Page 65 - Encyclopedia of Nursing Research

32 n CARDIovASCULAR RISK FACToRS: CHoLESTERoL

in the clinical setting is lacking. More innova- Panel (ATP) issued the first guidelines for
tive, creative methods for dissemination of our identifying and managing hypercholester-
C knowledge of symptom occurrence and symp- olemia in adults. Since that time, results of
tom management must be explored. Evaluating numerous randomized controlled trials con-
feasibility and fidelity along with the effective- firmed that lowering LDL-C was important
ness of an intervention during a study will in the primary and secondary prevention
allow for a more successful transition to real of CHD. The most recent revision of these
life settings (Breitenstein et al., 2010). guidelines (Executive Summary of the Third
An ongoing effort to strengthen collabo- Report of the national Cholesterol Education
ration among staff nurses, advanced practice Program, 2002), referred to as ATP III, con-
nurses, and nurse researchers is a priority. tinues to focus on LDL-C as the primary tar-
Designing and maintaining joint research get of risk reduction therapy, considers other
relationships with other disciplines is essen- lipid and nonlipid risk factors, and empha-
tial to facilitate the development of scien- sizes therapeutic lifestyle change (TLC) and
tific credibility of nurse-initiated protocols pharmacological therapies for reducing indi-
and pediatric oncology nurse investigator vidual risk and the public health burden of
studies. CHD. With continued emphasis on identifica-
tion of individuals at risk and more attention
Marilyn Hockenberry to adherence-enhancing strategies, ATP III
Cheryl Rodgers incorporates numerous roles for nurses and
nursing across health care settings where lipid
abnormalities are diagnosed and treated.
ATP III continues to define hypercholes-
CardiovasCular risk terolemia as TC 240 mg/dl or greater (6.21
mmol/L) for individuals 20 years and older;
FaCtors: Cholesterol TC levels of 200 to 239 mg/dl are considered
borderline high, and less than 200 mg/dl is
considered desirable. LDL-C levels are cat-
Cardiovascular disease (CvD) is a major egorized as follows: very high (≥190 mg/
cause of disability and premature mortality dl), high (160–189 mg/dl), borderline high
in men and women in the United States, in (130–159 mg/dl), above optimal (100–129
the industrialized world, and in the major- mg/dl), and optimal (<100 mg/dl). Results of
ity of developing countries. Atherosclerotic- several clinical trials suggested that LDL-C
CvD processes begin early in life and are lowering beyond 100 mg/dl in secondary
influenced over time by the interaction of prevention (after an acute coronary event)
genetic and potentially modifiable envi- was associated with improved cardiovas-
ronmental factors including health-related cular outcomes, raised questions regard-
lifestyle behaviors. Hypercholesterolemia— ing the established cut points for LDL-C,
elevated serum total cholesterol (TC)—is and prompted a modification to the ATP III
recognized as an independent risk factor for treatment algorithm (Grundy et al., 2004).
coronary heart disease (CHD). Low-density Specifically, an LDL-C goal of less than
lipoprotein cholesterol (LDL-C), the major 70 mg/dl is now considered a therapeutic
atherogenic lipoprotein, typically constitutes option for patients at very high risk.
60% to 70% of serum TC and is the primary ATP III recommends a fasting lipopro-
target of cholesterol-lowering therapy. In tein profile (TC, LDL-C, high-density lipopro-
1988, on the basis of available epidemiologi- tein cholesterol, and triglyceride) should be
cal and clinical data, the national Cholesterol obtained once every 5 years in adults 20 years
Education Program (nCEP) Adult Treatment or older. A basic principle of prevention is