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Hyperlipidemia: lifestyle modifications combined with pharmacologic treatment
Hyperlipidemia, also referred to as dyslipidemia, is a condition that occurs when fats are deposited in the arteries increasing the risk of blockage. Hyperlipidemia is a major health issue among Hispanic females, which increases the risk of cardiovascular diseases in this patient population (Lamar et al., 2020). Current evidence indicates that the national prevalence of hyperlipidemia among U.S. adults is 11.3% (MacDonald, 2022). About 27.3% of the population in Miami-Dade County has high cholesterol (Miami-Dade Matters, 2019). This project aims to identify the effectiveness of combining lifestyle modifications with pharmacology treatment in improving cholesterol levels in mid-aged female Hispanics with hyperlipidemia diagnosis.
Hyperlipidemia: lifestyle modifications combined with pharmacologic treatment
Population
Hispanics are among the ethnic groups at the highest risk of developing hyperlipidemia. Middle-aged Hispanic females are at risk of hyperlipidemia due to various risk factors. Evidence from research indicates that the prevalence of hyperlipidemia is high across all Hispanics, but some groups within the population are more affected such as women. Various factors make women more vulnerable to hyperlipidemia which makes it interesting to focus on the mid-age female population.
Social determinants
The social determinants of health that predispose Hispanic females to hyperlipidemia include individuals’ socioeconomic status, household income, level of education, access to healthy foods, employment, and gender. Socioeconomic status is closely related to other factors such as the level of household income and education level. Individuals of lower socioeconomic status are more likely to have lower education levels, lower household income, and poor access to healthy foods, which could influence their health outcomes (Hudson et al., 2020).
Risk factors
Several risk factors predispose Hispanic females to hyperlipidemia such as high body mass index (BMI), obesity, older age, female gender, low physical activity level, alcohol use, and diabetes (Lamar et al., 2020). The risk of hyperlipidemia is higher in individuals with high BMI, advanced age, and those that are physically inactive due to an increase in weight. Lamar et al. (2020) indicated that women were more affected by hyperlipidemia compared to men, particularly those who are older, obese, and those with underlying conditions such as diabetes. Females are more likely to be obese and physically inactive.
Literature review
Ramírez et al. (2020) conducted a study and wrote an article titled “Prevalence of hyperlipidemia and its associated factors in university students in Colombia.” The purpose of the study was to establish how prevalent hyperlipidemia was and the factors associated with its development. The authors used studied 361 students. They used a sociodemographic survey method in their descriptive cross-sectional study. The researchers established that the prevalence rate was 33.8%, and the risk factors included male sex and alcohol consumption. The limitations identified included the lack of data on participants’ glucose levels, height, and weight. 
In another study, Rodriguez et al. (2017) conducted a study called “High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos” this study focused on identifying the factors that facilitate awareness in Hispanic patients with high cholesterol. This quantitative study focused on populations from 18 to 74 years of age, of which only 29.5% were undergoing treatment; specifically, the younger patients did not have treatment due to a lack of interest. However, the older patients participated in comprehensive treatments that included medications and healthy lifestyles. The patients who followed the comprehensive treatment in detail showed an improvement of 64%, achieving control of the pathology and demonstrating greater awareness about the disease and the treatment. Likewise, they identified that Cuban and South American people sought less attention for cholesterol control than patients of Puerto Rican and Dominican origin. Finally, this study identified a relationship between age and origin of birth with the follow-up of a comprehensive treatment since other patients with a lower rate of effectiveness in reducing cholesterol did not follow a treatment or a pharmacological treatment but did not include healthy lifestyles.
The study done by Risica et al. (2021) conducted a study called “Clinical outcomes of a community clinic-based lifestyle change program for prevention and management of metabolic syndrome: Results of the ‘Vida Sana/Healthy Life’ program.” In this study, the authors identified that Hispanic populations are more likely to develop cardiovascular diseases. In developing an eight-week program in a community care center for Spanish speakers, the authors performed clinical examinations and physical examinations as entry indicators. Also, they evaluated the knowledge that patients had about healthy habits for the control of cardiovascular diseases, specially high cholesterol, is the leading cause of to development of serious pathologies. The population included women and men of Hispanic origin between 18 and 70; those who showed insufficient knowledge about healthy habits had worse cholesterol results. Finally, the program improved the knowledge of healthy habits, causing a weight reduction and improvement in clinical examinations and physical examinations, demonstrating that the intervention in healthy habits is an essential factor for the control of cardiovascular pathologies and improving the quality of patient life.
Fernandez (2021) was interested in identifying which factors predispose the Latino population to suffer from non-communicable diseases such as heart disease and how these factors increase the health disparity between Hispanic and American populations. In this study, the author identified obesity as the first factor due to inadequate diets that increased plasma cholesterol and triglyceride levels, predisposing patients to developing Dyslipidemia, including hyperlipidemia. Patients with cardiometabolic risk usually start pharmacological treatment to control signs and symptoms. However, the Latino population tends to resist making lifestyle changes and adopting healthy health behaviors, such as healthy eating and physical activity. For the author, the lack of weight control, diet, and physical activity is the leading cause of the high prevalence of metabolic and cardiac diseases in the population. Therefore, the author suggests that healthy behaviors should be promoted among the Hispanic population in a preventive way to reduce weight, control eating, and encourage physical activity since, unlike other diseases, Dyslipidemia is preventable from lifestyles. Healthy.
           The article by Mohsen et al. (2020) was titled “Effectiveness of lifestyle modification on lipid profile for patients with hyperlipidemia.” The authors aimed at examining how lifestyle modification affects the lipid profiles of patients with hyperlipidemia. The study sample included 100 participants. A quasi-experimental design was used in the study. The findings indicated that there were significant differences in the improvement of cholesterol level, triglyceride, and blood pressure levels between the patients that received the lifestyle intervention and those that did not. The study limitation was the small sample size.  
           Vincent et al. (2019) conducted a study and created an article titled “Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol.” The purpose of the study was to determine how does respond to changes in the intake of cholesterol and markers for lipoprotein-cholesterol in patients at risk of cardiovascular disease. The authors extracted data from 55 publications with 2652 participants. They conducted a meta-regression analysis of data extracted from randomized trials involving dietary interventions. The authors established that there was a positive association between dietary cholesterol and changes in the concentration of LDL cholesterol. The limitations of the study findings include the uncertainty in the practical implications of the findings due to the limitations in the methods used.
Strengths and weaknesses
           The major strengths of the articles were that all of them were relevant to the topic as each study focused on hyperlipidemia. All the studies revealed that lifestyle modification can be effective in improving cholesterol levels in patients with hyperlipidemia. The studies were published in peer-reviewed journals which enhances the credibility of the evidence provided. All the studies were current. The conclusions made were consistent with the results and statistical data provided in the articles. The weakness identified among the studies is that the results obtained from each study respond to a specific population; although it can be applied and verified in other populations, the results closed to specific communities can make it challenging to apply to other populations with more significant limitations for the researchers.
Proposal
           Based on the evidence obtained from the literature review, the problem of high cholesterol can be addressed through a combination of lifestyle modification and medications involving diet and exercise (Mohsen et al., 2020). Lifestyle modification can be recommended for mid-age Hispanic females with hyperlipidemia to reduce their cholesterol levels. The intervention will aim at reducing the fats that have already accumulated in the body and also prevent fat accumulation from dietary intake. The lifestyle modifications will be combined with medications to enhance the effectiveness of the medications in controlling hyperlipidemia. 
The resources required to implement the intervention include brochures with information about healthy diets and appropriate exercises, medications for controlling hyperlipidemia, and meeting rooms in which patients will be educated about the intervention. The professionals involved will include nurses, physicians, pharmacists, and dietitians. The nurses will educate patients about the program; physicians will conduct assessments to establish that the patients meet hyperlipidemia diagnoses; pharmacists will prescribe medications, while the dietitians will educate the patients about healthy diets. 
           Nurses can be effective in an advanced role as they have the training and skills required to perform advanced practice roles such as evaluating and managing patients, leadership, and patient education. The advanced role allows a nurse to make autonomous and complex care decisions. Nurses can use their expert knowledge and clinical capacities to meet the primary care needs of patients and can provide some of the care services provided by physicians, and other professionals in the interdisciplinary care team (Woo et al., 2017). The implementation of the intervention would take 15 weeks, after which it will be evaluated to determine whether the expected outcomes were achieved. The expected outcome is a reduction in the cholesterol level, which is critical in the treatment and management of hyperlipidemia.
References
Fernandez M. L. (2021). Lifestyle Factors and Genetic Variants Associated to Health Disparities in the Hispanic Population. Nutrients, 13(7), 2189. Hudson, S. E., Feigenbaum, M. S., Patil, N., Ding, E., Ewing, A., & Trilk, J. L. (2020). Screening and socioeconomic associations of dyslipidemia in young adults. BMC Public Health, 20(1), 1-9. https://doi.org/10.1186/s12889-019-8099-9
Lamar, M., Durazo-Arvizu, R. A., Rodriguez, C. J., Kaplan, R. C., Perera, M. J., Cai, J., Espinoza Giacinto, R. A., González, H. M., & Daviglus, M. L. (2020). Associations of lipid levels and cognition: findings from the hispanic community health study/study of latinos. Journal of the International Neuropsychological Society: JINS, 26(3), 251–262.
MacDonald, T. (2022). Prevalence of High Cholesterol Among the Adult U.S. Population: NHANES 2013–2018.  Current Developments in Nutrition,  6(Suppl 1), 925. https://doi.org/10.1093/cdn/nzac067.045
Miami-Dade Matters. (2019). Community health dashboards. Miami-Dade Matters. Retrieved from https://www.miamidadematters.org/indicators/index/view?indicatorId=254&localeId=414
Mohsen, M. M., Riad, N. A., Badawy, A. I., Abd El-Hammed, B. M., & Elsherbini, D. M. A. E. (2020). Effectiveness of life style modification on lipid profile for patients with hyperlipidemia. American Journal of Nursing, 9(1), 8-18. https://doi.org/10.11648/j.ajns.20200901.12
Ramírez, A. A. Á., Peláez, J. L., Bermúdez, I. M., & Botero, J. Y. G. (2020). Prevalence of hyperlipidemia and its associated factors in university students in Colombia. Heliyon, 6(11), e05417.
Risica, P. M., McCarthy, M. L., Barry, K. L., Oliverio, S. P., Gans, K. M., & De Groot, A. S. (2021). Clinical outcomes of a community clinic-based lifestyle change program for prevention and management of metabolic syndrome: Results of the ‘Vida Sana/Healthy Life’ program. PloS one, 16(4), e0248473. https://doi.org/10.1371/journal.pone.0248473
Rodriguez, C. J., Cai, J., Swett, K., González, H. M., Talavera, G. A., Wruck, L. M., Wassertheil-Smoller, S., Lloyd-Jones, D., Kaplan, R., & Daviglus, M. L. (2017). High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos. Journal of the American Heart Association, 4(7), e001867. https://doi.org/10.1161/JAHA.115.001867
Vincent, M. J., Allen, B., Palacios, O. M., Haber, L. T., & Maki, K. C. (2019). Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol. The American Journal of Clinical Nutrition, 109(1), 7-16.
Woo, B.F.Y., Lee, J.X.Y. & Tam, W.W.S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15, 63. https://doi.org/10.1186/s12960-017-0237-9

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