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This Week in JAMA
JAMA. 2003;290:853.
Risk Factors for Coronary Heart Disease
Two articles in this issue of THE JOURNAL challenge the belief that a large percentage of patients with coronary heart disease (CHD) lack any of the major conventional CHD risk factors—diabetes, cigarette smoking, hyperlipidemia, and hypertension. In an analysis of data from 3 prospective US cohort studies, Greenland and colleagues (SEE ARTICLE) found that 87% to 100% of patients who experienced a fatal CHD event had an antecedent exposure to at least 1 conventional risk factor. Khot and colleagues (SEE ARTICLE) analyzed data from patients with CHD enrolled in 14 international randomized clinical trials and, similarly, found that more than 80% of patients with CHD had at least 1 of the 4 conventional CHD risk factors. In an editorial, Canto and Iskandrian (SEE ARTICLE) urge physicians to increase efforts to control conventional CHD risk factors in their patients.
New Drug Labeling Information From Pediatric Studies
The 1997 Food and Drug Administration Modernization Act provides an additional 6 months of marketing exclusivity for conducting pediatric studies requested by the FDA on approved drugs that are being used off label in children. To examine the health benefits derived from these pediatric studies, Roberts and colleagues (SEE ARTICLE) analyzed the new labeling changes that resulted from these studies. Between July 1988 and April 2002, 53 drugs were granted pediatric exclusivity, and 33 drug products have new labels with important pediatric information on dosing, safety, and efficacy. In an editorial, Budetti (SEE ARTICLE) calls for additional action to encourage appropriate testing of drugs for use in children.
Ketogenic Diet and Lipoprotein Levels in Children
The ketogenic diet, a high-fat, low-carbohydrate, adequate-protein diet, is used for the management of difficult-to-control seizures in children. Kwiterovich and colleagues conducted a prospective study of children with intractable seizures initiating treatment with a high-fat ketogenic diet to determine the effect of the diet on plasma lipoproteins. After 6 months, mean plasma levels of atherogenic apolipoprotein B–containing lipoproteins, total cholesterol, and triglycerides increased significantly, and antiatherogenic high-density lipoprotein cholesterol decreased significantly.
(SEE ARTICLE)
Funding and Conclusions of Randomized Drug Trials
Als-Nielsen and colleagues analyzed data from randomized drug trials included in meta-analyses published in the Cochrane Library to assess whether an association between trial funding source and study conclusions reflects the magnitude of the treatment effect or occurrence of adverse events. Conclusions of drug trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as the treatment of choice than conclusions of trials funded by nonprofit organizations or by both nonprofit and for-profit organizations, or than those of trials in which funding was not reported. In adjusted analyses, the association between trial conclusions and funding source did not appear to reflect treatment effect or adverse events.
(SEE ARTICLE)
Medical News & Perspectives
A new plan will allow companies to seek Food and Drug Administration approval for health-related claims on food labels based on a wide range of evidence. Critics say the approach will confuse consumers.
(SEE ARTICLE)
Sex Ratio in Families With Breast, Ovarian Cancer
In an analysis of sex ratio in the offspring of families with at least 3 breast and/or ovarian cancer cases in 2 generations, mutations in BRCA1 but not BRCA2 were associated with an excess of female births.
(SEE ARTICLE)
CLINICIAN'S CORNER
Novel Risk Factors for Atherosclerosis
A review of the evidence on the predictive ability of 4 emerging risk factors for atherosclerotic vascular disease—C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine.
(SEE ARTICLE)
Physician Discontent
Mechanic examines sources of physician dissatisfaction and strategies to address the time pressures and changing demands of medical practice.
(SEE ARTICLE)
Communication About Out-of-Pocket Costs
The Patient-Physician Relationship
Analyses of paired surveys of general internists and their patients compare their beliefs and practices about discussions of out-of-pocket health care costs.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about risk factors for heart disease.
(SEE ARTICLE)
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