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This Week in JAMA
November 16, 2005

This Week in JAMA

JAMA. 2005;294(19):2395. doi:10.1001/jama.294.19.2395
-EXPRESS

Whether aggressive lowering of low-density lipoprotein (LDL) cholesterol with high-dose statin therapy will reduce the time to occurrence of a major cardiac event after myocardial infarction was explored in the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study. In this issue of JAMA, Pedersen and colleaguesArticle report that patients who were randomly assigned to high-dose atorvastatin, 80 mg/d, had no greater reduction in major coronary events or cardiovascular or all-cause mortality than patients who were randomly assigned to standard-dose simvastatin, 20 to 40 mg/d, through a median 4.8 years’ follow-up. In an editorial, CannonArticle reviews clinical trial data that support a “lower is better” LDL cholesterol treatment goal.

Preventing Graft Failure After CABG Surgery

Vein grafts in coronary artery bypass graft (CABG) surgery are subject to neointimal hyperplasia, atherosclerosis, and eventually graft failure. Results from the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial, which assessed the safety and efficacy of pretreating autologous vein grafts with edifoligide—a decoy for factors involved in initiation of neointimal hyperplasia—are reported in this issue. The trial investigatorsArticle found that edifoligide pretreatment was no better than placebo in preventing graft failure at 12 to 18 months or major adverse cardiac events a year after surgery. In an editorial, Conti and HunterArticle discuss potential reasons for the lack of benefit from edifoligide pretreatment.

Dietary Intake, Blood Pressure, and Lipids

The effects of diet on blood pressure and serum lipids were assessed in the randomized, crossover design, Optimal Macronutrient Intake Trial to Prevent Health Disease (OmniHeart), which involved 3 saturated fat–reduced diets (1 carbohydrate rich, 1 protein rich, and 1 unsaturated or monounsaturated fat rich). Appel and colleaguesArticle report that all 3 diets were associated with improvements from baseline in blood pressure and lipid levels. However, the protein diet and the monounsaturated fat diet were associated with further decrements in blood pressure and improvements in lipid levels compared with the carbohydrate diet. In an editorial, WeinbergerArticle discusses real-world applicability of nutritional interventions.

Molecular Classification of Unexplained Polyposis

To improve diagnosis and treatment of patients with unexplained hamartomatous or hyperplastic/mixed polyposis, Sweet and colleaguesArticle performed molecular analyses on blood samples and central review of the histopathology from 49 unrelated patients. They report the results of their molecular analyses, the identification of a potential novel susceptibility gene, ENG, for juvenile polyposis syndrome, and final histopathological diagnoses. In an editorial, CarethersArticle discusses the importance of molecular classification to define polyposis syndromes and associated cancer risks.

Pregnancy Characteristics and Risk of Breast Cancer

Estrogens, progesterone, and several other hormones are produced by the placenta during pregnancy. Cnattingius and colleagues hypothesized that placental weight could be an indirect measure of hormone exposure during pregnancy and, given known associations of hormone exposure with breast cancer, might be associated with subsequent breast cancer risk. They tested their hypothesis in a large population-based cohort study and found that a mother’s risk of breast cancer increased with increasing placental weight in prior pregnancies.

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Medical News & Perspectives

Neurorehabilitation

Although technology holds promise for mending bodies disabled by stroke, spinal cord injuries, and other conditions, such factors as limited funding and a short supply of well-trained investigators may slow advances in rehabilitation medicine.

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1918 Influenza

Scientists have reconstructed the virus that caused the 1918 influenza pandemic and gained insights into the properties that made this pathogen so deadly.

(Photo credit: James Gathany/CDC)

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CLINICIAN’S CORNER

Etiology, diagnosis, and therapy of adrenal insufficiency.

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Strong FDA Needed

The importance of a strong Food and Drug Administration is highlighted in a review of the agency’s history.

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JAMA Patient Page

For your patients: Information about adrenal insufficiency.

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