The nurse as expert practitioner in global cardiovascular risk management.

Randomised controlled trials have demonstrated the benefit of nurse-run clinics for secondary prevention of coronary heart disease through impacting upon health perceptions and on cardiovascular risk factors. However, to achieve positive results, intensive intervention is needed and this requires a significant time commitment. At present, nurses tend to be involved in individualised interventions directed at patients who already have coronary heart disease. There is a need now to consider a community approach to prevention of cardiovascular disease. It is also important to try to influence the structural, economic, and cultural issues that are impacting upon cardiovascular risk management.