In This Issue of Archives of Internal Medicine

To determine the contribution of heredity to erectile dysfunction (ED), a classic twin study was conducted in the Vietnam Era Twin Registry. Information on 2 self-report measures of ED, difficulty in having an erection and difficulty in maintaining an erection, were gathered from 890 monozygotic and 619 dizygotic pairs. The estimated heritability of liability for dysfunction in having an erection is 35% and in maintaining an erection is 42%. Adjustment for established ED risk factors did not appreciably alter the estimated heritabilities. This study demonstrates an ED-specific genetic component that is independent of genetic influences on known ED risk factors.

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Some form of national health insurance is inevitable, if for no other reason than the almost exponentially increasing costs of practice and malpractice insurance, and with that, the rapidly increasing number of American citizens who are uninsured or significantly underinsured. Unfortunately, any such program will likely cause the federal government to exercise such massive control over the medical profession that it will be reduced to de facto employee status. The only feasible way to avoid this consequence is for the profession itself to assume the necessary resolve and initiative to develop a national health insurance program that addresses the financial problems while fully sharing responsibility with the government.

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Twenty-four Massachusetts hospitals pilot tested a collaborative cardiovascular secondary prevention quality improvement approach. The program integrates quality improvement and communication features through the use of an interactive, Web-based Patient Management Tool for data collection and online feedback. Physician champions and hospital teams working collaboratively were able to implement data collection and system change at the point of care. Significant improvement in the use of secondary cardiovascular prevention guidelines in a diverse group of hospitals was produced in less than 1 year.

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The authors analyzed statin use and fracture rates in 4 large prospective studies and performed a cumulative meta-analysis of published and unpublished observational studies and clinical trials. After adjustment for multiple factors, including age, body mass index, and estrogen use, there was a trend toward fewer hip fractures and, to a lesser extent, nonspine fractures among statin users in each of the 4 prospective studies. The meta-analysis of observational studies was consistent with these findings. The meta-analysis of clinical trial results did not support a protective effect with statin use. The authors conclude that observational studies suggest that the risk of hip and nonspine fracture is lower among older women taking statin medications for hyperlipidemia, but post hoc analyses of cardiovascular trials do not.

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Low-fat, high–complex carbohydrate diets have been recommended to prevent obesity and promote weight loss; however, the efficacy of these diets consumed with no overt attempt at energy restriction remains controversial. In a randomized 14-week intervention trial, Hays et al compared the influence of a control diet, a low-fat, high–complex carbohydrate diet, and a low-fat, high–complex carbohydrate diet plus exercise on body weight and composition in 34 individuals aged 56 to 78 years. None of the groups significantly reduced their total energy intake over time. The 2 groups consuming the low-fat, high–complex carbohydrate diet lost more weight and percent body fat compared with controls. High carbohydrate intake did not result in decreased resting metabolic rate or reduced fat oxidation. These results show that a reduction in dietary fat without overt energy restriction or change in energy intake is an effective means of promoting weight loss in overweight individuals.

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