Migraine, particularly migraine with aura, is associated with an increased risk of ischemic stroke, but whether migraine is associated with other ischemic vascular events is not clear. In an analysis of data from a prospective study of healthy middle-aged women, Kurth and colleaguesArticle examined the association of migraine with subsequent risk of overall and specific cardiovascular disease (CVD). The authors found that compared with women with no migraine history, any history of migraine was associated with increased risk of CVD. Active migraine with aura was associated with increased risks of major CVD, ischemic stroke, myocardial infarction, death from ischemic CVD, coronary revascularization, and angina, whereas active migraine without aura was not associated with increased risk of these CVD events. In an editorial, Lipton and BigalArticle discuss possible explanations for these findings and their clinical implications.
Highly active antiretroviral therapy (HAART) has resulted in dramatic declines in opportunistic and other infections in adults and children infected with human immunodeficiency virus (HIV), but no studies have compared pediatric infection rates in the HAART vs pre-HAART eras. Gona and colleaguesArticle analyzed data from a prospective study of US children infected with HIV to estimate the incidence rates for first occurrence of 29 opportunistic or other infections between January 2001 and December 2004 and compared these with infection rates in the pre-HAART era. The authors report substantial reductions in opportunistic and other infections during the HAART vs pre-HAART eras. In an editorial, Harwell and ObaroArticle discuss advances in the care of HIV-infected children and the challenge of ensuring optimal treatment for children throughout the world.
Inflammation likely plays a role in age-related macular degeneration (AMD), and data from case-control studies suggest an association between a complement factor H (CFH) gene polymorphism, Y402H, and AMD. Despriet and colleagues assessed this relationship and the modifying effects of smoking and serum markers of inflammation in a population-based cohort. The authors found the CFHY402H polymorphism in 36.2% of their study population, and they calculated a population-attributable risk for CFHY402H of 54%. Elevated levels of serum inflammatory markers and smoking added to the increased risk of AMD in persons with the Y402H allele.
Brain natriuretic peptide levels are elevated in pulmonary artery hypertension. Machado and colleagues hypothesized that levels of plasma N-terminal-pro-brain natriuretic peptide (NT-proBNP) would correlate with the severity of pulmonary hypertension and mortality risk in patients with sickle cell disease and tested their hypothesis in 2 cohort studies of patients with sickle cell disease. The authors found that an NT-proBNP level greater than 160 pg/mL was common in patients with sickle cell pulmonary hypertension and was an independent predictor of mortality.
“When physicians give counsel, they do not substitute their judgment for that of the patient or family. Instead, physicians work in partnership with patients and families to craft a mutually determined decision that best meets the demands of a particular situation.” From “The Physician's Counsel.”
Unique ethical issues arise in designing clinical trials with placebo groups that include patients with advanced cancer or other terminal illnesses.
Mittelman reviews the epidemiology of hyperlipidemia, treatment, primary prevention in women and particularly African American women, and goals of therapy in his discussion of Ms T, a 39-year-old African American woman with elevated lipid levels.
An article in the Archives of Neurology reports that levels of cerebrospinal fluid β-amyloid 42—a biomarker for Alzheimer disease—decrease significantly with age, and this decline is accelerated in persons with the apolipoprotein E allele. Rosenberg discusses new insights from transgenic mouse models of Alzheimer disease and related dementias and their potential clinical applications.
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 HIV infection in children.
This Week in JAMA . JAMA. 2006;296(3):251. doi:10.1001/jama.296.3.251