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doi: 10.1097/JCN.0000000000000545
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Join Us in St Paul, Minnesota, for the 25th Annual Cardiovascular Nursing Symposium

Registration for the 2019 Annual Cardiovascular Nursing Symposium is now open! Join us at the InterContinental Saint Paul Riverfront in St Paul, Minnesota, on April 11 to 13, 2019, for the cardiovascular nursing meeting of the year.

Topics for this year's symposium include the following:

  • Exercise and Lifestyle Interventions:What's Their Role in CVD Prevention and Treatment?
  • Advancing Patient Centered Care Through Shared Decision Making
  • Lipid Management in 2019: Putting Evidence-Based Guidelines Into Practice
  • Women and CVD: Creating Awareness and Making Prevention a Priority
  • Cardio-oncology: Preventing and Treating Cardiovascular Complications Associated With Cancer Treatments
  • Cardiac Syncope: What Does This Mean for Return to Work and Sports?
  • Lower Extremity PAD: How to Help Your Patients Get Back on Their Feet
  • Regenerative Medicine, Stem Cells, and Heart Disease: Current Applications and Future Directions

In addition to the main arena presentations, participants can choose to attend two of the following concurrent sessions:

  • Cardiac Diagnostics: Using Data to Assess Risk, Diagnose, and Treat CVD (session 1)
  • E-Health Technology and Self Care: Improving CVD Outcomes for Those Living in Rural or Remote Areas (session 1)
  • Is It Cardiac or Pulmonary? Patient Assessment and Diagnostic Evaluation of Dyspnea (session 2)
  • Multi-Cultural Health and CVD: Risk Assessment and Management in Ethnic Populations (session 2)
  • Moderated Poster Session (sessions 1 and 2)

In addition to the general sessions, the fifth annual Pharmacology Preconference will be held in the morning of Thursday, April 11. Participants can earn continuing education credits while learning the latest in preventive cardiology and networking with colleagues in the field. Topics for the Pharmacology Preconference include the following:

  • Aspirin: The Magic Bullet for Prevention of CVD and Cancer?
  • Medications and Menopause: Implications for Healthy Hearts and Strong Bones
  • Asthma, COPD, and CVD: Why Is Everyone Short of Breath?

Registration is now open at pcna.net/symposium. Register before March 1, 2019, to receive standard booking price.

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The Role of Prevention for Reducing Cardiovascular Healthcare Costs

Healthcare costs related to cardiovascular disease (CVD) alone have a tremendous impact on the economy in the United States totaling more than 400 billion dollars; they are expected to rise to a staggering 1 trillion dollars by the year 2035.1 Currently, there is little evidence to support universal screening for CVD, similar to that for various types of cancer. However, as Shaw and colleagues1 recently reported from their analysis estimating 10-year CVD costs of the Multi-Ethnic Study of Atherosclerosis (MESA) study, improved detection and prevention of advanced subclinical CVD could significantly influence long-term health and reduce future healthcare costs.

The MESA study was a registry of more than 6000 healthy individuals.2 The socioeconomic features of the study participants included a diverse population with approximately 40% reporting a history of a risk factor diagnosis such as dyslipidemia or hypertension. In addition, there was a strong correlation between an individual's risk factors and comorbidities and an increase in CVD events.2 A key finding of the MESA study was that a person's socioeconomic status directly affected resource consumption and further increased costs related to CVD.

In the MESA study, participants were scored with a risk stratification instrument called the Framingham risk score, and a 10-year predicted risk was tallied.2 Data included cardiac risk factor history taking including family history of CVD and any history of tobacco use. The study participants were asked to report any personal diagnosis of diabetes, hyperlipidemia, and hypertension.2 Their lipids, glucose, and blood pressure were also measured. The study showed that overall healthcare costs increased not only as the individual's risk increased from low to high but also as age increased. In addition, healthcare costs' increase also correlated with higher coronary artery calcium scores.1 The cost of CVD medications exhibited the most substantial portion of the 10-year costs. Low-risk participants resulted in a total 10-year mean expense of approximately 8 million dollars, whereas the high-risk participants totaled approximately 74 million dollars in CVD healthcare costs.1

Prevention is the best weapon that healthcare providers can use to help reduce CVD healthcare costs through awareness and education.1 Finding ways to maintain a population that is at low risk for CVD for several years will benefit not only the individual but also public health as a whole. It will also drive down healthcare costs. Thus, investing in successful prevention programs should be a priority initiative of cardiovascular healthcare. Community programs that raise awareness of CVD, educate about CVD risk factors, and demonstrate how to make favorable lifestyle changes would reduce the need for costly medications and long-term clinical care.1 In addition, reaching vulnerable populations may require health policy initiation through local and state governments that focuses on improving health behaviors such as access to healthier food options, the importance of physical activity, and tobacco control.

Community programs play a pivotal role in improving the overall quality of life, prevention of disease, and improving health of its population. Therefore, if more programs were directed toward CVD prevention, it would substantially benefit the people in a given community.1 Some of the most common arenas to provide community outreach include schools, workplaces, healthcare facilities, and community activities. For example, employers providing a farmer's market at work offer employees access to fresh produce in a cost-effective manner that is also easily accessible. Nurses are vital stakeholders for providing awareness and education within clinical settings and communities for CVD prevention. We can influence change by educating people regarding the importance of lifestyle changes. Lifestyle modifications will empower the population, thus having an impact on reducing healthcare costs associated with CVD and improving overall public health.1 Nurses could collaborate with community leaders to raise awareness of the importance of prevention because leading risk factors (obesity, tobacco use, physical inactivity, high cholesterol, and high blood pressure) are those that are most effective in prevention, when modified. Prevention is the most critical tool we can use to fight CVD and alleviate the economic burden as a result.

1. Shaw LJ, Goyal A, Mehta C, et al. 10-Year resource utilization and costs for cardiovascular care. J Am Coll Cardiol, 2018;71(10):1078–1089.

2. Bild DE, Detrano R, Peterson DO, et al. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2005;111(10):1313–1320.

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Staying Fit During the Holidays: Plan to Keep Moving and Have Fun

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Figure

Are you looking for ways to keep fit during the holidays? Does your exercise routine seem to come to a halt when you are with family or friends and away from your usual routine during the holidays?

Several websites offer valuable tips to enhance your fitness while having a good time.1–4

For example, Alice Henneman, MS, a registered dietitian,2 makes suggestions from her experience and Cedric X. Bryant, PhD, FACSM, the chief science officer at the American Council on Exercise,1 provides ideas obtained by polling health professions. Word cloud graphics are effective illustrations of major trends or strategies in this case related to physical activity. This season, consider build, make, and take.1–4

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Build Activities Into Family Visits and Outings

One strategy is to find trails, tracks, and parks before you travel. Another one is to look for a holiday fun run or fitness event. Here are others:

  • Grab a buddy.
  • Search for holiday fitness music as a family.
  • With the family, chop down your own Christmas tree.
  • Build physical activity into holiday traditions.
  • Get family or friends to text you reminders and provide motivation.
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Make Time for Physical Activity

To avoid sitting for prolonged periods, try fitting physical activity wherever you can. Here are some tips:

  • Make time for a quick workout between holiday parties.
  • Make adjustments that will help you stay fit during the season.
  • Try exercising early before festivities begin.
  • Eat less and spend more time exercising than last Christmas.
  • Break physical activity up into small chunks of time.
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Take a Walk

Often, party goers and holiday shoppers can fit in walking. What do you think of these ideas?

  • Walk the mall before you shop the mall.
  • Take a walk after holiday meals.
  • Walk home from a party.
  • Walk the dog.

Happy Holidays!

  1. Bryant C. 8 secrets to staying fit during the holidays: health professionals reveal what works for them. US News and World Report. November 20, 2015. https://health.usnews.com/health-news/blogs/eat-run/2015/11/20/8-secrets-to-staying-fit-during-the-holidays
  2. Centers for Disease Control and Prevention. 5 Healthy Eating Tips for the Holidays. 2017. https://www.cdc.gov/features/diabetesmanagement/index.html
  3. Griffith S. 3 ways to make sure you exercise during the holidays. TIME Magazine. November 28, 2016. http://time.com/4583238/exercise-motivation-during-holidays
  4. University of Nebraska-Lincoln. 9 tips for staying active over the winter holidays. 2018. https://food.unl.edu/9-tips-staying-active-over-winter-holidays
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Can Eating Yogurt Reduce Cardiometabolic Risk?

Postprandial inflammation is associated with an increased risk for insulin resistance and atherosclerosis.1 In individuals who are obese, the intestinal function is compromised, leading to chronic inflammation and exposure to endotoxins, which are toxins present inside a bacterial cell that is released when the cell disintegrates. Bacterial endotoxins cross the intestinal barrier and cause systemic inflammation. Dairy proteins and calcium may lessen these negative effects, which include hyperlipidemia and hyperglycemia. They delay gastric emptying and decrease fat absorption.2 On the basis of this information, Ruison Pei, PhD, MS, from the University of Wisconsin-Madison hypothesized that eating yogurt before a meal would reduce these postprandial chronic inflammation biomarkers. This would then reduce risk for cardiometabolic disease in healthy premenopausal women. She and her colleagues further hypothesized that the positive effects of reducing inflammation and improving metabolism would be more profound in women who are obese than in normal-weight women, because of intestinal barrier dysfunction associated with obesity.3

Pei and her colleagues did 2 studies looking at the same group of women: 120 randomly assigned premenopausal women who ate 339 g of low-fat yogurt or 324 g of soy pudding for 9 weeks before a meal. Half of each group had body mass index levels considered healthy, and the other half had obese levels. In the first study, they found that the women who were obese and ate yogurt had less inflammatory biomarkers and less hyperglycemia than those who ate the pudding. The women without obesity who ate yogurt had less hypoglycemia than those eating the pudding.2 In the second study, they saw lower tumor necrosis factor levels and higher endotoxin antibodies in the women eating yogurt, regardless of their weight. The women who were obese and ate yogurt had 3% to 6% lower diastolic blood pressure.4

The conclusion reached is that eating 8 oz of low-fat yogurt before a meal can improve postmeal metabolism and therefore reduce the risk of cardiovascular and metabolic diseases. Brad Bolling, PhD, one of the investigators, said the goal of future research is to identify which compounds in yogurt produce the inflammation-lowering effects. He states: “Ultimately we would like to see these components optimized in foods, particularly for medical situations where it is important to inhibit inflammation through the diet. We think this is a promising approach.”3

  1. O'Keefe JH, Bell DSH. Postprandial hyperglycemia/hyperlipidemia (postprandial dysmetabolism) is a cardiovascular risk factor. Am J Cardiol. 2007;100:899–904.
  2. Pei R, Martin DA, DiMarco DM, Bolling BW. Evidence for the effects of yogurt on gut health and obesity. Crit Rev Food Sci Nutr. 2015;57(8):1569–1583.
  3. Pei R, DiMarco DM, Putt KK, et al. Premeal low-fat yogurt consumption reduces postprandial inflammation and markers of endotoxin exposure in healthy premenopausal women in a randomized controlled trial. J Nutr. 2018;148(6):910–916. https://doi.org/10.1093/jn/nxy046
  4. Pei R, DiMarco D, Putt K, et al. Low-fat yogurt consumption reduces biomarkers of chronic inflammation and inhibits markers of endotoxin exposure in healthy premenopausal women: a randomized controlled trial. Br J Nutr. 2017;118:1043–1051.
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The Importance of Atrial Fibrillation Burden

Atrial fibrillation (AF) is increasingly viewed as a public health problem because of its increased incidence, prevalence, and adverse impact on the growing aging population. Past studies of the burden of AF have focused on the presence or absence of AF, which is viewed as a binary approach. This has limited our understanding of the risks for AF and its actual impact on patient outcomes. Ideal approaches to defining burden would be enhanced by a comprehensive view of how the type (paroxysmal, persistent, or permanent), AF duration, and role of lifestyle and intensive risk factor modification influence AF burden. A recent scientific statement from the American Heart Association1 provides a more in-depth and comprehensive discussion on this topic.

The statement makes a case for defining AF burden as the duration of the longest AF episode or the number of AF episodes during a certain monitoring period and expressing that as a percentage.1 An excellent review of the literature and analysis of the most recent clinical trials of anticoagulation and antiplatelet agents, as well as an analysis of data from AF registries, led to the conclusion that patients with persistent AF are at the highest risk for stroke than those with paroxysmal AF. In addition to stroke risk, persistent AF was noted to be associated with lower cognitive function when compared with persons having no AF or paroxysmal AF. However, few data exist, and a greater study of this relationship is required for more definitive conclusions. On the other hand, AF has been associated with lower quality of life, yet few interventions have connected reduced AF burden with better quality of life. This could be related to the multiple ways of measuring quality of life and the confusion on measuring AF burden.

Important for preventive cardiovascular nurses is the section on risk factor management programs and AF burden. The review of studies suggests that a structured and comprehensive risk factor management program focused on the reduction of traditional atherosclerosis risk factors and emphasis on weight loss and maintenance of a health weight effectively reduces AF burden. Areas for further research on the effect of risk factor reduction and AF burden are necessary for exercise training, intensive blood pressure lowering, and stress reduction interventions.

As new monitoring technology and approaches evolve, the ability to detect AF episodes and, ultimately, burden will improve. Cardiovascular nurses have the opportunity to improve patient outcomes by reducing AF burden with their preventive clinical approaches and innovative future research.

1. Chen LY, Chung MK, Allen LA, et al; on behalf of the American Heart Association Councils on clinical Cardiology, Cardiovascular and Stroke Nursing, Quality of Care and Outcomes Research, and Stroke. Atrial fibrillation burden: moving beyond atrial fibrillation as a binary entity. Circulation. 2018;137:e623–e644.

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