Cholesterol and coronary heart disease: screening and treatment.

The prevention of coronary heart disease would represent a major saving to the NHS. Systematic review of evidence relating to screening for CHD and its prevention suggests that blood cholesterol measurement on its own is a poor predictor of risk. The evidence suggests that lifestyle changes and drug treatments other than cholesterol-lowering drugs are the most cost-effective approach to prevention. Nurses should ensure that all risk factors are assessed and a range of preventive measures considered in situations where CHD is a potential risk.

Compression therapy for venous ulcers: a systematic review.

This article summarises the findings of a systematic review carried out by the NHS Centre for Reviews and Dissemination and the Center for Evidence-Based Nursing. Based on a rigorous analysis and synthesis of available research, the review concludes that training in the assessment of leg ulcers and the correct application of compression therapy appears to be more important than the particular products used. Recommendations for audit are also reported.

The management of stable angina.

Symptoms of chronic stable angina are easily identifiable and indicate that a patient is at increased risk of heart attack and death. In patients with less severe angina, medical treatments are as effective as more invasive treatments and produce better survival rates. There is little evidence that the main types of medical treatment differ in effectiveness. For patients at higher risk, invasive revascularisation procedures--coronary artery bypass grafting (CABG) and angioplasty--are more appropriate. CABG is slightly more effective than angioplasty. A high proportion of patients receiving angioplasty require re-treatment. The risk of recurrence and coronary events is reduced if patients who receive invasive procedures also have long-term low dose aspirin and cholesterol-lowering therapy. There is no clear evidence that intracoronary stents are more cost-effective than standard angioplasty. There is a need for evidence-based guidance to help determine referral thresholds for further investigation, and revascularisation procedures. There is evidence of inequality of access to testing and treatment, by gender, ethnic group and social class. Access should be monitored in order to promote equity.

Mental health promotion in high-risk groups.

This article summarises a systematic review of the literature on promoting mental health in high-risk groups. The review suggests that there are a variety of effective interventions for preventing mental health problems in high-risk groups. This has implications for the scope of practice of nurses and others working in a range of services, including midwifery, health visiting, school health, mental health, terminal care, district nursing and primary health care.