Cardiovascular disease (CVD), the leading cause of morbidity and mortality worldwide, is a complex multifactorial disease which is influenced by environmental and genetic factors. There is substantial evidence on the relationship between diet and CVD risk. An understanding of how genetic variation interacts with the diet to influence CVD risk is a rapidly evolving area of research. Since diet is the mainstay of risk factor modification, it is important to consider potential genetic influences on CVD risk. Nutrigenomics is the study of the interaction between diet and an individual's genetic makeup. Single nucleotide polymorphisms are the key factors in human genetic variation and provide a molecular basis for phenotypic differences between individuals. Whole genome and candidate gene association studies are two main approaches used in cardiovascular genetics to identify disease-causing genes. Recent nutrigenomics studies show the influence of genotype on the responsiveness to dietary factors or nutrients that may reduce CVD risk. Nutrigenomics research is expected to provide the scientific evidence for genotype-based personalized nutrition to promote health and prevent chronic disease, including CVD. It is imperative that healthcare providers, including cardiovascular nurses, are trained in genetics to foster delivery of competent genetic- and genomic-focused care and to facilitate incorporation of this new knowledge into current clinical practice, education, and research.

Atherosclerosis is an inflammatory disease that can be assessed by circulating biomarkers. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an enzyme produced in atherosclerotic plaque and is bound to low density lipoprotein and high-density lipoprotein cholesterol. It has a role in the pathogenesis of atherosclerosis by promoting vascular inflammation. It is emerging as a vascular-specific marker and predictor of risk for cardiovascular disease (CVD) events. Increasing evidence from many prospective epidemiologic studies have shown that elevated levels of Lp-PLA(2) are associated with future CVD events. Measurement of Lp-PLA(2) in individuals may provide clinically relevant information about their future risk of CVD events. Pharmacologic therapies and/or risk factor modification could be initiated after identification of individuals at risk for CVD. This review provides an overview of the pathophysiology, epidemiologic evidence, and clinical utility of Lp-PLA(2).

Heart failure is an increasingly common condition in the United States and is associated with high mortality and burden to health care. It is a chronic condition that is characterized by progressive left ventricular enlargement. While medical therapy can slow the progression of left ventricular remodeling, surgical approaches to treatment have been developed to improve the survival and quality of life of heart failure patients. This article reviews the surgical procedures for left ventricular dysfunction and focuses on cardiac support devices as a new therapy for heart failure patients. The nursing care of patients with cardiac support devices will be presented and a case study will highlight practical points to help guide patient care.

Patient education post-coronary artery bypass graft (CABG) surgery is an essential component of nursing care aimed at assisting patients in caring for themselves at home, following discharge from hospital. While there has been a recent interest in conducting meta-analysis and systematic reviews on the effectiveness of patient education during the preoperative period, no review was found on the topic of postoperative CABG patient education. This systematic review addressed the clinically-relevant questions: what approach, mode, and dose is most effective in producing changes in CABG patient education? Studies were included in the systematic review if they met the following selection criteria: (1) the sample represented adult (> or =18 years) patients who underwent CABG surgery; (2) the educational intervention involved the provision of self-care information following surgery but before discharge from hospital; (3) the outcome assessed related to self-care behavior; and (4) the study report was published in English between 1986 and 2008. A descriptive synthesis was used to code and extract data on publication information, study design, sample size, and quality of study, as well as postoperative CABG teaching, self-care behavior performance, and demographic characteristics of the patients who participated in the studies. A quantitative synthesis consisted of a statistical approach, which was used to calculate the magnitude of the treatment effects on self-care behavior. Results indicated larger effect sizes for CABG patient education in which the content was individualized, and given in a combination of media on an individual basis, and in more than one session.

(1) To assess the efficacy of a 20 minute massage therapy session on pain, anxiety, and tension in patients before an invasive cardiovascular procedure. (2) To assess overall patient satisfaction with the massage therapy. (3) To evaluate the feasibility of integrating massage therapy into preprocedural practices. Experimental pretest-posttest design using random assignment. Medical cardiology progressive care units at a Midwestern Academic Medical Center. Patients (N=130) undergoing invasive cardiovascular procedures. The intervention group received 20 minutes of hands on massage at least 30 minutes before an invasive cardiovascular procedure. Control group patients received standard preprocedural care. Visual analogue scales were used to collect verbal numeric responses measuring pain, anxiety, and tension pre- and postprocedure. The differences between pre- and postprocedure scores were compared between the massage and standard therapy groups using the Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores were identified along with an increase in satisfaction for patients who received a 20-minute massage before procedure compared with those receiving standard care. This pilot study showed that massage can be incorporated into medical cardiovascular units' preprocedural practice and adds validity to prior massage studies.

The purpose of this study is to compare differences in patient preferences for visitors during hospitalization for a cardiovascular event specifically comparing cardiac intensive care unit (CICU) patients to those on cardiac step down units (SDU). A convenience sample 63 subjects from the CICU, mean age of 61.2 +/- 14.4 years, 21 males and 41 females, were compared with 61 subjects, mean age of 67.9 +/- 14.4 years, 15 females and 46 males, on the "Patient's Perception of Visits in the Hospital" questionnaire. The CICU patient perceived higher value for visiting specifically because visitors assisted with interpretation of information (P<.02), were calming (P<.05), providing information about them to staff (P<.01), helped with care (P<.000), and reinforced treatments (P<.004). There were no differences in total stressor score between CICU and SDU patients, though the CICU patient worried more about their visitors traveling (P<.025). The SDU patient perceived that visitors were disruptive to rest (P<.001) and that visitors intensified their pain (P<.008). The majority of patients preferred unlimited visiting hours, with 3 visitors at a time, and some limits on children. Text data identified unlimited visiting for close family members, the benefit of support from visitors, and the stress of lengthy visits. These data provide voice to cardiovascular patient's perception of visitors.

Patients with heart failure (HF) face significant challenges in maintaining quality of life (QOL), particularly for sexual intimacy. Although recommended for all cardiac patients, it has been suggested that few HF patients receive sexual counseling. This study explored sexual counseling needs, sexual concerns, and sexual activity using a descriptive survey with HF patients (n = 45), recruited from a HF clinic or cardiology office. Most (77%) had not discussed sexual concerns with a health care professional (HCP). Sexual concerns that were rated as occurring 'occasionally/frequently' included partner overprotectiveness (63%), partner fear of sex (36%), lack of sexual interest (42%), erectile problems (74%), orgasmic difficulties (51%). Frequency of sexual intercourse before HF to present was striking, with 53% reporting no sexual activity in the last 2 months compared with 11% before diagnosis of HF. HCPs must provide sexual counseling to HF patients and partners to enhance QOL and to assist in any adaptations to sexual activity.

Advances in treatment have prolonged life in heart failure (HF) patients, leading to increased attention to quality of life (QOL) and psychological functioning. It is not clear if ethnic differences exist in factors associated with psychological well-being. We examined psychosocial factors associated with depression and anxiety in 97 HF patients. Medical records were reviewed and patients (M age 53, 50% African American) completed surveys examining social support, coping, spirituality, and QOL for their association with depression and anxiety. Multiple regressions suggested that psychosocial factors were associated with psychological health. Patients with lower social support, lower meaning/peace and more negative coping reported greater depression; positive coping, and lower meaning/peace were associated with higher anxiety. Ethnicity stratified models suggested that spiritual well-being was associated with depression only among African Americans and QOL partially mediated this relationship. Findings suggest the importance of considering the unique psychosocial needs of diverse populations to appropriately target clinical interventions.

Healthcare providers should be concerned with improving the quality of life (QOL) of patients with heart failure (HF) because disease-specific QOL is linked to disease progression. The present study investigated the significance of elevated b-type natriuretic peptide (BNP), NYHA classification and depression to HF-related QOL to develop better management strategies. Outpatient subjects with left ventricular systolic dysfunction (n=108; mean age=64.9+/-12) completed the self-administered Minnesota Living with Heart Failure questionnaire and the Center for Epidemiologic Studies Depression Scale. Functional status was measured using the New York Heart Association Classification (NYHA) and BNP concentrations were measured in plasma samples. Multiregression analysis determined that plasma BNP levels did not contribute significantly to the total QOL score while depression (r=0.63, t ratio=7.43, P<.0001) and NHYA class (r=0.47, t ratio=3.31, P<.001) were significant contributors. NYHA III subjects exhibited worse depression scores (II 15+/-7 and III: 22+/-10, P<.001) and elevated plasma BNP (II: 2.0+/-0.5 and III: 2.4+/-0.6, P<.001). Low-cost psychological assessments are recommended to evaluate depression and suggest that those HF patients with NYHA III be closely monitored for depression and reduced QOL.

The serious detrimental effects of smoking after heart transplantation (HTX) are well established, but data that demonstrate the effects on female HTX recipients are scarce. The purpose of this study was to describe tobacco use, exposure to second hand smoke (ESHS), and health perceptions of female HTX recipients and examine relationships between these variables of interest and demographic and clinical characteristics of women following HTX. Seventy-two women (mean age, 54.3+/-12.7 years; mean time since transplant, 5.5+/-4.5 years) were enrolled from a single HTX center. Demographic and clinical data, tobacco use, ESHS, and health perceptions were obtained through self-report and chart reviews. Tobacco use was verified by measurement of urine cotinine levels. Twenty-four women were nonsmokers before and after HTX. Eighteen (37.5%) of the 48 women who were former smokers before HTX had returned to tobacco abuse. Only 4 of the 18 accurately reported their smoking behaviors. Forty percent of nonsmokers reported ESHS. Tobacco use and ESHS were highest among African American women. Forty percent of the sample perceived their health status as fair-poor; the remaining 60% reported good-excellent health. In a multivariate analysis, current tobacco use (odds ratio [OR], 5.20; confidence interval [CI], 3.83-9.13) and ESHS (OR, 1.82; CI, 1.17-2.82) were independent predictors of lower health perceptions. Although a majority of the female recipients who used tobacco ceased smoking before HTX, a substantial proportion demonstrated recurrent tobacco use after HTX. Our findings suggest the need for aggressive screening and risk factor interventions to promote smoking cessation before and after HTX in this unique population of female HTX recipients.