A Conversation with Ineke Sterk – Nurse Practitioner at Rivas Care Group

Ineke Sterk works as a nurse practitioner at Rivas Zorggroep. She is part of the internal medicine department. She describes what her daily work entails.

“I see many patients who have had cardiovascular disease during my office hours,” says the nurse practitioner. “For example, people sometimes suffer an ocular infarction and lose part of their vision. In such cases, it’s important to identify the cause. Does the person perhaps have high blood pressure, diabetes, or dangerously high cholesterol? And could that high cholesterol be hereditary?”

“In our region, only about four out of ten people have been identified as having genetically elevated cholesterol. So there’s still room for improvement! That’s why we wanted to become a LEEFH center.” “Roel Lubbers (pediatrician), Pascal Fransen (internist), Mario Creanza (cardiologist), and Leo Wielaart (family physician) are the doctors involved in our LEEFH center,” explains Sterk.

Family doctors

It is very important that general practitioners are aware of Familial Hypercholesterolemia (FH). They can play a greater role in screening. As a LEEFH center, we have an important role to play in raising awareness among general practitioners and in informing and training them. The diagnosis of FH is typically made at the clinic, but it can also be performed by the general practitioner. Family screening is, of course, done in collaboration with LEEFH. I play a role in that; for example, I put together an information packet for the patient and their family members, and I fill out the forms in advance and get the process started.

Blind spots

There are still many people who don’t know they have FH. About 43% of cases have been identified. There will always be gaps in our understanding, but by raising awareness, we hope to change that. “The region where we work isn’t one where people just go to the doctor on a whim,” says Sterk. “We want to raise awareness about FH.”

Ringing in the ears with high cholesterol

“High cholesterol should set off alarm bells,” says the nurse practitioner. You need to use risk assessment models, but you also have to be very vigilant yourself. You should always ask yourself where high cholesterol comes from.

Unfortunately, the media tends to portray medication in a negative light. On top of that, many people aren’t eager to start taking medication. Sometimes I have to talk their ears off to convince them. I advise patients to take medication. If you have a hereditary form of high cholesterol, you’re at higher risk of developing cardiovascular disease. In that case, medication is truly in your best interest. With FH, a healthy lifestyle is unfortunately not enough to lower cholesterol.

What happens if you have FH?

Ineke Sterk is very firm on this point: “If FH goes untreated, half of those affected will develop cardiovascular disease around the age of 50. Men slightly earlier than women. FH is a condition that responds well to medication. Diet and lifestyle are important, but they really aren’t enough. You want to detect it early. And you want to prevent people from dying of cardiovascular disease.”

Texting with patients

“Patients really appreciate having a central point of contact. That’s also part of my role as a nurse practitioner. I’m easy to reach, including through BeterDichtbij, an app that lets me video chat and message patients. Recently, I received a message from one of my patients: ‘My daughter, who has FH, is pregnant. What should she do now?’ It is our job as professionals to inform and treat our patients. As a LEEFH center, we closely follow the latest national developments, and we also stay in touch with other LEEFH centers across the country to learn from one another. There’s no need to reinvent the wheel. A continuing education session for general practitioners and practice assistants is scheduled for late September. The date for the patient information evening will be announced soon!