Secretory phospholipase A2 (sPLA2) generates phospholipid products implicated in atherosclerosis. Nicholls and colleagues assessed the effects of varespladib—an sPLA2 inhibitor—on cardiovascular outcomes in a multicenter trial involving 5145 patients who were randomly assigned to 16 weeks’ treatment with varespladib or placebo within 96 hours of presentation with an acute coronary syndrome (ACS). The authors found that varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of myocardial infarction.
In a randomized trial that enrolled 1202 patients who had undergone treatment for primary colorectal cancer, Primrose and colleagues evaluated the efficacy of scheduled carcinoembryonic antigen (CEA) assessment and computed tomography (CT)—separately or combined—to detect recurrent, treatable disease during 5 years’ follow-up. The authors report that compared with minimum follow-up—a single CT examination if requested by the hospital clinician—CT or CEA screening each improved colorectal cancer recurrence detection, but combining the 2 strategies offered no additional benefit.
The coronary artery calcium (CAC) Agatston score is used to predict cardiovascular disease risk. However, some data suggest that increased plaque calcium density may be protective for cardiovascular disease (CVD). In a prospective cohort of 3398 patients who had CAC measurement and were free of known CVD at baseline, Criqui and colleagues found that CAC volume was positively and independently associated with incident CVD risk, whereas, at any level of CAC volume, plaque calcium density was inversely associated with CVD events. In an Editorial, Greenland discusses CAC measurement and CVD risk assessment.
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Patients with heterozygous inactivating glucokinase (GCK) mutations have mild fasting hyperglycemia from birth. In a cross-sectional study that involved 3 groups of middle-aged adults (99 GCK mutation carriers; 89 nondiabetic, familial, family members without a GCK mutation; and 83 patients with young-onset type 2 diabetes), Steele and colleagues found that despite having hyperglycemia for a median duration of 48 years, patients with a GCK mutation had a low prevalence of microvascular and macrovascular complications. In an Editorial, Florez discusses glycemic targets and complications in diabetes.
Recent advances in understanding the pathophysiology and natural history of diverticulitis have led to substantial changes in treatment guidelines. Morris and colleagues summarize recent literature (80 articles; published in 2000-2013) that addressed the pathophysiology and natural history of diverticulitis and medical and surgical management. Among the authors’ findings were that peritonitis and sepsis are uncommon complications of diverticulitis and that aggressive antibiotic or surgical intervention for chronic or recurrent disease is rarely warranted.
Related Article at jamasurgery.com and Continuing Medical Education
A recent article in JAMA Neurology reported magnetic resonance imaging evidence of early brain changes in healthy, typically developing infants who had no family history of Alzheimer disease but who were carriers of the apolipoprotein E (APOE) ε4 allele —the major susceptibility gene for late-onset Alzheimer disease. In this From the JAMA Network article, McDonald and Krainc discuss the neuroanatomical findings present in infancy and possible implications for development of Alzheimer disease in later life.
Highlights. JAMA. 2014;311(3):217–219. doi:10.1001/jama.2013.279276