Prior investigations suggested that treatment with the selective cannabinoid-1 receptor blocker rimonabant reduces body weight and improves several cardiometabolic risk factors. Pi-Sunyer and colleaguesArticle report results of a randomized trial comparing the efficacy and safety of rimonabant (5 mg and 20 mg) with placebo, plus diet and exercise, on 1- and 2-year changes in body weight and cardiometabolic risk factors in overweight or obese patients. The authors found that rimonabant was generally well tolerated and that the 20-mg dose was more effective than placebo in reducing weight, waist circumference, and triglyceride levels and increasing high-density lipoprotein cholesterol during the first year. In year 2, patients who continued taking 20 mg of rimonabant maintained their weight loss, whereas patients who were rerandomized to placebo regained weight. In an editorial, Simons-Morton and colleaguesArticle discuss the implications of participants' nonadherence and loss to follow-up for interpretation of the study results.
Most studies assessing the effects of underweight and obesity on mortality have been conducted in Western populations and little is known about the associations in Asian populations. Gu and colleagues examined the relationship between body mass index (BMI) and mortality in a nationally representative sample of Chinese men and women 40 years and older. After adjusting for a number of demographic factors, the authors found a U-shaped association between BMI and all-cause mortality. Men with a BMI of 24.0 to 24.9 and women with a BMI of 25.0 to 26.9 had the lowest risk of all-cause mortality.
Lower socioeconomic status (SES) has been associated with increased all-cause and cardiovascular mortality. Shishehbor and colleagues hypothesized that functional capacity and heart rate recovery are associated with lower SES. They tested this hypothesis and assessed the contribution of these measures to the SES-mortality relationship in a prospective cohort study of patients referred for exercise stress testing. The authors found that impaired functional capacity and abnormal heart rate recovery were strongly and independently associated with lower SES and accounted for a large portion of the correlation between SES and mortality.
In a randomized trial of ventilated neonates having central line placement, Taddio and colleagues assessed the effectiveness and safety of topical tetracaine, intravenous morphine, and the combination compared with no treatment and relative to each other. The authors found that compared with no treatment or tetracaine alone, morphine and tetracaine plus morphine were associated with lower pain scores. Morphine caused respiratory depression and tetracaine caused erythema.
Prognostic data are useful to inform decision making by patients and clinicians. Using data from a population-based study of community-dwelling US adults 50 years and older, Lee and colleagues developed and validated a prognostic index for 4-year mortality based on simple-to-obtain patient-reported variables.
“Chris . . . was wide wake when I told him there was nothing more that I, as his physician, could do for him other than make his last days more peaceful and dignified. ‘I understand,’ he said.” From “Errands.”
Clinical trial results indicate that two novel oral anticoagulants may be promising alternatives to current drugs used to treat and prevent thromboembolic events following orthopedic surgery.
Evolving indications for the implantable cardioverter-defibrillator (ICD) and advances in technology are reviewed.
The metabolic syndrome was found to be inferior to the Framingham Risk Score in predicting coronary heart disease (CHD) in middle-aged men in a study reported in the Archives of Internal Medicine. Kohli and Greenland discuss the utilities of individual and global risk-factor assessments in predicting or preventing future cases of CHD.
Legal and ethical considerations when law enforcement officials interview hospital patients.
For your patients: Information about the metabolic syndrome.
This Week in JAMA . JAMA. 2006;295(7):723. doi:10.1001/jama.295.7.723