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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.
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.
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.
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.
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.
Scientists are exploring the clinical potential of a gene-silencing
technique called RNA interference.
Health risks for US immigrants visiting friends and relatives in other
countries are reviewed and risk reduction strategies are suggested.
Recent trends in the diagnosis and treatment of severe acute pancreatitis.
Spirituality and medicine.
For your patients: Information about pancreatitis.
This Week in JAMA. JAMA. 2004;291(23):2787. doi:10.1001/jama.291.23.2787