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This Week in JAMA
July 22 2009

This Week in JAMA

JAMA. 2009;302(4):349. doi:10.1001/jama.2009.1067

In a multicenter prospective cohort study, Mattsson and colleagues Article assessed the accuracy of several cerebrospinal fluid (CSF) biomarkers of Alzheimer disease—β-amyloid1-42, total tau protein, and phosphorylated tau—in predicting incipient Alzheimer disease in patients with mild cognitive impairment at baseline. The authors found that these 3 CSF biomarkers had good accuracy in identifying patients who progressed to Alzheimer disease during a median 3-year (range, 2-11 years) follow-up. However, Alzheimer disease prediction based on these biomarkers was less accurate than reported in single-center studies, and considerable intersite variability in assay results was observed. In an editorial, Petersen and Trojanowski Article discuss the applicability of these findings for research studies and clinical practice.

Two articles in this issue address the relationship between modifiable lifestyle factors and cardiovascular health. First, Djoussé and colleagues Article analyzed data from the Physicians' Health Study I to examine the association between healthy lifestyle habits and lifetime risk of heart failure. The authors found that not smoking, regular exercise, moderate alcohol intake, maintaining normal weight, and cereal, fruit, and vegetable consumption were associated with a lower lifetime risk of heart failure in male physicians. In the second article, Forman and colleagues Article report an analysis of data from the Nurses' Health Study II to assess the association between low-risk lifestyle factors and risk of incident hypertension in women. The authors found that modifiable factors—including body mass index less than 25, daily exercise, and components of a healthy diet—were associated with a significantly lower incidence of self-reported hypertension. In an editorial, Roger Article discusses the contribution of personal and societal choices to cardiovascular health.

Some evidence suggests an association between lipoprotein(a) (Lp[a]) and risk of coronary heart disease. To assess whether Lp(a) concentration is associated with the risk of other vascular diseases or nonvascular mortality, members of the Emerging Risk Factors Collaboration analyzed data from 36 prospective studies that recorded Lp(a) concentration and subsequent major vascular morbidity or cause-specific mortality. The investigators found continuous, independent, and modest associations of Lp(a) concentration with risk of coronary heart disease and stroke. Lipoprotein(a) concentration was not related to aggregate nonvascular mortality, including cancer and noncancer deaths.

Examinations received as part of research study participation may identify disease unrelated to the condition under study. Whether investigators have an obligation to address these ancillary findings—particularly in medically resource-poor settings—is unclear. In discussion of a research study that enrolled Malinese children with severe malaria, Dickert and Wendler Article review investigators' responsibilities to meet research participants' needs for ancillary care. A commentary by Hyder and Merritt Article discusses ancillary care responsibilities in public health research in low-resource settings.

“From my perspective, autism is not a developmental disorder but a unique developmental order.” From “Ashes in Eyes.”

The US Food and Drug Administration is taking steps to reduce drug-induced liver damage, including considering changes to the labeling and dosing of acetaminophen, a common cause of such injuries.

The trap of meaning

Public health action amid scientific uncertainty

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

Theme Issue on Violence and Human Rights

Join John Forman, MD, MSc, Wednesday, August 19, from 2 to 3 PM eastern time to discuss diet and lifestyle risk factors and incident hypertension in women. Register at http://www.ihi.org/AuthorintheRoom. Send questions to replies@jama-archives.org.

How would you manage a patient with skin cancer who experienced wrong-site surgery? Go to www.jama.com, read the case, and submit a response by August 9 for possible online publication.

For your patients: Information about mild cognitive impairment.

This article was corrected online for typographical errors on 7/21/2009.