The Role of Diet in the Prevention of Cardiovascular Disease - Term Paper Example

Assessment 2: Review protocol Student Name: Student ID: Review Topic: The role of diet in prevention of cardiovascular disease in people with high cholesterol Background: Cardiovascular diseases belong to the broad spectrum of non-communicable diseases that are responsible for the biggest proportion of deaths worldwide. Non-communicable diseases accounted for 36 million deaths, or 63% deaths globally in 2008. In addition, 48% of these deaths were due to cardiovascular diseases (48%) while cancer and chronic respiratory conditions accounted for 21% and 12% respectively. Hypercholesterolemia is responsible for 35% of all the cases of cardiovascular diseases recorded. Low density lipoproteins are known to accumulate in blood vessels thus occluding blood supply to distant organs and tissues (Delgado-Lista et al., 2012). In the America, 82,600,000 adults suffer from cardiovascular diseases and 2,200 deaths are recorded daily following these conditions (de Oliveira Otto et al., 2012). In Australia, approximately one third of the deaths recorded annually result from cardiovascular diseases (Magee et al., 2012). These deaths are preventable through the adoption of healthy lifestyles, and reduction in smoking as well as alcohol consumption (Mozaffarian et al., 2015). Intake of low fatty diets is also one aspect that should be explored as a potential way of mitigating cardiovascular conditions due to the close association. Over the decades, pharmacotherapy has constituted the mainstay intervention against cardiovascular diseases with the aim of controlling the cholesterol levels in blood. The use of drugs such as statins is well supported by several research studies that confirm their role in reducing the cholesterol levels. Consequently, a significant proportion of individuals suffering from cardiovascular diseases primarily rely on pharmacological interventions as the primary therapy for hypercholesterolemia (Baigent et al., 2010). On the other hand, pharmacological therapy has also been less efficacious in the prevention of cardiovascular diseases due to certain genetic predispositions that have caused resistance to the drugs. Cardiovascular diseases hardly cause instant death but rather the resultant illnesses and debilitation are progressive in nature. During the periods of illness, the individuals become less productive as they continue to drain the available resources away. Apparently, this exacerbates the poverty levels (Bloom et al., 2012). In addition, individuals suffering from these conditions eventually use medication over prolonged periods of time resulting into undesirable side effects that they are forced to bear (Pijlman et al., 2010). On the other hand, about 80% of cardiovascular diseases may be avoided through adoption of healthy diets free from high amounts of cholesterol, restriction of tobacco use, and regular physical activity (Astrup et al., 2011). Therefore, development and implementation of an integrated approach, which addresses the main risk factors is central in the fight against cardiovascular diseases. In addition to curbing premature morbidity and mortality associated with cardiovascular diseases, the integrated approach should also entail strategies that address these conditions at the primary, secondary as well as tertiary levels of disease prevention (Berry et al., 2012). The use of drugs is very convenient but not ultimately effective in preventing cardiovascular diseases and may not be reliable for all persons who have the highest risk of developing cardiovascular diseases. In fact, some individuals have proven resistance to the drugs hence not effective in the prevention of cardiovascular diseases. In addition, the side effects that result from over reliance on drugs are well known and documented hence the need to minimize their use. Similarly, other non-pharmacologic approaches remain very essential in the prevention of the incidence of cardiovascular diseases (Bibbins-Domingo et al., 2010). Dietary adjustments could therefore be very useful in managing the cholesterol levels and reducing the incidence of cardiovascular diseases subject to further investigations to assess the efficacy. Various studies have suggested the potential use of certain dietary approaches in the fight against the menace of cardiovascular diseases that cause preventable morbidity and mortality, however, it is not very clear how efficient the use of diet could be in the prevention of cardiovascular diseases (Chow et al., 2010). This review seeks to analyse the efficacy of dietary modifications in the prevention of cardiovascular diseases through the reduction of cholesterol levels. The following research question will be applied in the course of this review: What is the role of diet in the prevention of cardiovascular diseases amongst individuals with levels of cholesterol? The PIO framework was utilized in the process of developing the research question above by identifying the target population, the planned intervention as well as the expected outcomes (Baxter and Jack, 2008). Persons with high levels of cholesterol were chosen as the targeted population in this study review. In addition, the intervention to be undertaken comprised of making adjustments to the diets consumed by these individuals while aiming to realize a reduced incidence of cardiovascular diseases as a desired outcome (Lloyd-Jones et al., 2010). This is commonly referred to as the PIO framework which assists the researcher to ensure all the useful information is collected to inform the research question following its segmentation into three key portions (Bradshaw and Stratford, 2010). Moreover, the framework is useful in tweaking the research question to clearly identify the targeted population, the intervention as well as the possible outcomes of such interventions. In this way the framework ensures that the outcomes of a research study meet the validity criteria and remain free from all forms of bias (Bryman, 2015). The PIO framework helps to ensure that the issue under investigation is clarified and the research study is feasible to be undertaken with limited challenges. Similarly an inclusion and exclusion criteria is also useful in the determination of a study population by subjecting it to certain attributes set by the researcher (Burns, 2012). This assists the researcher in the identification of the study subjects that will provide the data required to adequately answer the research question. Upon review of several articles regarding the prevention of cardiovascular diseases, it is evident that there is need for further studies on dietary modifications and their efficacy in preventing the conditions (Maftei et al., 2014). The importance of this research question to nursing and midwifery practice cannot be underscored. In the first place, dietary modifications provide a safe and cost effective measure for mitigating cardiovascular diseases through the reduction of cholesterol levels (Creswell, 2013). Cardiovascular diseases cause preventable deaths and nurses are the frontline healthcare providers who enormously contribute to the health and wellbeing of patients. Consequently, there is need for more reliable evidence on the utilization of dietary modifications to reduce the incidence of cardiovascular diseases (Gill and Johnson, 2010). This will no doubt contribute to the improvement of the quality as well as the safety of the care provided by nurses through the introduction of scientifically proven approaches that mitigate blood cholesterol levels without harming the patients in the long run (LoBiondo-Wood and Haber, 2014). The reliance on diet as a primary strategy for controlling the blood cholesterol levels is also very compatible with all cohorts of individuals who have the highest risk of developing cardiovascular diseases (Shekelle et al., 1981, p. 69). Nurses encounter all groups of persons and the knowledge on dietary modifications as means of preventing cardiovascular diseases will no doubt expand the options they provide to their clients in need of safe methods of controlling blood cholesterol (Bibbins-Domingo et al., 2010, p. 596). Search strategy- Database Search String and Implementation The electronic databases EBSCOhost was utilized as an interface research database whereas an advanced search was conducted in the CINAHL database for purposes of this study (Burns and Grove, 2010, p.12). This provides the latest journals as well as other publications relevant for nursing and healthcare research. The databases also have adequate tools to facilitate the process of screening through and filtering several articles thus only retaining those relevant for answering the research question (Bauer, 2010, p. 229). The PIO frame coupled with abbreviations, truncation, and wildcards were utilized in conducting the searches. The PIO frame was useful in the determination of the key words that were used during the search. Limitation of the search was then realized using Boolean, truncation, wildcards, and abbreviations in accordance with the PIO strategy (Brown et al., 2009, p. 376). The Boolean operators were useful in the limitation of the search so that only relevant information was obtained with minimal results. Wildcards helped in the expansions of the search so that it included variant words. In addition, the use of abbreviations helped in the establishment of a close linkage between the articles most of which abbreviate medical conditions rather than providing the full description. Finally, the truncations were useful in retrieving articles with different forms of the search words which were astericized (LoBiondo-Wood and Haber, 2014, p.14). The key words for every aspect of the PIO frame were then separately entered in the search builders of the databases used in this review. The search was further filtered using specifications such as articles published during the last ten years in English language. Additional filters included specifying full text articles for clinical trials conducted within the specified timeframe (Ash and Miller, 2010, p. 235). An inclusion and exclusion criteria was also applied coupled with PIO frame in order to retrieve relevant articles for the study. The study population comprised of persons with hypercholesterolemia whereas the interventions entailed intake of low fat diets or diets devoid of saturated fatty acids, and the intended outcome was prevention of cardiovascular diseases (Bryman, 2015, p.16). In regards to population, individuals with normal blood cholesterol levels were excluded. In addition, other interventions such as pharmacotherapy or exercises were also excluded from this review. Finally, the review excluded other outcomes such as prevention of renal diseases and weight loss. The review only included journal articles published within the last ten years and excluded other publications such as reports, conference proceedings, etc. Keywords (truncation, abbreviations, wildcards) P I O High cholesterol Diet* Prevent* cardiovascular Cholesterol Food Prevent* coronary arter* disease Hyperlipidemia Nutrition Prevent heart disease* Hypercholesterolemia Fat free or free fat Minimi? Cardiovascular Low density lipoprotein Low fat Reduc* atherosclerosis High density lipoprotein Unsaturated diet Reduce* cardiovascular disease HDL and LDL Healthy diet Lower* CVD Search String: 1. High cholesterol 2. Cholesterol 3. Hyperlipidemia 4. Hypercholesterolemia 5. Low density lipoprotein 6. High density lipoprotein 7. HDL and LDL 8. Or\1-7 – this combined all population key words mentioned above 9. Diet* 10. Food 11. Nutrition 12. Fat free or free fat 13. Low fat 14. Unsaturated diet 15. Healthy diet 16. Or\9-15 – this combines all the intervention key words. 17. Prevent* cardiovascular 18. Prevent* coronary arter* disease 19. Prevent heart disease* 20. Minimi? Cardiovascular 21. Reduc* atherosclerosis 22. Reduce* cardiovascular disease 23. Lower* CVD 24. Or\ 17-23 – combines all outcomes key words 25. 8 AND 16 AND 24 – this combined all the key words in the PIO frame thus useful in distinguishing the specific articles discussing dietary interventions for a population of people with hypercholesterolemia, and a desired outcome of preventing cardiovascular diseases. 26. Limits the search in 24 to yield articles that have been published within English, clinical trial or randomised trial, current published within the last 10 years and full text articles. Results- The Peer Reviewed Articles The primary articles are shown below: Guasch-Ferré, M., Babio, N., Martínez-González, M.A., Corella, D., Ros, E., Martín-Peláez, S., Estruch, R., Arós, F., Gómez-Gracia, E., Fiol, M., others, 2015. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am. J. Clin. Nutr. 102, 1563–1573. Mozaffarian, D., Micha, R., Wallace, S., 2010. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 7, e1000252. Praagman, J., Beulens, J.W., Alssema, M., Zock, P.L., Wanders, A.J., Sluijs, I., van der Schouw, Y.T., 2016. The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition–Netherlands cohort. Am. J. Clin. Nutr. ajcn122671 Siri-Tarino, P.W., Sun, Q., Hu, F.B., Krauss, R.M., 2010. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509 Wang, Q., Afshin, A., Yakoob, M.Y., Singh, G.M., Rehm, C.D., Khatibzadeh, S., Micha, R., Shi, P., Mozaffarian, D., Ezzati, M., others, 2016. Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease. J. Am. Heart Assoc. 5, e002891. Table 1: Peer-reviewed Research Articles Article Reference (authors and publication date) Study Design (ie: ethnography, cohort, RCT phenomenology,) Population (how many participants, age, gender, disease, etc) Intervention OR Issue (what was being implemented or studied) Outcomes (what were the main findings of the study?) 1 Mozaffarian, D., Micha, R., Wallace, S., 2010. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 7, e1000252. This article was published in 2010 This was a randomized controlled trial The population included individuals with increased polyunsaturated fatty acids for a period of one year without any interventions The intervention was consumption of polyunsaturated fatty acids instead of saturated fatty acids The outcome was reduction of coronary heard diseases 2 Praagman, J., Beulens, J.W., Alssema, M., Zock, P.L., Wanders, A.J., Sluijs, I., van der Schouw, Y.T., 2016. The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition–Netherlands cohort. Am. J. Clin. Nutr. ajcn122671. The article was published on 2016 by the American Journal of Clinical Nutrition This was a cohort study The study population included 35,597 participants drawn from the European Prospective Investigation into Cancer as well as Nutrition-Netherlands cohort The intervention comprised of dietary intake of saturated fatty acids The outcome was prevention of ischemic heart disease 3 Guasch-Ferré, M., Babio, N., Martínez-González, M.A., Corella, D., Ros, E., Martín-Peláez, S., Estruch, R., Arós, F., Gómez-Gracia, E., Fiol, M., others, 2015. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am. J. Clin. Nutr. 102, 1563–1573. The study was published in 2015 in the American journal of clinical nutrition This was a cohort study The study population comprised of 7038 participants who had the higest risk of developing cardiovascular diseases The intervention entailed modification of dietary intake of fat The outcome was reducing the risk of cardiovascular disease 4 Siri-Tarino, P.W., Sun, Q., Hu, F.B., Krauss, R.M., 2010. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509 This was a randomized clinical trial The population comprised of individuals with high blood cholesterol levels The intervention included substituting saturate fats with polyunsaturated fats The outcome was reduction in the incidence of cardiovascular diseases 5 Wang, Q., Afshin, A., Yakoob, M.Y., Singh, G.M., Rehm, C.D., Khatibzadeh, S., Micha, R., Shi, P., Mozaffarian, D., Ezzati, M., others, 2016. Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease. J. Am. Heart Assoc. 5, e002891. The article was published in 2015 by the American Journal of heart Association The researchers quantified the burden of coronary heart diseases attributed to dietary fats based on country, gender and age. Similarly, the etiologic effects on associated mortality as well as the optimal intake of the fats were comparatively assessed based on age, gender, and country The population included all the cohorts in the general population The intervention included intake of saturated, polysaturated as well as trans fat The outcome was the proportionate global burden of coronary heart diseases Discussion The process of writing the research question has conferred several benefits to my nursing and midwifery practice that ultimately translates to safe and quality care to the consumers of nursing and midwifery services. In the first place, the process has broadened my knowledge on the process of research and enhanced my understanding of the various technicalities involved in the formulation of a competent research question that guides the research process (LoBiondo-Wood and Haber, 2014, p. 14). The process of writing a research question depends on an identified gap that requires further evidence through the research process. It requires the researcher to focus on a specific issue and formulate an appropriate question whose answer will inform the research problem (Burns and Grove, 2010, p.16). Today, nursing and midwifery have shifted to evidence-based practice and thus this process is very useful in ensuring that as a nurse, I have the technical skills that are useful in strengthening the current practice perspectives. The process entailed the identification of a specific theme that ensured that I focus on addressing a specific gap identified that is relevant to nursing practice (Brown et al., 2009, p. 375). In the process of writing the research question, I reviewed several journals and other published material thus was able to increase my knowledge on the research topic as well as the scientifically established approaches of addressing the research problem (Bryman, 2015, p. 16). In addition, the utilization of the PIO framework creates clarity on the components of a research question thus I was able to enhance my capacity in the formulation of relevant research questions that ensure the findings meet both the reliability as well as validity criteria (Bauer, 2010, p. 231). Moreover, accurately formulating a research question ensures the collection of relevant data that addresses specific gaps identified in nursing practice through the provision of new evidence that promotes the quality and safety of care provided to our clients (Brown et al., 2009, 379). The criteria for inclusion and exclusion of study participants specifies the relevant attributes that are useful in ensuring the intended data is collected to address the identified research problem. It helps to prevent the collection of huge volumes of data which may not be relevant to the researcher in regards to the subject of investigation. In the same breadth, I have improved my research skills on filtering the study population so that I only have the most suitable candidates for a particular study problem (Baxter and Jack, 2008, p.546). Using the various elements of the PIO framework and other limiters such as truncation, Boolean, wildcards as well as abbreviations has similarly enhanced my skills as a potential nurse researcher hence providing suitable ground for promoting evidence based practices through the research process on identified gaps in nursing practice (Bauer, 2010, p. 229). This has a positive bearing on nursing and midwifery practice by ensuring that the professionals are adequately equipped to address the challenges in nursing practice that hamper the delivery of quality and safe nursing care to clients. The process has also strengthened the capacity of the nursing and midwifery profession in addressing the relevant issues related to practice through the reliable utilization of scientifically proven methods that yield reliable evidence (Brown et al., 2009, p.376). I utilized the EBSCOhost and CINAHL databases in the search of relevant articles to support the research question. These databases provide up-to-date journals and other publications relevant for the nursing and midwifery research activities (LoBiondo-Wood and Haber, 2014, p. 15) Through the utilization of these databases, I was able to horn my skills and increase my understanding of the various approaches that help increase the reliability of a research study. I have learnt how to find relevant articles that support an investigation intended to inform nursing and midwifery practice through quality research activities (Bradshaw and Stratford, 2010, p. 14). The databases permit one to enter the various components of a research question independently and are capable of combining such entries to ensure relevant articles are retrieved in relation to the research topic (Bryman, 2015, p. 12). In addition, the database provides options for limiting the searches through the use of truncation, wildcards, abbreviations, and Boolean so that only relevant articles are retrieved for a particular research problem thus further reinforcing the reliability of the research findings (Burns and Grove, 2010, p. 12). This process has no doubt built my capacity in the research process and these benefits will no doubt improve nursing and midwifery practice by ensuring an enhanced quality of nursing and midwifery research thus promoting evidence-based practices (LoBiondo-Wood and Haber, 2014, p.16). The process has broadened my understanding of the role of diet in the prevention of cardiovascular diseases in people with high levels of cholesterol through the review of the various articles that supported the formulation of this research question (Lloyd-Jones et al., 2010, p. 599). This evidence is very useful in nursing and midwifery practice thus promoting the delivery of safe and quality care to clients with elimination of unwanted consequences that result from prolonged use of statins to control cholesterol levels (Berry et al., 2012, p. 325). References Ash, L., Miller, C., 2010. Interprofessional collaboration for improving patient and population health. Dr. Nurs. Pract. Essent. 235. Astrup, A., Dyerberg, J., Elwood, P., Hermansen, K., Hu, F.B., Jakobsen, M.U., Kok, F.J., Krauss, R.M., Lecerf, J.M., LeGrand, P., others, 2011. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am. J. Clin. Nutr. 93, 684–688. Baigent, C., Blackwell, L., Emberson, J., Holland, L.E., Reith, C., Bhala, N., Peto, R., Barnes, E.H., Keech, A., Simes, J., others, 2010. 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Pijlman, A.H., Huijgen, R., Verhagen, S.N., Imholz, B.P.M., Liem, A.H., Kastelein, J.J.P., Abbink, E.J., Stalenhoef, A.F.H., Visseren, F.L.J., 2010. Evaluation of cholesterol lowering treatment of patients with familial hypercholesterolemia: a large cross-sectional study in The Netherlands. Atherosclerosis 209, 189–194. Shekelle, R.B., Shryock, A.M., Paul, O., Lepper, M., Stamler, J., Liu, S., Raynor Jr, W.J., 1981. Diet, serum cholesterol, and death from coronary heart disease: the Western Electric Study. N. Engl. J. Med. 304, 65–70. Siri-Tarino, P.W., Sun, Q., Hu, F.B., Krauss, R.M., 2010. Saturated fat, carbohydrate, and cardiovascular disease. Am. J. Clin. Nutr. 91, 502–509.  Appendix 1: Screen shots of database search Read More