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This Week in JAMA
JAMA. 2006;296:251.
Women, Migraine, and Cardiovascular Disease
Migraine, particularly migraine with aura, is associated with an increased risk of ischemic stroke, but whether migraine is associated with other ischemic vascular events is not clear. In an analysis of data from a prospective study of healthy middle-aged women, Kurth and colleagues (SEE ARTICLE) examined the association of migraine with subsequent risk of overall and specific cardiovascular disease (CVD). The authors found that compared with women with no migraine history, any history of migraine was associated with increased risk of CVD. Active migraine with aura was associated with increased risks of major CVD, ischemic stroke, myocardial infarction, death from ischemic CVD, coronary revascularization, and angina, whereas active migraine without aura was not associated with increased risk of these CVD events. In an editorial, Lipton and Bigal (SEE ARTICLE) discuss possible explanations for these findings and their clinical implications.
Incidence of Infections in HIV-Infected Children
Highly active antiretroviral therapy (HAART) has resulted in dramatic declines in opportunistic and other infections in adults and children infected with human immunodeficiency virus (HIV), but no studies have compared pediatric infection rates in the HAART vs pre-HAART eras. Gona and colleagues (SEE ARTICLE) analyzed data from a prospective study of US children infected with HIV to estimate the incidence rates for first occurrence of 29 opportunistic or other infections between January 2001 and December 2004 and compared these with infection rates in the pre-HAART era. The authors report substantial reductions in opportunistic and other infections during the HAART vs pre-HAART eras. In an editorial, Harwell and Obaro (SEE ARTICLE) discuss advances in the care of HIV-infected children and the challenge of ensuring optimal treatment for children throughout the world.
Complement Polymorphism and Macular Degeneration
Inflammation likely plays a role in age-related macular degeneration (AMD), and data from case-control studies suggest an association between a complement factor H (CFH) gene polymorphism, Y402H, and AMD. Despriet and colleagues assessed this relationship and the modifying effects of smoking and serum markers of inflammation in a population-based cohort. The authors found the CFH Y402H polymorphism in 36.2% of their study population, and they calculated a population-attributable risk for CFH Y402H of 54%. Elevated levels of serum inflammatory markers and smoking added to the increased risk of AMD in persons with the Y402H allele.
(SEE ARTICLE)
Sickle Cell Disease, NT-proBNP Levels, and Mortality
Brain natriuretic peptide levels are elevated in pulmonary artery hypertension. Machado and colleagues hypothesized that levels of plasma N-terminal-pro-brain natriuretic peptide (NT-proBNP) would correlate with the severity of pulmonary hypertension and mortality risk in patients with sickle cell disease and tested their hypothesis in 2 cohort studies of patients with sickle cell disease. The authors found that an NT-proBNP level greater than 160 pg/mL was common in patients with sickle cell pulmonary hypertension and was an independent predictor of mortality.
(SEE ARTICLE)
A Piece of My Mind
"When physicians give counsel, they do not substitute their judgment for that of the patient or family. Instead, physicians work in partnership with patients and families to craft a mutually determined decision that best meets the demands of a particular situation." From "The Physician's Counsel."
(SEE ARTICLE)
Medical News & Perspectives
Unique ethical issues arise in designing clinical trials with placebo groups that include patients with advanced cancer or other terminal illnesses.
(SEE ARTICLE)
CLINICIAN'S CORNER
Hypercholesterolemia
Clinical Crossroads
Mittelman reviews the epidemiology of hyperlipidemia, treatment, primary prevention in women and particularly African American women, and goals of therapy in his discussion of Ms T, a 39-year-old African American woman with elevated lipid levels.
(SEE ARTICLE)
Alzheimer Disease Risk Identification
From the Archives Journals
An article in the Archives of Neurology reports that levels of cerebrospinal fluid  -amyloid 42—a biomarker for Alzheimer disease—decrease significantly with age, and this decline is accelerated in persons with the apolipoprotein E allele. Rosenberg discusses new insights from transgenic mouse models of Alzheimer disease and related dementias and their potential clinical applications.
(SEE ARTICLE)
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 HIV infection in children.
(SEE ARTICLE)
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