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Patients with heart failure have increased plasma concentrations of the vasoconstrictor peptide endothelin-1, which has been associated with worse clinical outcomes. In the Value of Endothelin Receptor Inhibition With Tezosentan in Acute Heart Failure Studies (VERITAS), 1448 patients with acute heart failure were randomly assigned to receive either tezosentan or placebo. Change in dyspnea over 24 hours and the incidence of death or worsening of heart failure at 7 days were assessed. McMurray and colleagues, writing for the study investigators, report that tezosentan offered no benefit vs placebo for these clinical outcomes.
Some evidence suggests that today's obese population is healthier than the obese population in the 1960s. To assess whether such health improvement is associated with a reduced risk of disability, Alley and ChangArticle analyzed self-reported functional limitations in mobility and the performance of 3 activities of daily living (ADLs) among participants aged 60 years and older in the National Health and Nutrition Examination Surveys for 1988-1994 and 1999-2004. The authors found that functional impairment among obese individuals increased 5.4% and ADL impairment did not change between 1988-1994 and 1999-2004. In contrast, among normal-weight individuals there was no change in functional impairment, and ADL limitations declined. In an editorial, Gregg and GuralnikArticle discuss the long-term effects of obesity on disability.
In a prior study, Flegal and colleagues found that compared with individuals of normal weight, those who were underweight or obese had significantly increased risks of all-cause mortality and that overweight individuals had a decreased risk. To further explore these associations, the authors analyzed national data on mortality and body mass index (BMI) for adults 25 years and older and calculated cause-specific excess deaths associated with underweight, overweight, and obesity. The authors report cause-specific excess deaths by BMI levels for cardiovascular disease, cancer, and all other causes in 2004.
To update the estimated prevalence of chronic kidney disease (CKD) in the United States, Coresh and colleagues analyzed data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys and assessed the contributions of diabetes, hypertension, and obesity to changes in CKD prevalence. The authors report that between 1988-1994 and 1999-2004, the prevalence of CKD increased from 10% to 13%. This increase in prevalence was partly explained by the increasing prevalence of diabetes and hypertension among individuals 20 years and older.
Mr P, a 63-year-old man with multiple cardiovascular risk factors, has been poorly adherent to suggested medical regimens for more than 20 years. Bodenheimer discusses a 5-step process for the practice of evidence-based medicine and the responsibilities of physicians, health care systems, and patients to ensure the benefits of evidence-based medicine are realized.
“We all use defense mechanisms to deal with pain, and mine was intellectualization.” From “Teddy.”
Ongoing research to detect tumor-specific DNA in the blood may help improve diagnostic testing for cancer.
Global strategies for tobacco control
New era of cardiovascular disease epidemiology
Monitoring improvement in patient safety
Join R. Monina Klevens, DDS, MPH, November 21 from 2 to 3 PM eastern time to discuss invasive methicillin-resistant Staphylococcus aureus infections. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
How would you manage a 93-year-old man with advanced dementia and eating problems? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication with the article. Submission deadline is November 28.
For your patients: Information about assessing disability.
This Week in JAMA . JAMA. 2007;298(17):1977. doi:10.1001/jama.298.17.1977