that they can reduce their risk of heart attack and other cardiovascular events by maintaining healthy cholesterol levels.

Dr. Diggins also advised clinicians to encourage their patients with high cholesterol to:

• Exercise for 30 to 60 minutes a day for the majority of the week.
• Work toward and maintain a healthy body weight.
• Quit smoking.
• Reduce their intake dietary cholesterol, saturated fat, and trans fat.
• Limit their intake of dietary carbohydrates to less than 60% of their daily calories.
• Consume foods rich in omega-3 fatty acids such as salmon, mackerel, sea bass, walnuts, and green leafy vegetables.
• Limit themselves to 1 (women) or 2 (men) alcoholic beverages a day.

Adults are not the only patients in need of better cholesterol management, as a CDC data briefreportedthat 1 in 5 children and adolescents has high total cholesterol, low high-density lipoprotein (HDL) cholesterol, or high non-HDL cholesterol.

Fortunately, clinicians may be ideally placed to help this population, as a recentJAMA Pediatricssurveyrevealedthat parents are increasingly bringing their children to retail clinics rather than pediatricians’ offices.

2. Hypertension

Retail clinics provide patients with an accessible opportunity to keep track of their high blood pressure, which is anothercommonly recognizedCVD risk factor.

“Nurse practitioners and physician assistants in retail clinics play a vital role in evaluating, treating, and monitoring patients with hypertension,” Kristen Marjama, DNP, FNP-BC, manager of clinic education and development for Walmart Care Clinic,previously explained. “The convenience of the retail clinic enhances the ability of the patient to stop in for a 1-month blood pressure check or come back for their 6-month refill. Not to mention that the pharmacy is just a few steps away.”

As hypertension can often go unnoticed by patients, Dr. Marjama encouraged clinicians to check their patients’ blood pressure during each visit.

“Many patients with uncontrolled hypertension are walking around without any signs or symptoms,” Dr. Marjama said. “The patient who is at risk or undiagnosed does not typically walk in [to a retail clinic] to be seen for his or her blood pressure, [so] it’s a best practice to obtain blood pressure on all patients with any chief complaint.”

Clinicians should also educate patients with hypertension about the associated risks, and provide them with strategies to better control their blood pressure, Dr. Marjama said.

3. Allergies

Many children experience allergic diseases such as asthma, hay fever, and eczema, and these conditions could be putting them at risk for developing CVD in their youth.

Specially, a recent study published in theJournal of Allergy & Clinical Immunologyfound that allergic diseases nearly doubled a child’s likelihood of developing high blood pressure and cholesterol, increasing the child’s risk for CVD.

“Clinicians should recognize that allergic disease can have harmful effects on other aspects of children’s health,” the study’s lead author, Jonathan Silverberg, MD,previously toldContemporary Clinic. “It is important to recognize these harmful effects in order to prevent them or treat them early.”

Dr. Silverberg recommended that retail clinicians encourage parents to have their allergy-affected children frequently screened for high blood pressure and cholesterol. Additionally, clinicians should advise parents to help their children maintain a well-balanced diet and a less sedentary lifestyle, as well as educate them on the importance of preventative medication therapy.

“Parents may be reluctant to have their children use different medications for allergic disease out of concern for side effects,” Dr. Silverberg said. “It is important for parents to understand that if the allergic diseases is left unchecked, it may contribute to cardiovascular and other health risks later in life.”

4. Depression

Treating depression, which is also a known CVD risk factor, can ultimately have a positive effect on a patient’s heart health.

A new study conducted by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City analyzed data on 7550 patients, all of whom had completed at least 2 questionnaires where they reported any history of depression or cardiovascular events.

The research team found that 6% of patients who were depressed throughout the study and 6.4% of those who developed depression during the study reported a major cardiovascular event. Comparatively, only 4.6% and 4.8% of patients who were previously depressed and never depressed, respectively, had experienced a major cardiovascular complication.

The study authors noted that treating depression can provide affected patients with a short-term reduction of CVD risk, but they added that further studies are needed to establish best practices for managing the mood disorder.

“With the help of past research, we know depression affects long-term cardiovascular risks, but knowing that alleviating the symptoms of depression reduces a person's risk of heart disease in the short term, too, can help care providers and patients commit more fully to treating the symptoms of depression,” said study author Heidi May, PhD, in a press release. “The key conclusion of our study is: if depression isn't treated, the risk of cardiovascular complications increases significantly.”

The study’s findings were presented at the 2016 American College of Cardiology Scientific Sessions.