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In This Issue of Archives of Internal Medicine
October 25, 2004

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2004;164(19):2083. doi:10.1001/archinte.164.19.2083

Comparative Benefits of Clopidogrel and Aspirin in High-Risk Patient Populations

Clopidogrel has been evaluated in clinical trials that included cardiovascular patients with different risk levels for a cardiovascular event. In this article, Hirsh and Bhatt reviewed the results of the Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events (CAPRIE) and Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trials, with special emphasis on comparing the outcomes in high-risk patients with those of the total populations in the trials. High-risk subgroups of patients participating in the CAPRIE and CURE studies were more responsive to the beneficial effects of clopidogrel compared with the study population as a whole. High-risk groups in the CAPRIE and CURE studies would be expected to derive enhanced benefit from treatment with clopidogrel over that achieved by acetyl salicylic acid.

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Postprandial Glucose Regulation and Diabetic Complications

Atherosclerotic disease accounts for much of the increased mortality and morbidity associated with type 2 diabetes mellitus. Epidemiological studies support the potential of improvedglycemic control to reduce cardiovascular complications. An association between glycosylated hemoglobin level and the risk for cardiovascular complications has frequently been reported. In this article, Ceriello and colleagues examine the hypothesis that controlling postprandial glucose level is an important strategy in the prevention of cardiovascular complications associated with diabetes.

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The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat

In the United States, obesity is a major clinical and public health problem causing diabetes, dyslipidemia, and hypertension, as well as increasing cardiovascular and total mortality. Dietary restrictions of calories and saturated fat are beneficial. However, it remains unclear whether replacement of saturated fat with carbohydrates (as in the US National Cholesterol Education Program [NCEP] diet) or protein and monounsaturated fat (as in our isocaloric modified low carbohydrate diet, which is lower in total carbohydrates but higher in protein, monounsaturated fat, and complex carbohydrates) is optimal. In this study, Aude and colleagues randomized patients to the NCEP diet or an isocaloric MLC diet lower in total carbohydrates but higher in protein, monounsaturated fat, and complex carbohydrates. Compared with the NCEP diet, the MLC diet caused significantly greater weight loss over 12 weeks.

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Prevalence of Heart Disease and Stroke Risk Factors in Persons With Prehypertension in the United States, 1999-2000

In the 30 years since the initiation of the National High Blood Pressure Education Program, the awareness, treatment, and control of high blood pressure (BP) have increased, but they remain suboptimal. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defines persons with above-optimal levels but not clinical hypertension as having “prehypertension.” Whereas numerous studies have noted the clustering or coexistence of clinically high risk factors and their relation to heart disease and stroke, few studies have examined the co-occurrence of risk factors in persons with above-optimal BP levels. In this study, Greenlund and colleagues examined data from a nationally representative sample of the US population to compare differences in the prevalence of concomitant heart disease and stroke risk factors in persons with normal BP, prehypertension, and hypertension. The greater prevalence of risk factors in persons with prehypertension vs normotension suggests the continued need for early clinical detection and intervention of prehypertension and comprehensive preventive and public health efforts.

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