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Abnormal lipids, sometimes referred to as diabetes dyslipidemia, is a common condition in patients with diabetes. With the increasing number of patients with abnormal lipids, especially those with type 2 diabetes, health care practitioners, including nurses, have to properly manage patients with diabetes as well as abnormal lipids. This article examines the pathophysiology of abnormal lipids, the management of abnormal lipids, and the lipid goals for patients with diabetes. Lastly, this article discusses pharmacologic and nonpharmacologic therapies and the role of primary care providers and nurses in the management of abnormal lipids.

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AIMS: Specialized nurses estimated the HeartScore in an urban Greek population by recognizing cardiovascular disease (CVD) risk factors in the setting of the Onassis Cardiovascular Prevention Program (OCPP). They also provided nursing consultation and assessed the clinical and biochemical characteristics of the studied population. METHODS AND RESULTS: Individuals were recruited through TV announcements and via the website of the Onassis Cardiac Surgery Centre. All participants visited the Onassis Cardiac Centre from 20 September to 30 October 2011. Overall, 2,145 individuals were included in the study. CVD risk was calculated by the HeartScore and serum total cholesterol was measured (mean: 193±43 mg/dl). Although 33% of the participants reported dyslipidaemia, only 17% were on hypolipidaemic treatment. Hypertension and dyslipidaemia frequency increased with age. CONCLUSION: In the present study, specialized nurses estimated the HeartScore in a Greek urban population. The majority of the studied population was undiagnosed and untreated. These results highlight the necessity for both primary and secondary prevention programs that can be carried out by specialized nurses. Such programs may improve the diagnosis and treatment of CVD risk factors; early initiation and optimization of therapy as well as management of drug intolerance (e.g. statins) can contribute to CVD risk reduction.

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BACKGROUND: Changes in federal health policy are providing more access to medical care for persons with chronic disease. Providing quality care may require a team approach, which the American College of Physicians calls the "medical home." One new model may involve nurse-managed protocols. PURPOSE: To determine whether nurse-managed protocols are effective for outpatient management of adults with diabetes, hypertension, and hyperlipidemia. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and CINAHL from January 1980 through January 2014. STUDY SELECTION: Two reviewers used eligibility criteria to assess all titles, abstracts, and full texts and resolved disagreements by discussion or by consulting a third reviewer. DATA EXTRACTION: One reviewer did data abstractions and quality assessments, which were confirmed by a second reviewer. DATA SYNTHESIS: From 2954 studies, 18 were included. All studies used a registered nurse or equivalent who titrated medications by following a protocol. In a meta-analysis, hemoglobin A1c level decreased by 0.4% (95% CI, 0.1% to 0.7%) (n = 8); systolic and diastolic blood pressure decreased by 3.68 mm Hg (CI, 1.05 to 6.31 mm Hg) and 1.56 mm Hg (CI, 0.36 to 2.76 mm Hg), respectively (n = 12); total cholesterol level decreased by 0.24 mmol/L (9.37 mg/dL) (CI, 0.54-mmol/L decrease to 0.05-mmol/L increase [20.77-mg/dL decrease to 2.02-mg/dL increase]) (n = 9); and low-density-lipoprotein cholesterol level decreased by 0.31 mmol/L (12.07 mg/dL) (CI, 0.73-mmol/L decrease to 0.11-mmol/L increase [28.27-mg/dL decrease to 4.13-mg/dL increase]) (n = 6). LIMITATION: Studies had limited descriptions of the interventions and protocols used. CONCLUSION: A team approach that uses nurse-managed protocols may have positive effects on the outpatient management of adults with chronic conditions, such as diabetes, hypertension, and hyperlipidemia. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

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: The ACC/AHA 2013 cholesterol treatment guidelines focus on lowering the risk of heart disease and stroke and not on targeted treatment goals in adult patients. This article offers a synopsis of the new guidelines and how to apply them in clinical practice.

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Low levels of statin adherence may compromise treatment outcomes. The aim of this study was to investigate whether nurse-led cardiovascular risk-factor counseling could improve statin adherence and lipid levels without increasing patients' anxiety. Patients with indications for statin therapy for primary or secondary prevention of cardiovascular disease were randomly assigned to receive routine care or extended care (EC) at baseline and at months 3, 9, and 18. Patients in the EC group received a personalized risk-factor passport, showing modifiable and unmodifiable individual risk factors and a graphical presentation of their calculated absolute 10-year cardiovascular disease risk as well as the target risk that could be reached if all modifiable risk factors were optimally treated. Lipid levels were assessed at each visit. Carotid intima-media thickness was measured at baseline and at month 18. Adherence, anxiety, quality of life, symptoms, and smoking status were assessed using a self-administered questionnaire at each visit. A total of 201 patients were included in the study. Statin adherence was significantly higher (p <0.01) and anxiety was significantly lower (p <0.01) in the EC group than in the routine care group. Low-density lipoprotein cholesterol was statistically significantly lower in the EC group than in the routine group (2.66 vs 3.00 mmol/L, respectively, p = 0.024) in primary prevention patients only. Intima-media thickness improved significantly from baseline (p <0.01) in all patients, irrespective of group assignment. In conclusion, cardiovascular risk-factor counseling resulted in improved lipid profiles in primary prevention patients and higher levels of adherence to statins and lower levels of anxiety in all patients.

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The National Health and Nutrition Examination Survey (1999-2000 and 2001-2002) was utilized to examine and compare low-density lipoprotein levels in Mexican Americans with diabetes.

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Nurse-led assessment/management of risk factors is effective in many chronic medical conditions. We aimed to evaluate whether this finding was true for patients with intermittent claudication and to analyze its impact on patient-reported quality of life and predicted mortality due to coronary heart disease. We prospectively studied a series of 78 patients (51 men; median age, 65 years [IQR: 56-74 years]), diagnosed with intermittent claudication and referred to a nurse-led risk assessment/management clinic (NLC) from a consultant-led vascular surgical clinic. The NLC used clinical care pathways to manage antiplatelet medication, smoking cessation, hyperlipidemia, hypertension, and diabetes and to provide exercise advice. All patients were reassessed at a 3 months. Medication compliance, smoking status, fasting lipid profiles, blood pressure, and HbA1c were recorded. Disease-specific quality of life was assessed using King's College VascuQoL and predicted cardiac morbidity and mortality were calculated using the PROCAM and Framingham risk scores. We found that NLC enrollment produced an antiplatelet and a statin compliance of 100%, a smoking cessation rate of 17% (9 patients) and significant improvements in total cholesterol (median, 5.2-4.5 mmol/l), LDL (median, 3.1-2.5 mmol/l) and triglyceride (median, 1.7-1.4 mmol/l) levels. Significant disease-specific quality of life improvements and significant reduction in both the PROCAM (14% to 10%) and Framingham (14% to 11%) coronary risk scores were observed. Providing care at NLCs for claudicants is effective in assessing and managing risk factors, improves disease-specific quality of life and reduces predicted morbidity and mortality due to coronary heart disease.

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PURPOSE: This study was to monitor the effects of forming desirable eating and exercise habits and change the blood lipid levels by developing and applying E-Mail educational programs for a hyperlipidemia health check-up. METHOD: The research design used a nonequivalent control group pre-post test. Ninety-nine subjects (Exp.=50, Cont.=49) were selected randomly and the male subjects agreed to a hyperlipidemia health check-up at a comprehensive medical screening center. This study verified validity and reliability through factor analysis on a life habit measurement tool. The data was analyzed with SPSS win 12.0 using an chi- square-test,t-test, ANOVA and ANCOVA. RESULT: Eatingand exercise habit scores of the experimental group which were educated through E-Mails changed considerably more than that of the control group which was not educated. Total-cholesterol and LDL-cholesterol in the experimental group was considerably lower than that in the control group, but HDL-cholesterol increased considerably. Triglycerides, however, didn't show change. CONCLUSION: An E-Mail educational program may be applied as a hyperlipidemia health check-up nursing intervention strategy.

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PURPOSE: This study was to monitor the effects of forming desirable eating and exercise habits and change the blood lipid levels by developing and applying E-Mail educational programs for a hyperlipidemia health check-up. METHOD: The research design used a nonequivalent control group pre-post test. Ninety-nine subjects (Exp.=50, Cont.=49) were selected randomly and the male subjects agreed to a hyperlipidemia health check-up at a comprehensive medical screening center. This study verified validity and reliability through factor analysis on a life habit measurement tool. The data was analyzed with SPSS win 12.0 using an chi-square-test,t-test, ANOVA and ANCOVA. RESULT: Eatingand exercise habit scores of the experimental group which were educated through E-Mails changed considerably more than that of the control group which was not educated. Total-cholesterol and LDLcholesterol in the experimental group was considerably lower than that in the control group, but HDL-cholesterol increased considerably. Triglycerides, however, didn't show change. CONCLUSION: An E-Mail educational program may be applied as a hyperlipidemia health check-up nursing intervention strategy.

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By 2030, it is predicted that type 2 diabetes will affect 4.4% of the world's population, an estimated 366 million individuals. Diabetic dyslipidemia is a modifiable risk factor for cardiovascular disease, which is a major cause of premature mortality in type 2 diabetes. The management of diabetic dyslipidemia requires a multidisciplinary approach and the role of the nurse within the healthcare team is pivotal. Their broad remit positions nurses not only at the forefront of care, where they are well placed to recognize the clinical signs of the condition, but also as patient advisor, counselor, educator, monitor and motivator during the continuum of care. Poor concordance is a common problem for patients receiving multiple medications. Educating the patient about the importance of lifestyle change, and ensuring that lifestyle and pharmacological interventions are sustained are important components of effective care. Choosing therapies that enable patients to reach their treatment goals with a simple dosage regimen may also help to maximize patient concordance. Nurses must remain up to date with treatment options and management guidelines in order that they can communicate relevant information to patients, empowering them to make informed decisions about their health. Specific, measurable, achievable, relevant and time-specific (SMART) goals should be set for each patient. This form of individualized care, in which the patient becomes fully engaged with their treatment plan and personal goals appear attainable, may help to reduce the projected burden of type 2 diabetes and its complications on healthcare services in the future.

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Dyslipidemia, especially elevated low-density lipoprotein cholesterol (LDL-C), increases the risk of coronary heart disease and subsequent morbidity or mortality. For more than a decade, the National Cholesterol Education Program (NCEP) has endeavored to raise awareness of the dangers of dyslipidemia and to encourage the implementation of recommended treatment strategies. However, despite this initiative, previously published NCEP targets were not met. The recently released NCEP-Adult Treatment Panel III guidelines recommend more aggressive LDL-C reduction, elevation of categorical low high-density lipoprotein binding protein, and increased monitoring of moderate triglyceride elevations. Although the 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) are the most powerful medications available to reduce LDL-C, studies have shown that more than half of patients treated with these drugs do not achieve therapeutic targets and the resultant decrease in coronary heart disease events. There are a number of possible reasons for this, including potency of the statins and a lack of compliance on the part of patients and providers. Another concern with the available statins is the issue of drug-drug interactions. Some of these concerns may be addressed by newer agents in this drug class that are in development. They appear to have the potential to induce even greater reductions in LDL-C and to positively affect other lipoproteins. They also have the potential for less risk of drug-drug interactions. Nurse practitioners can play a pivotal role in improving the management of dyslipidemia by ensuring the proper implementation of current guidelines, helping patients adhere to treatment protocols, and remaining abreast of developments that may pave the way toward even more effective intervention in the future.

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Coronary heart disease (CHD) is the major cause of death worldwide (Murray and Lopez, 1997) and confers a significant socio-economic burden on all populations. The careful identification and optimal treatment of all individuals at risk of CHD is necessary for significant reductions in morbidity and mortality to be realized. This strategy demands an integrated approach by healthcare teams, with nurses playing a significant role at all stages of patient care. Guidelines advocate lipid lowering as a central component of all treatment regimens. Identification by nurses of all individuals who would benefit from lifestyle and therapeutic interventions to normalize lipid profiles, as well as the recognition of the impact of increasing prevalances of diabetes and obesity on the risk of developing CHD, are clearly critical. Nurses also have an important role to play in the implementation of drug regiments and lifestyle changes, including appropriate ways to minimize the treatment gap and maximize patient concordance.

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OBJECTIVE: To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care. RESEARCH DESIGN AND METHODS: This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure(>or=140/80 mmHg), raised total cholesterol (>or=5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4-6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention. RESULTS: Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25-2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86-1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32-0.92], P = 0.02). CONCLUSIONS: This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

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Reduction of dietary fat intake and increased physical activity are first-line interventions for elevated total serum cholesterol (TC) and low-density lipoprotein (LDL) serum cholesterol, which are major and modifiable risk factors for coronary heart disease. This retrospective study reports on the effects of a nurse-managed behavioral intervention (NMBI) program on TC and LDL levels in hyperlipidemic patients. Survival analysis indicated that NMBI patients had a significantly higher probability of attaining normal TC and LDL levels than did patients who received only standard nursing care. Additional analysis showed that actual TC and LDL values declined significantly across the study period with marginally significant group by time interactions. These findings provide preliminary evidence of the effectiveness of the behavioral intervention program with hyperlipidemic patients.

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BACKGROUND: Firm evidence exists for reduction in mortality and morbidity by lipid-lowering therapy in patients with coronary artery disease (CAD), yet a significant proportion remain untreated. This prospective study determined the effectiveness of a planned strategy of management using a cardiac rehabilitation nurse in achieving (1) lower 6-month low-density lipoprotein (LDL) levels and (2) a higher proportion of patients on pharmacologic therapy. METHODS: A cardiac rehabilitation nurse arranged for the lipid profiles and initiated pharmacologic therapy as soon as possible after the diagnosis of CAD. In phase 1, this planned-strategy intervention group (n = 80) was compared with the usual-care control group (n = 189), where the management was left at the discretion of the attending cardiologist with the assignment to the 2 groups based on the weekly on-call rotations of the attending cardiologists in a nonrandomized manner. In phase 2 of the study all patients (n = 366) were enrolled in the planned strategy of management. RESULTS: There were no significant differences in the baseline lipid values between the control and intervention groups. The 6-month cholesterol and LDL values and the percentage of patients on lipid-lowering medications were significantly better in the intervention group (P =.01). In phase 2 the results obtained in the intervention group were duplicated in a much larger group of consecutive patients. The 6-month (millimoles per liter) results in the control, intervention, and phase 2 groups (respectively) were cholesterol 4.92 +/- 0.06, 4.60 +/- 0.07, 4.30 +/- 0.05; low-density lipoprotein 2.91 +/- 0.06, 2.68 +/- 0.07, 2.4 +/- 0.06; high-density lipoprotein 1.18 +/- 0.07, 1.12 +/- 0.09, 1.10 +/- 0.01; triglycerides 1.89 +/- 0.12, 1.78 +/- 0.09, 1.70 +/- 0.05; and on medications 49%, 83%, and 84%. CONCLUSION: A planned strategy of management with use of early pharmacologic therapy with a cardiac rehabilitation nurse assigned to obtain and follow lipid profiles and initiate therapy is more effective in controlling dyslipidemia than leaving the management to the cardiologist.

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