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Two articles in this issue of JAMA report results
from 2 randomized clinical trials that investigated the efficacy of 2 interventions
to improve outcomes following acute ST-segment elevation myocardial infarction
(STEMI). In the first article, investigators from the Clinical Trial of Reviparin
and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation
(CREATE)Article report the effect of reviparin, a low-molecular-weight
heparin, initiated within 12 hours of symptom onset and added to usual therapy,
on mortality, myocardial reinfarction, or stroke at 7 and 30 days. Compared
with patients receiving placebo, patients receiving reviparin had less mortality
and reinfarction and no significant increase in stroke risk. The second trial,
CREATE–Estudos Cardiológicus Latinoamérica (CREATE-ECLA),Article
tested the efficacy of a high-dose glucose-insulin-potassium
infusion compared with placebo to reduce mortality, cardiac arrest, and cardiogenic
shock in patients with acute STEMI. No benefit from the infusion was demonstrated.
In an editorial, CaliffArticle discusses the implications of these results for clinical
care and clinical trial design.
Sodium Channel Defect in Dilated Cardiomyopathy
Previous research has identified several gene defects associated with
dilated cardiomyopathy. Olson and colleaguesArticle report
their findings of heritable mutations in the gene encoding the cardiac sodium
channel, SCN5A, present in patients with dilated
cardiomyopathy and associated with susceptibility to early-onset dilated cardiomyopathy
and atrial fibrillation. In an editorial, Adler and FusterArticle discuss sodium channel physiology and the pathophysiology of idiopathic cardiomyopathies
and atrial fibrillation.
Obesity, Weight Gain, and Risk of Kidney Stones
Some investigators have reported an association of large body size with
an increased risk of kidney stones, but the specific contributions of weight,
weight gain, and body mass index (BMI) have not been described. Taylor and
colleagues assessed the relationship of body size—reflected in weight,
weight change, BMI, and waist circumference—to incident symptomatic
kidney stones in participants in 3 large prospective studies of health professionals.
After adjusting for age, dietary factors, fluid intake, and thiazide use,
they found that obesity, weight gain since early adulthood, and higher waist
circumference were associated with an increased risk of incident kidney stones.
In analyses by sex, they found the magnitude of risk may be greater in women
Exposure to Infant Siblings and Risk of MS
Living with siblings may increase the likelihood of early life infections,
and there is some evidence that early life infections may protect against
the development of multiple sclerosis (MS). Ponsonby and colleagues conducted
a case-control study to assess whether exposure to infant siblings in the
first 6 years of life is associated with the risk of MS. They found that increasing
duration of contact with siblings younger than 2 years in the first 6 years
of life was associated with a reduced risk of MS.
Medical News & Perspectives
New insights into the factors that give rise to Parkinson disease are
improving scientists’ understanding of the disorder and pointing to
novel therapeutic approaches.
Surfactant in Pediatric Acute Lung Injury
Endotracheal installation of exogenous surfactant improved oxygenation
and decreased mortality in pediatric acute lung injury.
Chest pain in women with normal or nonobstructive coronary angiograms
is not as benign as commonly thought.
Chronic Disease Care
Casalino discusses the disease management model for chronic disease
care and the Center for Medicare & Medicaid Services’ disease management
JAMA Patient Page
For your patients: Information about multiple sclerosis.
This Week in JAMA . JAMA. 2005;293(4):397. doi:10.1001/jama.293.4.397
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