2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.

Many developments have occurred since the publication of the widely-used 2009 Canadian Cardiovascular Society (CCS) Dyslipidemia guidelines. Here, we present an updated version of the guidelines, incorporating new recommendations based on recent findings and harmonizing CCS guidelines with those from other Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used, per present standards of the CCS. The total cardiovascular disease Framingham Risk Score (FRS), modified for a family history of premature coronary disease, is recommended for risk assessment. Low-density lipoprotein cholesterol remains the primary target of therapy. However, non-high density lipoprotein cholesterol has been added to apolipoprotein B as an alternate target. There is an increased emphasis on treatment of higher risk patients, including those with chronic kidney disease and high risk hypertension. The primary panel has recommended a judicious use of secondary testing for subjects in whom the need for statin therapy is unclear. Expanded information on health behaviours is presented and is the backbone of risk reduction in all subjects. Finally, a systematic approach to statin intolerance is advocated to maximize appropriate use of lipid-lowering therapy. This document presents the recommendations and principal conclusions of this process. Along with associated Supplementary Material that can be accessed online, this document will be part of a program of knowledge translation. The goal is to increase the appropriate use of evidence-based cardiovascular disease event risk assessment in the management of dyslipidemia as a fundamental means of reducing global risk in the Canadian population.

Investing in heart-healthy children: a primary prevention innovation in Atlantic Canada.

Inactivity and unhealthy eating are precursors to the development of coronary artery disease. In Atlantic Canada, there is a widely recognized escalation of obesity and Type 2 diabetes in children. Our multidisciplinary group developed a three-year program targeting children in grades 4, 5 and 6 in an effort to alter this debilitating life course. This pilot program comprises education, physical activity, evaluation and research. Working in teams, students' physical activity levels and pedometer readings are tracked as they virtually walk across Canada. Monthly motivation assemblies and feature activities are integrated into the program. Evaluation of the education component is provided by pre- and post-tests. Evaluation of the physical activity component is composed of the activity logbooks. Parent and teacher surveys are administered once a year.

Pulmonary hypertension: a review for nurses.

Pulmonary hypertension (PH) is a progressive disease resulting from increased pulmonary vasoconstriction, vascular remodelling and thrombosis, leading to right heart failure. Symptoms at clinical presentation are often vague and difficult to differentiate from other diseases. A good history and identification of key physical findings will facilitate earlier diagnosis resulting in tailored treatment to alleviate symptoms and improve outcomes. This article will provide an overview of PH including pathophysiology, clinical presentation, diagnostic testing, and treatment modalities with a Canadian perspective. The main focus is directed towards the care of patients with pulmonary arterial hypertension (PAH). Implications for nursing will also be discussed, focusing on education and support of patients and families.

A commentary on access to cardiovascular services: nursing roles and initiatives.

The Canadian Council of Cardiovascular Nurses (CCCN) applauds the work done by the Canadian Cardiovascular Society in setting benchmarks for wait times. The Canadian Cardiovascular Society is to be commended for developing the benchmark documents, as well as for establishing strategies for systematic dissemination to increase awareness, advocacy and implementation of the benchmarks across Canada. Quality nursing care, as defined within the CCCN framework, includes working with health teams to ensure that patients have timely access to specialized personnel, tests and procedures as required to prevent disease, promote health, address acute and episodic interventions, and to provide rehabilitative and palliative services, depending on patient need. To extend the access to care discussion, the CCCN suggests that further engagement of all stakeholders, especially clients/patients, is needed to find solutions to wait times and define benchmarks. In addition, preventing heart disease and promoting 'health care' should be recognized and acted on as central to reducing wait times for cardiovascular care. Finally, access to cardiovascular services will be more efficient when the first point of care is broadened to include nurses and other health care professionals. Nurses occupy creative, cost-effective roles directly aimed at reducing wait times and improving care while patients wait. The expanded role of interprofessional education and health care teams, as well as the inclusion of patients and families in program improvement, are solutions that the CCCN suggests may contribute to improved access to cardiovascular care and a sustainable health care system in Canada.

A stochastic model of the distribution of unequal competitors between resource patches.

We present a stochastic model of individuals' movements between two patches of resources. The population is made up of two types of individual with differing competitive abilities, and two types of movements occur, with individuals moving either to increase their intake rate or at random. Several previous models have used simulations to evaluate the likely distribution of individuals. We instead derive equations for the equilibrium distribution of the population, which can be solved numerically. This avoids the need to choose an initial distribution for the population, and enables us to obtain the probability with which rare events occur. This may not be possible when simulations are used, since a rare event may not occur at all. We find that when random movements are rare, an increase in the rate of random movements out of a patch can increase the number of individuals on that patch. We consider an approximation to the model with rare random movements, which provides an explanation for this phenomenon.