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In This Issue of Archives of Internal Medicine
June 9, 2008

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2008;168(11):1134. doi:10.1001/archinte.168.11.1134

Smoking History and Cognitive Function in Middle Age From the Whitehall II Study

Sabia et al examined the association between smoking history and cognition among middle-aged individuals in the Whitehall II cohort study. They also estimated the risk of death and nonparticipation among smokers. Compared with those who had never smoked, current smokers had higher risk of poor memory (odds ratio, 1.37; 95% confidence interval, 1.10-1.73). The loss to follow-up was significant among smokers either through death or nonparticipation in cognitive testing. There was also evidence to suggest reduced risk of cognitive deficit (approximately 30%) among ex-smokers, possibly due to improvement in other health behaviors. These data suggest that public health messages on smoking should continue to target smokers at all ages.

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25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men

Vitamin D deficiency has been proposed to be involved in the development of atherosclerosis and coronary heart disease, but relatively few studies have examined whether plasma 25-hydroxyvitamin D (25[OH]D) concentrations are associated with risk of myocardialinfarction (MI). In the Health Professionals Follow-up Study, prediagnostic circulating levels of 25(OH)D were inversely associated with risk of MI in men, even after controlling for known cardiovascular risk factors including lipids. Men deficient in circulating 25(OH)D (≤15 ng/mL) were at increased risk of MI compared with those considered to be sufficient (≥30 ng/mL) in 25(OH)D (multivariate relative risk, 2.09; 95% confidence interval, 1.24-3.54; P = .02 for trend). This study provides further evidence that optimal levels of 25(OH)D should be at least 30 ng/mL.

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Interaction of Age With Lipoproteins as Predictors of Aortic Valve Calcification in the Multi-Ethnic Study of Atherosclerosis

Calcific aortic valve disease is a common feature of aging and is associated with significant increases in cardiovascular morbidity and mortality. Prior epidemiologic studies have reported low-density lipoprotein cholesterol to be a risk factor for this disease, but trials of statin therapy have shown mixed results. In this cross-sectional analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, Owens et al examine the interaction of age on the lipoprotein-associated risks of aortic valve calcification (AVC). Low-density lipoprotein cholesterol was found to be a risk factor only in those younger than 65 years (in whom AVC prevalence is very low), while the total cholesterol to high-density lipoprotein cholesterol ratio was associated with a moderate increase in AVC risk across the entire age spectrum of this cohort. These results suggest that the character of the atherogenic dyslipidemia associated with AVC may change with age and raise the possibility that statins alone may not be the optimal therapeutic option for AVC in those 65 years or older.

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Cyclooxygenase Selectivity of Nonsteroidal Anti-inflammatory Drugs and Risk of Stroke

From the prospective, population-based cohort of the Rotterdam study, Haag et al report on the association between nonsteroidal anti-inflammatory drug (NSAID) use and the risk of incident stroke and ascertain whether any observed association is restricted to cyclooxygenase (COX)-2–selective NSAIDs. A total of 7636 persons 55 years and older and free of stroke at baseline (1991-1993) were followed for incident stroke until September 2004. During 70 063 person-years of follow-up, 807 persons developed a stroke. Current users of nonselective (hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.22-2.44) and COX-2–selective NSAIDs (HR, 2.75; 95% CI, 1.28-5.95) had a greater risk of stroke, but this was not observed with COX-1–selective NSAID use (HR, 1.10; 95% CI, 0.41-2.97). The greater risk of stroke appears not to be limited to the use of COX-2–selective NSAIDs.

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Characterization of Resistant Hypertension

Resistant hypertension is a common clinical problem and greatly increases risk of target organ damage. Gaddam et al have prospectively compared 279 consecutive subjects with resistant hypertension with 53 controls and found that resistant subjects were characterized by high levels of plasma aldosterone, 24-hour urinary aldosterone, and brain-type and atrial natriuretic peptides. These findings suggest that increased aldosterone levels and related intravascular volume expansion in spite of ongoing treatment with thiazide diuretics may underlie resistance to antihypertensive therapy. Linear regression analysis showed that there is a correlation between urinary aldosterone and 24-hour urinary cortisol levels, suggesting that a common stimulus, such as corticotropin, may underlie the aldosterone excess in patients with resistant hypertension.

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