Although high body mass index is an established risk factor for coronary heart disease, its role as an independent risk factor for stroke has been controversial. In a prospective study of over 21 000 US male physicians, obesity (defined as body mass index >30) was associated with a significant 2-fold increase in the risk of total stroke and its 2 major subtypes following a linear trend. Since body mass index is a modifiable risk factor, the prevention of stroke may be another benefit associated with preventing obesity in adults.
Several prospective studies have reported that weight loss or fluctuation in body weight (weight cycling) is associated with an increased risk of cardiovascular and all-cause mortality. This has raised concern that losing weight intentionally in older age might be hazardous to health. The findings from this prospective study of 5608 men who participated in the British Regional Heart Study suggest that the increased mortality risk associated with weight loss and weight fluctuation (cycling) is determined to a large extent by disadvantageous lifestyle factors and preexisting ill health. These findings have important clinical and public health implications and should reassure overweight and obese men that intentional weight loss or weight cycling in middle and older age is not harmful.
As part of the Atherosclerosis Risk in Communities Study, the race-specific incidence rates and risk factor prediction for coronary heart disease (CHD) were determined for black and white persons over 7 to 10 years of follow-up (1987-1997). Incidence of CHD was similar in black and white men and marginally higher in black women than in white women using standard definitions. Excluding revascularization procedures from the definition of CHD events revealed higher rates in blacks than in whites for both men and women. The same traditional risk factors were associated with CHD incidence in blacks as in whites. Hypertension appeared to be a more potent predictor and diabetes less predictive in blacks than in whites. Findings from this study, along with clinical trial evidence showing efficacy, support aggressive management of traditional risk factors in blacks as in whites. Particularly, this study supports aggressive management of hypertension in black women. Understanding the intriguing racial differences in risk factor prediction may be an important part of further elucidating the causes of CHD and may lead to better methods of preventing and treating CHD.
The relative value of thrombolysis and heparin for treatment of patients with pulmonary embolism is still a matter of debate. Agnelli et al performed a meta-analysis of studies comparing thrombolysis and heparin treatment in patients with pulmonary embolism with respect to the incidence of death, recurrence of pulmonary embolism, and major bleeding. The cumulative incidence of these adverse outcome events was similar in the 2 treatment groups. A risk reduction of 41% and 40% in favor of thrombolysis was observed for death and recurrence, respectively. When death and recurrence were analyzed together, a statistically significant risk reduction of 40% in favor of thrombolysis was observed. The rates of major bleeding were influenced by the thrombolytic regimens and by the use of invasive procedures, essentially pulmonary angiography. This was particularly the case for patients receiving thrombolytic treatment. The rate of intracranial bleeding in patients receiving thrombolysis for pulmonary embolism was 0.8%, similar to that reported in patients with myocardial infarction treated with thrombolysis. Findings from this meta-analysis showed that death and recurrences are reduced by thrombolysis with respect to heparin treatment. Excessive bleeding, which is mainly associated with invasive procedures, is the trade-off for the improved efficacy.
Approximate odds ratios and 95% confidence intervals for death, recurrence of pulmonary embolism, or major bleeding event.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2002;162(22):2517. doi:10.1001/archinte.162.22.2517