Determinants Of Cardiovascular Disease

Cardiovascular

Health Diary

Your cardiovascular health diary This diary is specially designed to help you keep track of your medication and avoid confusion. Your Patient Health Diary is also a useful record of your health. As you will see, the diary contains recording sections for medication and for measurements, such as blood pressure, so at any time you and your doctor can see how you are responding to treatment.

Managing multiple medications

While cardiovascular disease is common in Australia, there have been important improvements in treatment in recent years. As a result, death rates from cardiovascular disease have fallen significantly.5 This book should help ensure that you receive the maximum benefit from your treatment.

In a recent survey, up to one in four Australians reported taking four or more prescription medications5. When prescribed a number of medications, there is always the possibility of not always taking the correct medication at the correct time. To avoid this possible confusion, keep this book up-to-date at all times, and get rid of any medications that are no longer current for you. If you have any doubts about your medication, take this book with you and ask your doctor or pharmacist to clarify the situation.

How to use this book Take it with you whenever you see your doctor or fill a prescription from a pharmacist. Ask your doctor or specialist to record any measurements taken in the appropriate section. Make sure that your pharmacist completes the dispensing section: If your pharmacist substitutes a generic drug for the prescribed drug it is important that this change is recorded.

This book will help you keep track of the medications you take, their strengths and any changes to medication that your doctor or pharmacist makes.

Please note: The information within this diary is intended as a general introduction and is not meant to substitute for your doctor’s or healthcare professional’s advice. All care is taken to ensure that the information is relevant to the reader. If further information is required, please discuss with your doctor or healthcare professional.

Lifestyle recommendations In addition to taking the medications prescribed by your doctor, you can take an active part in your treatment by implementing lifestyle changes that have been shown to support your prescribed medications and improve your quality of life1.

Smoking cessation Smoking has been shown to increase the risks associated with coronary heart disease and stroke and as such it is highly recommended that as a part of your treatment that smoking be ceased. There are a number of programs available to assist you to stop smoking. Talk to your doctor or pharmacist about which program is best for you.

Speak to your doctor about advice on healthy eating. You may also be referred to a dietician for further advice on healthy eating.

Healthy eating Healthy eating that comprises mainly plant based foods with moderate amounts of lean meats, fish and reduced fat dairy products with moderate amounts of polyunsaturated and monounsaturated (good) fats has been shown to reduce the likelihood of coronary heart disease and the risks of heart attack and stroke.

C a rd i ova s c u l a r

H e a lth Diary 

Alcohol consumption Moderate alcohol consumption (up to 2 standard drinks per day for men and 1 standard drink per day for women) is recommended to support your treatment of cardiovascular disease.



Physical activity Regular exercise (total of 30 minutes per day) of moderate intensity on most days of the week can assist in the prevention of cardiovascular disease and reduce the risk of coronary heart disease and stroke. Regular exercise can be as simple as taking a daily walk. Talk with your doctor about what physical activities are best for you.

Healthy weight Maintaining a healthy weight through healthy eating and physical activity can assist with the prevention of cardiovascular disease. A healthy weight is measured either by Body Mass Index (BMI) which is calculated by dividing body weight (kg) by [height in metres)2 or by waist circumference usually measured at the navel. It recommended that your BMI should fall in the range of 18.5–24.9, or your waist should measure less than or equal to 94cm for men or less than or equal to 80cm for women. Speak with your doctor or pharmacist if you are having difficulty maintaining a healthy weight.



Cardiovascular

Health Diary

Understanding cardiovascular disease One disorder, many related conditions.

Cardiovascular disease affects almost one in five Australians5. Cardiovascular disease includes all diseases and conditions of the heart (cardio) and blood vessels (vascular). The most common diseases and conditions include hypertension (high blood pressure), heart attack, heart failure, coronary heart disease, stroke and chronic kidney disease. There are a number of risk factors for cardiovascular disease.1,3 These include: • Age – as you age the risk increases • Gender – men are more at risk • Family history of cardiovascular disease • Hereditary factors such as race • Depression • Chronic health conditions associated with cardiovascular disease such as high blood pressure, high cholesterol and diabetes.

C a rd i ova s c u l a r

H e a lth Diary 

People with cardiovascular disease may take a number of different medications to reduce present conditions, eg. high blood pressure; and reduce the risk of future events, eg. stroke or heart attack.

High blood pressure High blood pressure, medically known as hypertension, is a condition that affects over two million Australians6. High blood pressure means that your blood is pumping with more force than normal through your arteries and over time, this extra work and pressure can cause gradual damage to many organs in your body. While there are usually no symptoms, high blood pressure is one of the causes of stroke, heart disease, and kidney failure. If not controlled, high blood pressure can accelerate the silting of arteries with fatty plaques (cholesterol). This condition is called atherosclerosis.



High blood pressure (cont.) Atherosclerosis contributes to many illnesses, such as heart attack and stroke. Other risk factors for atherosclerosis include cigarette smoking and high blood cholesterol. In the blood pressure recording section, two measurements are taken. The first, higher number is the systolic pressure and represents the pressure in the artery when the heart is beating. The lower number is the diastolic and represents the pressure when the heart is resting between beats. The systolic pressure is always stated first and the diastolic second, eg. 140/90 (“140 over 90”).

The National Heart Foundation recommends the following blood pressure ranges1: • A blood pressure of <130/85 mmHg is recommended for adults less than 65 years; adults with renal insufficiency (kidney insufficiency) and/or diabetes and/or proteinuria 0.25 – 1.0g/day (protein in the urine). • A blood pressure of <140/90 mmHg is recommended for adults 65 years or older unless they have diabetes and/or renal insufficiency and/or proteinuria ≥ 0.25g/day. • A blood pressure of <125/75mmHg is recommended for adults with proteinuria greater than 1g/day.

Coronary heart disease/angina Coronary heart disease (also known as ischaemic heart disease) is a condition in which the heart does not get enough blood (ischaemia), usually as a result of atherosclerosis in blood vessels. When the blood supply to the heart is suddenly cut off by a blood clot, the result is a heart attack.



Cardiovascular

Health Diary

When the blood supply to the heart is temporarily restricted, angina pain can result. When the blood supply to the brain is cut off by a blood clot, the result is an ischaemic stroke. For patients with a history of coronary heart disease, there are a number of tests and procedures that can be used to monitor the condition. Most commonly, the heart is assessed using an electrocardiogram, or ECG, sometimes in combination with exercise or stress testing. Your doctor will use an ECG tracing to look for “ST segment elevation” or “T wave changes”. Apart from heart assessment, pain from blood supply restriction to the heart (angina pain) is commonly reported from exertion. If reported, medications for temporary relief and reduction of associated risk may be recommended. If you are diagnosed with coronary heart disease or angina, your doctor will advise what management options are most appropriate for you.

C a rd i ova s c u l a r

H e a lth Diary 

Cholesterol and triglycerides Like high blood pressure, high levels of cholesterol or triglycerides can increase the risk of heart attack, stroke and other cardiovascular diseases. Cholesterol is an essential type of fat manufactured in the liver and found in all tissues (in foods, only animal products contain cholesterol). Cholesterol is carried in the bloodstream in particles called lipoproteins and these are described by how big they are. Two commonly reported lipoproteins are: Low Density Lipoproteins (LDL); these are medium sized particles and High Density Lipoproteins (HDL); these are the smallest particles. Like cholesterol, triglycerides are a type of fat found in your fat cells and your blood. Triglycerides are the main form of fat stored in the body. They result from the digestion of fats from food, and provide you with the energy to undertake your daily activities. Raised levels of cholesterol in the blood and a high proportion of LDL can increase the risk of atherosclerosis. Eventually, atherosclerosis can clog arteries and cause a heart attack or angina, so it is important to reduce the total cholesterol level and increase the level of HDL. 

Cholesterol and triglycerides (cont.) Similarly, raised levels of triglycerides are often part of what is known as “metabolic syndrome”, a condition that increases your risk of cardiovascular disease. A person with metabolic syndrome will have excess weight around the waist and at least two of the following: • high blood pressure;

Apart from healthy eating, medication may be of benefit in reducing high cholesterol. The National Heart Foundation recommends aiming for the following cholesterol and triglyceride levels1: • LDL < 2.0 mmol/L • HDL > 1.0 mmol/L • Triglycerides < 1.5 mmol/L

• raised levels of triglycerides;

Diabetes

• low levels of high-density lipoprotein (HDL) cholesterol; or

The most common type of diabetes found in Australia is Type 2 diabetes. It is usually diagnosed during middle or later life and is both a condition in its own right and a risk factor for cardiovascular disease. Many people with diabetes also have other cardiovascular risk factors, such as high blood pressure and/or high cholesterol. For people with a clustering of risk factors, good control is critical. The goal of diabetes treatment is to reduce blood glucose and keep it at a reduced level.

• an abnormal fasting blood glucose. Whilst high cholesterol levels are recognised and well known as a risk factor, researchers are increasingly recognising that raised triglycerides can by themselves increase your risk of cardiovascular disease — even if your cholesterol levels are normal. To measure cholesterol and triglycerides, a blood sample is taken and analysed. While a number of different measures of cholesterol can be reported (eg. HDL cholesterol), two common measurements reported are the ratio of HDL to LDL and the level of triglycerides.



The blood glucose level is monitored by checking the blood usually prior to breakfast and is commonly described as the fasting plasma glucose or blood sugar level. Cardiovascular

Health Diary

In analysing blood for glucose, a key measure is glycosylated haemoglobin, commonly abbreviated as ‘HbA 1 c’. The measurement of fasting blood glucose level and if required, the HbA1c percentage, are two measures that your doctor may record in this diary. The National Heart Foundation recommends maintaining an optimal blood sugar or glucose level (BSL) of a HbA1c level ≤ 7%1.

Chronic kidney disease Chronic kidney disease is called the “silent disease” as there are often no warnings. It is possible to lose up to 90% of your kidney function before getting any symptoms. Maintaining kidney health is important because of their role in helping to regulate and maintain your body’s chemical balance. By making hormones that cause the expansion and contraction of blood vessels, stabilising the acid level and balancing a number of minerals and salts, the kidneys play

C a rd i ova s c u l a r

H e a lth Diary 

an important role in the functioning of your body. If your kidneys are not functioning properly, your blood pressure, heart and blood vessels can be affected increasing your risk of cardiovascular disease. Measuring the level of kidney functioning can be via a blood test or urine test. Measuring blood pressure is important because high pressure can be a result of kidney disease or cause kidney disease. Additionally, measuring your iron level in your blood may be required as chronic kidney disease can cause anaemia. The results from the blood or urine tests may report on a number of clinical values including creatinine level in the blood, Glomerular Filtration Rate (GFR) and protein in the urine are described as microalbuminuria or proteinuria. Your doctor will explain what the results indicate and what the next steps are to support your kidney health.

References: 1. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease 2007. 2. Kidney Health Australia. Chronic Kidney Disease, revised May 06 3. Kidney Health Australia. Heart Disease and Chronic Kidney Disease, revised Oct 05 4. CSIRO. Cholesterol Facts (www.csiro.au/ resources/ accessed 17.4.08) 5. Australian Institute of Health and Welfare. Medicines for cardiovascular health: are they used appropriately? Cardiovascular disease series no. 27, May 2007 6. Australian Institute of Health and Welfare. Indicators for chronic diseases and their determinants. Feb 2008



Measuring your cardiovascular health Factor:

Blood pressure

Target:

/

Date:

Actual:

Cholesterol HDL:LDL

Triglycerides

Fasting blood glucose level

Actual:

Actual:

Actual:

/ / / / / / / / / / / / / / / / / / / / / / / /



Cardiovascular

Health Diary

Factor:

HbA1c

Target:

/

Date:

Actual:

Proteinuria

BMI/waist or Hip:Waist

Other parameter

Actual:

Actual:

Actual:

/ / / / / / / / / / / / / / / / / / / / / / / /

C a rd i ova s c u l a r

H e a lth Diary 



Tracking your medications Medication:

10 

Dose:

Time/frequency:

Cardiovascular

Health Diary

Date initiated:

C a rd i ova s c u l a r

For the treatment of:

H e a lth Diary 

Date ceased:

Dr/Pharm signature:

11

If found, please return to:

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

Instructions to doctor

Instructions to pharmacist

Whilst this patient health diary is primarily focused upon cardiovascular health, other health parameters can be included that may need to be measured regularly. Space is included for recording of another parameter or if more than one, the parameters included that are not appropriate for your patient can be deleted and updated to the additional health parameter.

This patient health diary is primarily focused upon cardiovascular health but other health parameters may be included by the patient’s doctor. Supporting regular reviews of the health parameters for the patient and medication compliance can help improve health outcomes for the patient.

Please fill in the parameters for your patient, as applicable, and record the actual patient’s levels below these targets. Regular review of these parameters and the target with your patient can assist in your patient being consistent in the implementation of lifestyle changes and medication compliance. Please note the name and dose of the medication being prescribed in the ‘Medication’ and ‘Dose’ columns. Please note frequency and timing of medication.

With any change in medication, including titration and substitution, please note the date of this change in the ‘Date Ceased’ column, and fill in a new line with the details of the titrated/new drug. Please initial the ‘Initiated By’ section of the Diary for each cessation, titration or substitution of medication, and strike a line through this discontinued product.

Pharmacy details:

Additional space is included to allow the recording of a number of medications including those for conditions other than cardiovascular disease. With any change in medication, including titration, please note the date of this change in the. ‘Date Ceased’ column, and fill in a new line with the details of the titrated/new drug. Further copies of the Patient Health Diary are available via your Aspen representative.

12 

Please see your pharmacist for a copy of the Consumer Medicine Information (CMI) for your medications.

Cardiovascular

Health Diary

A patient resource provided by:

Aspen Pharmacare Australia Pty Ltd

ABN 51 096 236 985

For further patient information, please go to: www.aspenpharma.com.au FD80526