Identification and management of vascular risk: beyond low density lipoprotein cholesterol.

Vascular disease is basically an inherited metabolic disease. Eighty percent of individuals who develop disease have the same blood cholesterol levels as individuals who do not develop disease. With vascular disease pervasive throughout the world and current assessment techniques insufficient to identify those at risk, use of a multifactorial approach to vascular assessment is prudent. Assays are currently available that enable health care providers to determine risk beyond those traditionally used. These "novel" risk factors appear to be additive (Brown, 2001; Rader, 2000a, 2002; Superko, 1995), and when combined with traditional factors, LDL can be adjusted to prevent disease. In individuals with established disease, these factors can be instrumental in identifying an appropriate treatment protocol for halting the progression of disease. To date, the health care establishment as a whole has done a poor job of identifying and thoroughly treating cardiovascular risk. Even when risks were identified, often treatment protocols have not been aggressive enough to reach targeted goals (Hoerger, 1998; Jacobson, 2000; NHANES III, 2000). The unique role of the occupational health nurse offers an opportunity to follow a client during long periods of time. This is useful in establishing trust and getting to know the specific problems of each individual. The occupational health nurse, therefore, stands at the threshold of change for the client, easing and assisting the client to reach individual goals. This group of nurses can play a significant role in forging prevention and stamping out the number one killer of the American population.