Research Article Critique On The Effects Of Alcohol And Heart Disease - Essay Example

Worldwide, chronic conditions such as cardiovascular diseases, cancer and respiratory disease will claim the lives of about 35 million people this year, and the World Health Organization says that globally, heart disease, in its various forms, is the leading cause of death. Given its ability to strike men and women of all ethnicities and backgrounds, most nurses practicing in a clinical setting will, at some point or another, encounter patients with a heart condition and in many cases, the condition will go unrecognized. In their Online Journal of Issues in Nursing article, "Heart stopper Genes: Would You Recognize a high risk patient," Karen Greco, NM, RN, ANP discusses ways nurses can recognize those patients who may be at risk of heart disease, and cardiac patient Matthew Bayan tells of his experience as a young man living a healthy lifestyle who, after many tests, is diagnosed with cardiac disease. "As nurses, we are all aware of the well-known fact that coronary artery disease is one of the leading causes of death in the United States. What is less well known is that 25% pf the population have familial lipid disorder with an autonomic dominant pattern of inheritance associated with a condition known as low-density lipoprotein pattern B. This condition has been associated with a threefold risk of myocardial infarction," Greco writes. In many cases, cardiac disease goes unrecognized even by the experts and making it necessary that practicing nurses familiarize themselves with the risk factors, symptoms and issues surrounding cardiac disease. "The importance of an adequate family history cannot be overemphasized when assessing cardiac disease risk," Greco writes. "Since many primary care providers do not have the time to take a thorough family history, the nurse may be the first person to identify a person at risk for a genetically linked lipid disorder such as LDL." The second author tells his own personal account of suffering cardiac incidents and going years without a diagnosis, despite many diagnostic tests. "What do you think the typical heart disease patient looks like? The image that may come to mind is an overweight, fifty-five year-old male who smokes, does not exercise, and eats a diet high in saturated fat. We expect his total blood cholesterol to be well over 200 mg/dL. He would probably have high blood pressure, high salt intake, and high fat and sugar consumption. So what would we think when confronted with a forty-five-year-old man who is tall and thin, does not smoke, does not have high blood pressure, exercises every day and is on a low-fat diet. Sounds like the poster child for good health, doesnt he, especially if he had never had chest pains or shortness of breath," Bayan writes. Although his story is moving, and any medical professional can certainly sympathize with his tale of frustration and uncertainty, what makes the article interesting are the facts that the author does not reveal. Cardiovascular disease is complex with many different causes and effects. Although a genetic disposition to disease should certainly be considered, lifestyle and culture are equally important. These facts are omitted from the article. Many researchers have pondered the association between the heart and commonly ingested foods or beverages. Much media attention has been given to the subject of the health benefits of drinking alcohol, and in many cultures, wine and other alcoholic beverages plays a prominent role. Data and research done by some have generated several theories; the most popular refers to the "French paradox" which cites a lower risk of coronary heart disease between the French, who often drink wine with a fatty diet as compared with the typical resident of the United States (Goldberg, et al). Most researchers do not link casual drinking with heart disease, but many say there may be heart benefits to consuming wine or other alcoholic beverages in moderation. "Over the past several decades, many studies have been published in science journals about how drinking alcohol may be associated with reduced mortality due to heart disease in some populations. Some researchers have suggested that the benefit may be due to wine, especially red wine," the American Heart Association writes. Some researchers believe that the benefits of wine are not in the alcohol, but in the other components of the beverage, such as the flavonoids, and those benefits may be gained by eating foods like grapes or drinking grape juice (American Heart Association). Many health practitioners advise patients who consume alcohol to strengthen their heart to be aware of the dangers and some even say alcohol consumed in excess may actually contribute to heart disorders. "Drinking more alcohol increases such dangers as alcoholism, high blood pressure, obesity, stroke, breaks cancer, suicide and accidents. Its not possible to predict in which people alcoholism will become a problem," the American Heart Association says on its Web site. "Given these and other risks, the American Heart Association cautions people not to start drinking." Many of the dangers associated with too much drinking are also associated with heart disease. "Drinking too much alcohol can raise the levels of some fats in the blood. It can lead to high blood pressure, heart failure and an increased calorie intake. Excessive drinking and binge drinking can lead to stroke," the American Heart Association says. The association urges people to discuss the benefits and risks of alcohol on the heart with a medical professional. In his commentary printed in the International Journal of Epidemiology, "Reflections on alcohol and coronary heart disease," Michael G. Marmot, of the International Centre for Health and Society Department of Epidemiology and Public Health writes, "We concluded that moderate alcohol consumption was protective from IHD. We were concerned, however, with the other effects of alcohol. Above 21 units a week for men, and 14 for women, the frequency of psychosocial problems increases with amount drunk. Similarly, mortality rates increases with amount drunk." Bayan says, "There is no typical heart patient," and the only way to determine ones risk of heart attack is to perform lipid subclass testing. He says that other diagnostic tools did not indicate a heart problem and although he had a family history of heart disease - his father and grandfather had died of heart attacks - clinicians did not question him further or chart his family history. Many diagnostic tools are "inaccurate from twenty to fifty percent of the time in diagnosing small-particle LDL syndrome," he says. "Eighty percent of people having heart attacks have normal cholesterol levels. A quarter of the population has a condition called low-density lipoprotein pattern B that has been associated with a threefold risk of myocardial infraction. Although early intervention can often prevent an otherwise fatal event, these patients often go unrecognized until after a myocardial infraction has occurred because they may not have the usual risk factors associated with cardiovascular disease," Greco writes. Although diagnostic testing and family history are important components in diagnosing heart disease, a complete analysis of a patients lifestyle is also important. From reading Bayans account, we know that he ate a low-fat diet, was not overweight and did not smoke. We do not know if he was a drinker. The author places a great deal of emphasis on a genetic predisposition to heart disease, while not much information is revealed regarding the patients lifestyle. A genetic predisposition to certain conditions may certainly be considered a factor in determining ones risk for heart disease, and the authors statistics back up her argument: One study suggests that 66 percent of abnormalities are due to shared genetic components. However, lifestyle, especially in regard to alcohol consumption, must be equally weighed. How interesting it would be to know if Bayan were a drinker. Before his cardiac condition was discovered, did he drink a glass of wine with dinner or binge drink with his friends from time to time? Perhaps he abstained from alcohol all together. Based on this article, the reader never knows, and we do not have a complete picture of the factors that may have contributed to his condition. As Greco says, nurses work on the frontline of determining a patients risk factor for many conditions. I expect to reflect on this article often throughout my career, and as a nurse, I will always wonder how differently the data may have been interrupted if the reader had been given more information about the patients lifestyle. Heart disease is complex and this article has taught me that there is more to consider in a patient than tests and genetic predisposition. There is a story to be told as well, and as nurse, I hope to see the whole patient, not just the statistics and test results.   References   Marmot, M. (2001) Commentary: Reflections on alcohol and coronary heart disease (International Journal of Epidemiology) Greco, K.; Bayan, M. (September 30, 2000) Heart Stopper Genes: Would you recognize a high-risk patient? Online Journal of Issues in Nursing. Vol. 5, No. 3. Available http://www.nursingworld.org/ojin/topic13/tpc13_5.htm Goldberg, I; Mosca, L.; et al (20010 Wine and Your Heart, A Science Advisory for Healthcare Professionals. American Heart Association Science Advisory. Available http://stroke.ahajournals.org     Web Resources American Heart Association, Alcohol, Wine and Cardiovascular Disease, www.americanheart.org World Health Organization, www.who.int   Read More