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In This Issue of Archives of Internal Medicine
February 27, 2006

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2006;166(4):387. doi:10.1001/archinte.166.4.387

Transitions Between Frailty States Among Community-Living Older Persons

Frailty is increasingly recognized as a geriatric syndrome, distinct from disability and comorbidity, but relatively little is known about its natural history. In this prospective study, which included assessments of frailty at 18-month intervals among 754 community-living older persons, Gill et al found that frailty is a dynamic process, characterized by frequent transitions between frailty states over time. Transitions to states of greater frailty were more common than transitions to states of lesser frailty, and the probability of transitioning from being frail to nonfrail was very low, even over an extended period. These results suggest ample opportunity for the prevention and remediation of frailty.

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Neutropenia in Human Immunodeficiency Virus Infection

The Women's Interagency HIV Study (WIHS) examines the characteristics of human immunodeficiency virus (HIV) in women. Levine et al studied the correlates of neutropenia in the HIV-infected women enrolled in the WIHS and found that development of neutropenia was associated with worsening HIV disease parameters, such as increasing HIV viral load and decreasing CD4 cell count. Improvements in HIV disease parameters were associated with resolution of neutropenia, as was the use of highly active antiretroviral therapy. In addition, the use of highly active antiretroviral therapy without zidovudine was associated with protection against developing neutropenia. Neutropenia was not associated with decreased survival among HIV-infected women.

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Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women

The aim of the study was to investigate the association of incident metabolic syndrome with the progression of carotid intima-media thickness, a noninvasive measure of atherosclerosis, during 12 years in 101 women aged 60 to 70 years at baseline. The results show that incident metabolic syndrome is associated with accelerated progression of carotid atherosclerosis in elderly women, independent of traditional risk factors.

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Cocoa Intake, Blood Pressure, and Cardiovascular Mortality

Short-term intervention studies show that large amounts of dark chocolate and cocoa drinks improve endothelial function and reduce blood pressure (BP), but results of observational studies have not been published thus far. In this population-based study conducted in 470 Dutch elderly men, the intake of cocoa from the habitual consumption of cocoa-containing foods was investigated cross-sectionally with BP and prospectively with cardiovascular mortality. Buijsse et al report that cocoa intake is related to an approximately 3.5 mm Hg lower systolic and 2.0 mm Hg lower diastolic BP. After 15 years of follow-up, comprising 314 deaths, cocoa intake was also associated with a 45% to 50% lower risk of cardiovascular and all-cause mortality. This study suggests that habitual daily intake of cocoa reduces both BP and the risk of death from cardiovascular diseases and all causes.

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Contribution of Infection to Increased Mortality in Women After Cardiac Surgery

Women have a greater risk of in-hospital mortality compared with men after coronary artery bypass graft surgery. Rogers et al examined the role of infection in this relationship by following 9218 Michigan Medicare beneficiaries hospitalized for cardiac surgery. They obtained information regarding infection at any site using International Classification of Diseases, Ninth Revision codes and assessed mortality in the 100-day period after the date of surgery. Women were more likely than men to have an in-hospital infection. However, the risk of death with infection was greater in men than in women. Using population attributable risk, the authors show how these 2 opposing, underlying associations contribute to the overall excess number of deaths in women.

Percentage of deaths attributable to female sex by length of stay and by adjustment for infection. 

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