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In This Issue of Archives of Internal Medicine
February 9, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(3):216. doi:10.1001/archinternmed.2008.575

The Rising Prevalence of Chronic Low Back Pain

This study presents population-based telephone survey data from 1992 and 2006 on the prevalence of chronic low back pain in adults 21 years and older and on the demographic, health-related, and care-seeking characteristics of individuals with the condition. Results indicate that the prevalence of chronic low back pain more than doubled in the 14-year period. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health of those with chronic low back pain were similar for both years, while the proportion of individuals who sought care increased slightly.

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Continuation of Statin Treatment and All-Cause Mortality

To investigate the effectiveness of persistence with statin therapy in reducing all-cause mortality among primary prevention and secondary prevention patients, Shalev et al retrospectively followed up 229 918 new statin users for more than 9 years. In both primary prevention and secondary prevention cohorts, high continuity of treatment with statins conferred a substantial reduction in risk of death compared with patients with low continuity. A stronger risk reduction was calculated among patients with a baseline low-density lipoprotein level of 190 mg/dL or higher and patients initially treated with high-efficacy statins. Overall, the authors conclude that better continuity with statin treatment produced a clear reduction in all-cause mortality among patients with and without a known history of cardiovascular diseases.

See See page 260

Contemporary Trends in Dyslipidemia in the Framingham Heart Study

Dyslipidemia, with increased triglyceride and decreased high-density lipoprotein cholesterol levels, is a common accompaniment of obesity and a recognized cardiovascular risk factor. Although recent cross-sectional studies have reported an increase in obesity (and a decrease in cholesterol levels) in the US population, these studies have reported no change in levels of dyslipidemia. In contrast, during this same period (from the years 1991 to 2001) in sequential examinations conducted in the Framingham Offspring population there has been a significant decrease in triglyceride levels and a significant increase in high-density lipoprotein cholesterol levels. This reduction in dyslipidemia was observed in men and women alike and has occurred despite an overall increase in obesity. This unexpected and potentially favorable trend in lipid levels is currently unexplained but may be related to populationwide changes in the quality of diets that could favor increased catabolism of triglyceride-rich lipoproteins.

See See page 279

Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts

Neuhouser et al investigated multivitamin use and disease risk in the Women's Health Initiative (WHI), a large study of 161 808 postmenopausal women participating in either a set of clinical trials or an observational study. Of the WHI participants, 41.5% used multivitamins, but after a median of 8.0 years of follow-up in the clinical trials and a median 7.9 years in the observational study, there was no evidence that multivitamins confer meaningful benefit or harm in relation to cancer or cardiovascular disease. The risk for invasive cancers of the breast, colon/rectum, endometrium, lung, bladder, and ovary was no different among women who used multivitamin compared with those who did not use multivitamins. Similarly, risk of myocardial infarction, stroke, venous thrombosis, and death from any cause was no different for multivitamin users than for nonusers. Multivitamins do not appear to be effective for the prevention of cancer or cardiovascular disease.

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Smoking and Weight Change After New Health Diagnoses in Older Adults

Smoking and patterns of diet and activity are the top underlying causes of mortality, yet the reasons people adopt healthier habits are not well understood. Using panel survey data on older adults, Keenan found that smokers with recent diagnoses of stroke, cancer, lung disease, heart disease, or diabetes mellitus were 3.2 times more likely to quit smoking, and overweight or obese individuals with recent diagnoses lost 0.35 U of body mass index (calculated as weight in kilograms divided by height in meters squared), relative to those without new conditions (P < .001). Across a range of conditions, new diagnoses can serve as a window of opportunity to prompt older adults to change health habits, particularly to quit smoking. Quality improvement efforts targeting secondary prevention are likely to be well founded.

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