Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009
Women, particularly those younger than 55 years, have a higher in-hospital mortality after acute myocardial infarction than men of similar age. This study examined whether sex-related mortality differences have declined between 1994 and 2006. We found that women, especially women younger than 55 years, experienced larger improvements in hospital mortality after myocardial infarction than men, resulting in a narrowing of the mortality gap between younger women and men. Temporal changes in risk profiles explained almost entirely these sex differences in mortality trends.
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Physicians commonly prescribe Food and Drug Administration–approved drugs for off-label indications. Although some off-label uses are standard of care, many others have little or no scientific support. Few guidelines regarding the assessment of evidence or consent for off-label use are available to physicians. In this article, the authors identify 4 drug characteristics that signal the need for rigorous scrutiny of evidence before off-label prescribing: new drugs, novel off-label indications, serious adverse effects, and high cost. For off-label uses characterized by 1 or more of these signals for scrutiny, an evidence-guided ethical framework distinguishes 3 potentially appropriate categories of off-label use: (1) supported off-label use, (2) suppositional off-label use, and (3) investigational off-label use. These categories are based on the validity and relevance of available evidence. The categories are then linked to specific requirements for appropriate off-label prescribing, including the nature of disclosure to patients of the risks and benefits involved.
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Cardiorespiratory fitness (CRF) decreases with age and lifestyle. The maximum treadmill exercise test data of nearly 20 000 women and men aged 20 to 96 years were examined to determine the rate of decline in CRF associated with aging and lifestyle. Each patient had from 2 to 33 tests. The longitudinal analyses showed that CRF changed at a nonlinear rate, declining at an accelerated rate after age 45 years. The lifestyle variables of body mass index, level of physical activity, and smoking behavior were associated, independent of aging, with CRF across the adult life span. Being inactive, smoking, and having a high body mass index were associated with a lower age at which a patient could be expected to reach the threshold CRF levels associated with substantially higher health risks.
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This study aimed to determine the prevalence of myocardial infarction (MI) and risk of future hard cardiovascular (CV) events (determined by the Framingham coronary risk score [FCRS]) among US adults aged 35 to 54 years, who participated in NHANES during 1988 to 1994 and 1999 to 2004. In both epochs, the prevalence of MI was higher in men than in women, but the gap narrowed in recent years, as MI prevalence decreased among men and increased among women. Among men, mean FCRS showed an improving trend, while among women, mean FCRS worsened. Temporal trends in FCRS components revealed that men's CV risk factors improved more than women’s, with the exception of diabetes mellitus prevalence that increased in both sexes. Although men still have a higher prevalence of MI and risk for future coronary heart disease compared with women, this disparity has diminished.
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Kumanyika et al conducted a randomized trial in African Americans (mean age, 46.5 years; body mass index [BMI], 38 kg/m2; 90% female), in which 1 group involved 130 participants who identified 1 or 2 family members or friends in the same BMI range to enroll with them. Random assignment to “high support” meant that partners were expected to come to group and personalized counseling sessions and field workshops over the 2-year study. Random assignment to “low support” meant that partners were not allowed to come to the group session component. The participants assigned to high vs low support had similar weight loss (eg, −4.1 and −3.5 kg, respectively, at 6 months). However, in the first 6 months, the participants in both groups whose partners lost at least 5% of their baseline weight lost twice as much weight as participants whose partners lost less than 5%. These findings suggest that partners can help their family member or friend lose weight by providing support but also by losing weight themselves.
ITT indicates intention to treat.
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In This Issue of Archives of Internal Medicine. Arch Intern Med. 2009;169(19):1736. doi:10.1001/archinternmed.2009.362