The American Heart Association conducted a national survey to define the contemporary awareness and understanding of cholesterol as a risk factor for coronary heart disease. Structured phone interviews were conducted with a representative national sample of over 1000 Americans older than 40 years. Most respondents thought cholesterol was important, but most did not know their own cholesterol level or the recommended target level. Most people look to their physician for advice about cholesterol, and few rely on mass media or the Internet. Physicians have an opportunity to improve cholesterol education.
Weverling-Rijnsburger et al present data on men and women 85 years and older who were prospectively followed up for survival. Mortality from specific causes was related to levels of total and fractionated cholesterol at baseline. Contrary to observations in people in middle age, it appeared that neither total cholesterol nor low-density lipoprotein cholesterol is a risk factor of fatal cardiovascular disease in old age. In line with data on middle age, high-density lipoprotein cholesterol remained a risk factor for mortality from coronary artery disease and stroke in old age. Low levels of total and fractionated cholesterol were associated with an increased mortality risk. The present data help with the clinical interpretation of high serum cholesterol values in old age.
Surveys have shown that physicians in the United States report both receiving and honoring requests for physician-assisted death. To determine patient characteristics associated with acts of physician-assisted suicide, physicians among specialties involved in care of the seriously ill and responding to a national representative prevalence survey were asked to describe the characteristics of patients whose request for assisted dying they refused as well as those they honored. Of 1902 respondents (63% of those surveyed), 379 described 415 instances of refused requests and 80 instances of honored requests. Patients requesting assistance were seriously ill, near death, and had a significant burden of pain and physical discomfort. Nearly half were described as depressed at the time of the request. Most made the request themselves, along with family. In multivariate analysis, physicians were more likely to honor requests from patients making a specific request who were in severe pain or discomfort, had a life expectancy of less than 1 month, and were not believed to be depressed at the time of the request. Persons requesting and receiving assistance in dying are seriously ill with little time to live and a high burden of physical suffering.
Overweight and obesity are epidemic in Western societies and constitute a major public health problem owing to adverse effects on vascular health, including heart disease, hypertension, stroke, and diabetes mellitus. At the same time, more studies are showing that vascular factors may play a role in the development of Alzheimer disease (AD). The relationship between overweight and AD was examined in a longitudinal population-based study of 392 nondemented Swedish adults, aged 70 years, who were followed up to age 88 years. Women who developed AD between ages 79 and 88 years were overweight, as indicated by a higher average body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), at ages 70, 75, and 79 years compared with nondemented women. After adjustment for a variety of factors, it was found that for every 1.0 increase in BMI at age 70 years, risk for AD increased by 36%. These data suggest that overweight at older ages is a risk factor for dementia, particularly AD, in women. This may have profound implications for dementia prevention.
Average body mass index at examination ages 70, 75, and 79 years by incident dementia during the age interval 79 to 88 years among women.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2003;163(13):1505. doi:10.1001/archinte.163.13.1505