First Do No Harm….Lowering One Risk and Increasing Another

Roberta Heale, EBN Associate Editor, @robertaheale @EBNursingBMJ

Implementation of evidence into practice is the gold standard for healthcare. Ultimately, we want patients to have the best possible health outcomes, but nothing is without risk and balancing the risk is not always easy. Take cardiac prevention for example. The ongoing battle to prevent cardiac events led to the development of statins which have revolutionized cholesterol management. A low cholesterol profile is significantly associated with fewer cardiac events and statins are prescribed for both primary and secondary prevention, particularly in high-risk groups such as those with diabetes. However, it is well known that patients with diabetes often have increased blood glucose levels when taking statins. In fact, it has been widely known that statin therapy has been associated with the development of type 2 diabetes, but the numbers were thought to be relatively low (9%). A newly released population-based study reveals that statins appear to increase the risk for type 2 diabetes by 46% in the general population, even after adjusting for confounding factors.

Cardiac care and prevention has now become much more complicated. The risk of developing diabetes related to statins is dose dependent, so prescribing the lowest possible dose is warranted. Patient lifestyle counseling is even more important; increase exercise, stop smoking, low fat diet etc. No easy feat when obesity is on the rise. It’s more important than ever for patients to be fully informed in the decision to start statin therapy.

We want patients to receive the best quality of care, based on the best evidence. Yet, keeping up with changes is difficult. We live in a wonderful age of technology and information. At the same time, how do we stay current and, harder still implement new findings on a regular basis? Given the enormous amount of information available to us daily, this situation is not going away. Finding strategies for flexible approaches to practice is the new normal and keeping the patient the centre of care decisions is the best bet for maintaining your balance.


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