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This Week in JAMA
June 16, 2004

This Week in JAMA

JAMA. 2004;291(23):2787. doi:10.1001/jama.291.23.2787
Influences of Genetic Variation on Statin Therapy

Disparate responses to 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) therapy may be related to genetic variation in the drug targets. Chasman and colleaguesArticleconducted a DNA analysis for polymorphisms in 10 candidate genes related to lipid metabolism in a cohort of patients with hypercholesterolemia treated with pravastatin and then examined for changes in lipid levels in relation to genetic makeup through 24 weeks of therapy. They identified 2 single-nucleotide polymorphisms in the HMG-CoA reductase gene that were significantly associated with reduced efficacy of pravastatin. Individuals heterozygous for this variant had smaller reductions—22% in total cholesterol and 19% in low-density lipoprotein cholesterol—than individuals who were homozygous for the allele. In a commentary,ArticleHaga and Burke discuss the value of pharmacogenetic investigations to improve the safety and efficacy of drug treatment.

Overweight and Obesity in the United States

Two articles in this issue of JAMA address overweight and obesity in the United States. In the first, Ebbeling and colleaguesArticlereport results of 2 investigations of fast food intake in overweight and lean adolescents. They found that when served an "extra-large" fast food meal and told to eat as much as desired, overweight adolescents ate significantly more than their lean counterparts, both in terms of absolute energy intake and relative to their daily energy requirement. In an assessment of total energy intake during 2 days with and 2 days without fast food, overweight adolescents consumed more calories on days with fast food than on days without. In contrast, their lean counterparts had virtually the same total energy intake each day, suggesting that lean individuals "compensate" when eating fast food by reducing their energy intake the rest of the day. In a second article, Hedley and colleaguesArticleanalyzed data from 2 cycles of a national health survey and found no changes in the prevalence of overweight and obesity among children, adolescents, or adults from the survey years 1999-2000 and 2001-2002.

Laser Treatment for Acne

Investigators have reported a reduction in acne lesions and improvements in skin appearance after various types of laser treatments. To explore the potential efficacy of nonpurpuric pulsed dye laser treatment for acne, Orringer and colleagues conducted a randomized, split-face controlled clinical trial comparing lesion counts at baseline through 12 weeks on the treated and untreated sides of the face and changes in acne severity relative to baseline. Evaluators who were blind to treatment assignment found no significant reductions in lesion count or acne severity following laser treatment.

Licensure Laws and Elderly Driver Fatalities

Elderly drivers are at high risk of motor vehicle fatalities, and it is not known whether state-level licensure laws reduce fatalities among older drivers. Grabowski and colleagues analyzed US fatal crashes from 1990 through 2000 in relation to state laws requiring in-person renewal, vision tests, road tests, and frequent renewal cycles. Only in-person license renewal was related to a significantly lower fatality rate among drivers aged 85 years and older. For drivers between the ages of 65 and 84 years, none of the licensure requirements studied was associated with a lower fatality rate.

Genetic Risk of Atrial Fibrillation

Rare cases of familial atrial fibrillation (AF) have been reported, but whether parental AF increases the risk for its development in offspring is not known. Fox and colleagues reviewed data from the Framingham Offspring Study to address this question and found that development of new-onset AF in the offspring was associated with AF in a parent.

Medical News & Perspectives

Scientists are exploring the clinical potential of a gene-silencing technique called RNA interference.

(Photo credit: Nature Publishing Group)
Travel Medicine

Clinical Review
Health risks for US immigrants visiting friends and relatives in other countries are reviewed and risk reduction strategies are suggested.

Clinician's corner

Recent trends in the diagnosis and treatment of severe acute pancreatitis.

(Photo credit: Nature Publishing Group)

Spirituality and medicine.

JAMA Patient Page

For your patients: Information about pancreatitis.