Liver disease is now the fifth leading cause of death in the UK but the good news is that liver disease is largely preventable and there is much we can do in primary care to educate people about the risks. This article explains the importance of identifying those patients who are at risk of liver disease, implementing risk reduction strategies, ensuring an accurate diagnosis is made and optimising ongoing management, including self-care strategies.
Dealing with the complexity of lipid metabolism, its outcomes and modification can easily seem overwhelming for primary healthcare professionals. This article aims to help you understand the fundamentals using a back-to-basics approach designed to enhance your practical management of the most important risk factor for the development of atherosclerotic cardiovascular disease. The focus will be on the cholesterol-carrying lipoproteins LDL and HDL but we will also review important issues concerning the use of the total cholesterol to HDL ratio, the significance of triglycerides and the perennial question: 'to fast or not to fast?'
Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of mortality in the UK. In addition to the effect on quality of life, CHD imposes a huge annual burden with costs on healthcare relating to CHD estimated to be over £3.3 billion a year in the UK.1 Coupled with the obesity epidemic, costing the NHS an estimated £4.2 billion per year,2 this creates a huge burden upon healthcare resources. This article was sponsored by an educational grant from Alpro soya UK; however, the views expressed are the author's own.
This second article focuses on safe and effective prescribing of medications which will reduce risk of further cardiovascular events. This series provides a 'hands on' practical guide to conducting medication reviews of long-term cardiovascular conditions. In this issue, we look at how to ensure post-myocardial infarction patients are taking the right medications at the right doses to ensure they get maximum benefit.
As the use of insulin therapy becomes more common in the ever-growing population of people with diabetes, practice nurses need to be aware of the range of insulins now available and how they work as they take on more responsibility for the management of these patients. In this article, we look at the production and role of insulin in the body and how type 1 and type 2 diabetes affects this. Moving on to newer insulins, we review how longer-acting insulins are used to mimic the characteristics of natural background insulin, the role of shorteracting insulins available for mealtime bolus doses, and the use of insulin mixtures in practice.
Glycaemic index (GI) is a hot topic, often misunderstood by healthcare professionals and patients. This article fills the gaps by explaining the low-GI diet in detail, describing the benefits and barriers to using GI in practice, the benefits in patients with diabetes and the controversy that surrounds it. The aim is to help primary care professionals to make informed decisions on when and how to use GI in helping patients with diabetes to plan their diet.
If physical activity could be taken as a tablet, the dramatic benefits it achieves in reducing cardiovascular disease and diabetes as well as many other conditions mean all of us would be on it. But many people currently miss out because it takes more effort to increase physical activity than popping open a tablet bottle. This article sets out the evidence for physical inactivity as a major cardiovascular risk factor and how to put the evidence into practice and get patients moving.
Putting Prevention First, the national strategy for cardiovascular risk assessment for people aged 40 to 74 years, remains high on the healthcare agenda regardless of NHS changes. The "Cog Man" on the cover of the guidance and leaflets distributed to practices and pharmacies highlights the close links between the heart, brain, kidneys and diabetes and underlines the comprehensive nature of vascular risk assessment. In this article, we look at how to carry out an annual review in high-risk people with a cardiovascular risk score of 20% or higher but who do not have high blood pressure, diabetes, chronic kidney disease or atrial fibrillation.