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In This Issue of Archives of Internal Medicine
Octomber 12, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(18):1648. doi:10.1001/archinternmed.2009.331

Major Depression and Coronary Flow Reserve Detected by Positron Emission Tomography

Major depression has been associated with coronary heart disease, but the mechanisms are unclear. Coronary microvascular disease represents a proatherosclerotic state with substantial prognostic value. This study examined whether depression affects coronary microvascular function. Middle-aged, predominantly healthy male twins underwent myocardial perfusion imaging with positron emission tomography and myocardial blood flow quantitation and measurement of coronary flow reserve in response to adenosine, a measure of overall coronary vasodilator capacity. The results indicate a relation between depression and coronary microvascular dysfunction that is largely due to a shared genetic substrate. These data suggest that common pathophysiological processes link depression and early atherosclerosis.


Glucocorticoid Use and Risk of Atrial Fibrillation or Flutter

Glucocorticoid use is associated with cardiovascular disease, but data are limited on the risk of atrial fibrillation or flutter (AF/FL). Christiansen et al examined the impact of systemic glucocorticoid use on the risk of AF/FL in a large, population-based case-control study including 20 221 patients with AF/FL and 202 130 controls. Current glucocorticoid use was associated with increased risk of AF/FL (adjusted odds ratio [OR], 1.92; 95% confidence interval [CI], 1.79-2.06) compared with never use, and the association was even stronger in new users (adjusted OR, 3.62; 95% CI, 3.11-4.22). The increased risk remained robust in patients with and without pulmonary and cardiovascular diseases. Former glucocorticoid use was not associated with an increased risk of AF/FL (adjusted OR, 1.00; 95% CI, 0.96-1.06). Physicians should be aware of the almost 2-fold increased risk of AF/FL in glucocorticoid users.


Neighborhood Resources for Physical Activity and Healthy Foods and Incidence of Type 2 Diabetes Mellitus

The neighborhood people live in might play a role in their risk of developing type 2 diabetes mellitus (T2DM). Auchincloss et al examined whether neighborhood resources that support being physically active and having a healthy diet are associated with incidence of T2DM during 5 years of follow-up in a large and diverse population-based sample. The authors found that residents of neighborhoods with more favorable resources had lower T2DM incidence. Findings from this study are consistent with the hypotheses that improving neighborhood features such as having nearby, pleasant, safe destinations to walk to and improving the availability of healthy foods may be viable population-level strategies for addressing T2DM.


Medical and Psychosocial Diagnoses in Women With a History of Intimate Partner Violence

Intimate partner violence (IPV) affects as many as 4 in 10 women during their lifetime. This study characterized the relative risk of clinically identified diagnoses in women aged 18 to 64 with a past-year history of IPV (n = 242) compared with never-abused women (n = 1686). Compared with never-abused women, women with a history of IPV in the past year had a pronounced increased risk of receiving psychosocial/mental health diagnoses—with an almost 6-fold increase in risk of clinically identified substance abuse and nearly 5-fold increase in family and social problems, a 3-fold increase in depression, and a 2-fold increase in anxiety/neuroses and tobacco use. Abused women also had a more than 3-fold increase in risk of receiving a diagnosis of sexually transmitted disease, as well as significantly increased risk of headaches, contusions/abrasions, lacerations, abdominal pain, urinary tract infections, chest pain, and numerous diagnoses within the category of musculoskeletal conditions.


New-Onset Breast Tenderness After Initiation of Estrogen Plus Progestin Therapy and Breast Cancer Risk

Menopausal estrogen plus progestin therapy is associated with both increased incidence of breast tenderness and increased risk of breast cancer. This study analyzed data from participants of the Women's Health Initiative Estrogen plus Progestin Clinical Trial, a randomized trial of daily conjugated equine estrogens, 0.625 mg, plus medroxyprogesterone acetate, 2.5 mg, or placebo in postmenopausal women. Breast tenderness was reported on questionnaires at baseline and at 12 months, and breast cancer incidence was recorded for an average of 5.6 years. Among the women who were assigned to active treatment, those who reported the new onset of breast tenderness (NOBT) at the 12-month follow-up visit had approximately a 1.5-fold increased risk of breast cancer compared with women who did not have NOBT at the 12-month follow-up visit. The authors conclude that NOBT during the use of conjugated equine estrogens, 0.625 mg, plus medroxyprogesterone acetate, 2.5 mg, may identify women at elevated breast cancer risk.