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This Week in JAMA
JAMA. 2000;284:275.
Cholesterol and Risk for Heart Disease in Young Men
Observational studies and clinical intervention trials have established elevated serum cholesterol level as an important risk factor for coronary heart disease and cardiovascular disease in individuals 40 years or older, but few studies have evaluated the relationship between cholesterol level in younger individuals (<40 years) and the long-term risk of coronary heart disease and cardiovascular disease. Using data from 3 cohorts of men aged 18 through 39 years from 3 large prospective studies with 16 to 34 years of follow-up, Stamler and colleagues (SEE ARTICLE) found a continuous graded relationship between serum cholesterol level and the long-term risk of coronary heart disease, cardiovascular disease, and all-cause mortality. Estimated life expectancy for young men with serum cholesterol levels lower than 200 mg/dL was 3.8 to 8.7 years longer than for young men with levels of 240 mg/dL or higher. In an editorial, Grundy (SEE ARTICLE) argues for routine periodic measurement of serum cholesterol levels in young adults to identify and treat those at higher risk for coronary heart disease.
Psychosocial Function After Prophylactic Mastectomy
Only a minority of women at high risk for breast cancer choose to undergo prophylactic bilateral mastectomy despite evidence that prophylactic mastectomy reduces the incidence of breast cancer in this population. To assess long-term satisfaction and psychological and social function after this procedure, Frost and colleagues surveyed women with a family history of breast cancer who had undergone bilateral prophylactic mastectomy between 1960 and 1993. Most of the 572 respondents reported satisfaction with the procedure and decreased emotional concern about developing breast cancer. For 6 other psychological and social function variables, most respondents reported no change or favorable effects, but 9% to 36% reported negative effects.
(SEE ARTICLE)
Gene for Pediatric GER Maps to Chromosome 13
Sequelae of severe pediatric gastroesophageal reflux (GER) include failure to thrive and increased risk of morbidity due to respiratory diseases. Hu and colleagues conducted a genome-wide scan involving 5 families affected by severe pediatric GER to determine whether this disorder has a major genetic component. In these families, severe pediatric GER followed an autosomal dominant-trait hereditary pattern. Based on pairwise and multipoint linkage analyses, a gene for severe pediatric GER mapped to a 13-cM region on chromosome 13q.
(SEE ARTICLE)
Prenatal Care and Outcomes of Twin Births
Intensive utilization of prenatal care, defined as receiving more prenatal visits than the number recommended by the American College of Obstetricians and Gynecologists, has increased steadily since the early 1980s. In this analysis of birth and infant death records for twin births in the United States, Kogan and colleagues found that rates of preterm and preterm small-for-gestational age births among twins increased between 1981 and 1997, especially among women with intensive prenatal care utilization, and term small-for-gestational age births decreased. Preterm and total twin infant mortality for women with intensive prenatal care, however, decreased between 1983 and 1996 and remained lower than the overall twin infant mortality rate.
(SEE ARTICLE)
Guiding Older Persons Starting an Exercise Program
For most older persons who want to start an exercise program, existing guidelines for prior exercise stress testing may not be applicable. Gill and coauthors review the benefits and risks of physical activity and exercise among older persons. In the absence of empiric evidence supporting current guidelines, they propose an approach to clinical evaluation, exercise testing, and safety monitoring for persons aged 75 years or older who wish to begin an exercise program that considers the intensity of exercise, the underlying risk for adverse cardiac events, and the benefit of exercise relative to the risks and costs associated with routine exercise stress testing.
(SEE ARTICLE)
Medical News & Perspectives
Obese people who seek medical help to lose weight might get it from an unexpected source—a psychiatrist. It has been estimated that one fourth of obese persons have mental illness, usually depression.
(SEE ARTICLE)
Autoimmune Blistering Diseases
Grand Rounds at the Clinical Center of the National Institutes of Health
Clinical and immunopathologic features and treatment of the pemphigoid group of acquired autoimmune blistering diseases: bullous pemphigoid, pemphigoid gestationis, and mucous membrane pemphigoid.
(SEE ARTICLE)
Users' Guides to the Medical Literature
How to assess the validity of qualitative research reports: part 1 of a 2-part guide on qualitative research.
(SEE ARTICLE)
Initiative to Improve Outcomes of Diabetes
Research suggests that early diagnosis and aggressive treatment can reduce morbidity and mortality from diabetes mellitus, the goal of the National Diabetes Education Program.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on gastroesophageal reflux in infants and children.
(SEE ARTICLE)
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