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
and Brinton discuss the complex association between ESR1 and atherosclerosis.
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.
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.
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.
"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."
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.
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.
History of medicine: cultural determinants of neurasthenia as a medical
diagnosis and early debates on compulsory vaccination in France and the United
For your patients: Information about chronic obstructive pulmonary disease.
Flu Vaccine Reminder
It's better to give and to receive the flu vaccine, especially this
This Week in JAMA. JAMA. 2003;290(17):2225. doi:10.1001/jama.290.17.2225