Some evidence suggests that a diet high in vegetables and fruit reduces breast cancer risk and that a diet high in fat increases risk. However, the effect of these and other dietary factors on cancer progression is not clear. Pierce and colleaguesArticle report results from the Women's Healthy Eating and Living (WHEL) Study, a randomized trial that assessed the risks of breast cancer recurrence or new primary breast cancer and all-cause mortality among women who had been treated for early stage (stage I-IIIa) breast cancer and who were randomly assigned to either an intervention to promote a dietary pattern very high in vegetables, fruit, and fiber and low in fat or a comparison dietary pattern (“5-A-Day”). Over a mean 7.3-year follow-up, the authors found no differences in breast cancer events or all-cause mortality between women in the 2 groups. In an editorial, Gapstur and KhanArticle discuss current data relating to dietary intake and its relationship to cancer progression and survival.
The relationship between nonfasting hypertriglyceridemia and incident cardiovascular disease is addressed in 2 articles in this issue. In a prospective cohort study with 26 years of follow-up, Nordestgaard and colleaguesArticle tested the hypothesis that very high levels of nonfasting triglycerides are associated with an increased risk of myocardial infarction, ischemic heart disease, and death. The authors found that nonfasting triglycerides higher than 5 mmol/L (>442.5 mg/dL) predicted increased risks of the 3 study outcomes, particularly in women. Bansal and colleaguesArticle analyzed data from the prospective Women's Health Study to assess the association between fasting vs nonfasting triglyceride levels and risk of future cardiovascular events. They found that nonfasting triglyceride levels were associated with increased risks of future cardiovascular events, independent of baseline cardiac risk factors, other lipids, and markers of insulin resistance, whereas fasting triglyceride levels were not. In an editorial, McBrideArticle discusses the role of triglycerides in lipid metabolism and implications of the study results for patient care.
With increasing use of computed tomography coronary angiography (CTCA), concerns about radiation exposure and a possible increased risk of cancer must be addressed. In computer simulations, Einstein and colleagues determined the lifetime attributable risk of cancer associated with a single 64-slice CTCA study, in models adjusted for age, sex, and scan protocol. The authors' analyses revealed estimated lifetime attributable risks for cancer that are not negligible, particularly for persons who are young and female.
Ziegelstein discusses the pathophysiology and effects of acute emotional distress on cardiac function and the treatment of patients who survive an episode of serious cardiac arrhythmia in the setting of acute emotional distress.
“[U]ntil I was a good long way into all that debt and sleep deprivation, I had not understood very well what it meant to be human.” From “Life Math.”
Experts are developing a more complete picture of the feasibility of maintaining weight loss and a more hopeful message for millions who are overweight or obese.
Progress and challenges in electroconvulsive therapy for depression.
Advantages of computer-based pharmacoepidemiology for postmarketing surveillance of drug safety.
Join Roy C. Ziegelstein, MD, August 15, 2007, from 2 to 3 PM eastern time to discuss acute emotional stress and cardiac arrhythmias. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
For your patients: Information about acute emotional stress and the heart.
This Week in JAMA . JAMA. 2007;298(3):257. doi:10.1001/jama.298.3.257