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This Week in JAMA
JAMA. 2006;295:1481.
JAMA-EXPRESS
Fondaparinux in Acute STEMI
The Organization for the Assessment of Strategies for Ischemic Syndromes (OASIS-6) clinical trial investigators (SEE ARTICLE) assessed the effects of adding fondaparinux, a factor Xa inhibitor, to usual care, which included unfractionated heparin when clinically indicated vs placebo, on patient morbidity and mortality following acute ST-segment elevation myocardial infarction (STEMI). The OASIS-6 investigators report that patients receiving fondaparinux had significantly reduced death or reinfarction at 30 days vs usual care. In an editorial, Califf (SEE ARTICLE) discusses the implications of the trial results for care of patients following STEMI.
JAMA-EXPRESS
Abciximab in Acute Coronary Syndromes
In the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 2 (ISAR-REACT 2) Trial (SEE ARTICLE), patients with non–ST-segment elevation acute coronary syndromes having percutaneous coronary intervention after pretreatment with 600 mg of clopidogrel received abciximab or placebo to assess whether abciximab is associated with clinical benefit. The ISAR-REACT 2 Trial investigators report that compared with placebo, patients with elevated troponin levels who received abciximab had a reduced risk of a composite outcome of death, myocardial infarction, or urgent target vessel revascularization within 30 days of randomization. In an editorial, Steinhubl and Charnigo (SEE ARTICLE) discuss the importance of troponin levels for determining optimal therapy for patients with an acute coronary syndrome.
Calorie Restriction, Metabolism, and Longevity
Heilbronn and colleagues (SEE ARTICLE) examined the effects of 6 months of calorie restriction on biomarkers of calorie restriction, energy expenditure, and oxidative stress in healthy overweight adults. They found that those who restricted their caloric intake had reduced fasting insulin levels and core body temperature, reduced metabolic rate beyond the level expected from reduced body mass, and reduced DNA damage compared with a weight maintenance diet. In an editorial, Fontana (SEE ARTICLE) discusses the effects of calorie restriction on markers of aging.
Overweight and Obesity in the United States
Ogden and colleagues used data from the 1999-2000, 2001-2002, and 2003-2004 National Health and Nutrition Examination Surveys to assess the prevalence of and trends in overweight in children and adolescents and obesity in adults. In this 6-year period, the prevalence of overweight among children and adolescents and obesity among men increased significantly. Among women, obesity prevalence did not change, but the prevalence of severe obesity in women was nearly twice that in men.
(SEE ARTICLE)
JAMA-EXPRESS
Very High-Intensity Statin Therapy and Atherosclerosis
Intensive statin therapy can slow or halt progression of atherosclerosis, but whether it causes atheromas to regress is not known. In the ASTEROID (A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden) trial, patients who required coronary angiography and had at least 1 coronary artery obstruction with more than 20% luminal narrowing received 40 mg/d of rosuvastatin for 2 years. Nissen and colleagues (SEE ARTICLE) report that the therapy was associated with intravascular ultrasound-documented regression of atherosclerosis. In an editorial, Blumenthal and Kapur (SEE ARTICLE) discuss design limitations of ASTEROID and the need to assess whether atheroma regression is associated with a reduction in clinical events.
A Piece of My Mind
"The people in this area do not have many options for medical care. Their community is rife with hunger, poverty, malnutrition, and high infant mortality." From "Duffle Bag Medicine."
(SEE ARTICLE)
Medical News & Perspectives
The performance of the nation’s first fully equipped mobile surgical hospital, deployed to aid survivors of Hurricane Katrina, raises new questions about hospital surge capacity in the event of future disasters.
(SEE ARTICLE)
CLINICIAN'S CORNER
Dyspepsia
The Rational Clinical Examination
Clinical examination and computer models of upper gastrointestinal disease are inadequate to distinguish functional from organic causes of dyspeptic symptoms.
(SEE ARTICLE)
Author in the Room Teleconference
Join William C. Taylor, MD, on Wednesday, April 19, 2006, from 2 to 3 PM eastern time to discuss approaches to screening for colonoscopy. To register, go to www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about dyspepsia.
(SEE ARTICLE)
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