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This Week in JAMA
November 5, 2003

This Week in JAMA

JAMA. 2003;290(17):2225. doi:10.1001/jama.290.17.2225
Genetic Variation in Estrogen Receptor α and CVD

Estrogen receptors regulate expression of genes for several cardiovascular disease (CVD) risk factors by both estrogen-dependent and estrogen-independent mechanisms. In this analysis of data from the population-based offspring cohort of the Framingham Heart Study,Article Shearman and colleagues found that individuals with the CC genotype of estrogen receptor α (ESR1) c.454-397 had a significantly increased risk of myocardial infarction compared with those with the TT or CT genotype. In an editorial,Article Hopkins and Brinton discuss the complex association between ESR1 and atherosclerosis.

Childhood CVD Risk Factors and Adult Vascular Changes

Carotid artery intima-media thickness (IMT) measured by ultrasound has been shown to be predictive of clinical coronary atherosclerosis events in middle-aged and elderly adult populations. Two articles in this issue of THE JOURNAL examine the association between carotid IMT in adults and cardiovascular disease (CVD) risk factors measured in childhood and adolescence. In an analysis of data from repeated cross-sectional surveys of participants in the Bogalusa Heart Study that began in childhood, Li and colleaguesArticle found that low-density lipoprotein cholesterol measured either in childhood, adulthood, or as a cumulative burden since childhood and body mass index in childhood were significant predictors of carotid artery IMT in asymptomatic healthy young adults. Raitakari and colleagues,Article in an analysis of data from the Cardiovascular Risk in Young Finns Study, found that risk factors measured at ages 12 to 18 years predicted adult carotid artery IMT independent of contemporaneous risk factors. In an editorial,Article McGill and McMahan note that a single measurement of CVD risk factors in adolescence may be sufficient to evaluate long-term CVD risk and encourage starting prevention of CVD in adolescence.

Fenoldopam and Contrast-Induced Nephropathy

Preliminary evidence suggests that fenoldopam mesylate, a selective dopamine-1 receptor agonist, preserves renal blood flow after iodinated contrast administration, potentially reducing risk of contrast-induced nephropathy. In this randomized trial, however, Stone and colleagues found that risk of contrast-induced nephropathy was not significantly different among patients with chronic renal insufficiency undergoing invasive cardiac procedures who received fenoldopam mesylate compared with those who received placebo.

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ApoA-I Milano and Coronary Artery Atherosclerosis

ApoA-I Milano is a variant of apolipoprotein A-I, the major protein component of high-density lipoprotein (HDL) particles. In animal models, infusion of recombinant ApoA-I Milano/phospholipid complexes has been shown to rapidly reduce atherosclerotic plaque burden. Nissen and colleaguesArticle conducted a randomized trial among patients with acute coronary syndromes and found that coronary artery atheroma volume as measured by intravascular ultrasound decreased significantly from baseline among those who received 5 weekly infusions of recombinant ApoA-I Milano/phospholipid complexes. In an editorial,Article Rader discusses research on therapies for atherosclerosis that target HDL.

A Piece of My Mind

"I believe that the great majority of physicians come to medicine because of a love of science and a desire to help others." From "Galileo's Grapes: Recognizing Those Who Helped Make Us Who We Are."

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Medical News & Perspectives

Widening use of statins is expected to reduce heart attack and stroke risk for greater numbers of patients, but the expense is already straining health care budgets of many countries.

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Scientific Review/Clinical Applications

Part 1 of this 2-part article reviews evidence on the effects on clinical end points of therapies commonly used to treat COPD. Cases in part 2 illustrate strategies to manage COPD across the spectrum of disease severity.

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History of medicine: cultural determinants of neurasthenia as a medical diagnosis and early debates on compulsory vaccination in France and the United States.

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JAMA Patient Page

For your patients: Information about chronic obstructive pulmonary disease.

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Flu Vaccine Reminder

It's better to give and to receive the flu vaccine, especially this year.