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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(6):564.
Long-term Effects of Weight-Reducing Interventions in Hypertensive Patients
In patients with essential hypertension, weight loss is recommended as a first-step intervention to reduce blood pressure (BP). In this meta-analysis of randomized controlled trials of different weight loss interventions in hypertensive patients, Horvath et al found that therapy with dietary interventions or with orlisat resulted in a reduction of BP and body weight. A reduction of body weight of approximately 4 kg was necessary to achieve a reduction in systolic BP of approximately 6 mm Hg with dietary treatment and of approximately 2.5 mm Hg with orlistat. Even though sibutramine use reduced body weight, it did not lower or might even elevate BP. However, none of the studies provided data to answer the question of whether risk for mortality or other patient-relevant complications of hypertension can be lowered by weight reduction.
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Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation
Noheria et al systematically reviewed the literature for randomized trials looking at atrial tachyarrhythmia recurrence-free survival among patients treated with catheter ablation techniques for atrial fibrillation compared with the conventional antiarrhythmic drug therapy. A meta-analysis of 4 randomized trials involving 432 patients showed that the risk of surviving a year without recurrent atrial tachyarrhythmia was 3.73 (95% confidence interval, 2.47-5.63) times more likely with catheter ablation than with antiarrhythmic drug therapy. However, only 70% of the patients who underwent ablation (150 of 214) had a 1-year atrial tachyarrhythmia recurrence-free survival.
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Relations of Thyroid Function to Body Weight
Overt hypothyroidism and hyperthyroidism may be associated with weight gain and loss. Fox et al assessed whether variations in thyroid function within the normal range are associated with body weight over 3.5 years of follow-up in the Framingham Heart Study. At baseline, adjusted mean weight increased progressively from 64.5 kg to 70.2 kg in the lowest to highest thyrotropin (TSH) quartile (P < .001 for trend) and from 82.8 kg (lowest) to 85.6 kg (highest quartile) in men (P = .007 for trend). Baseline TSH concentration was not associated with weight change during follow-up. However, an increase in TSH concentration at the follow-up examination was positively associated with weight gain in women (weight gain of 0.5-2.3 kg across increasing quartiles of TSH concentration change; P < .001 for trend) and men (weight gain of 0.4-1.3 kg across quartiles of TSH concentration change; P = .007 for trend). Thyroid function (as assessed by serum TSH concentration) within the normal physiological range is associated with body weight. These findings raise the possibility that modest increases in serum TSH concentration within the normal range may be associated with weight gain.
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Colonoscopy Screening in African Americans and Whites With Affected First-Degree Relatives
In this study, data from 41 830 participants enrolled in the Southern Community Cohort Study were analyzed, and the proportion of colonoscopy procedures in individuals with family histories of colon cancer was determined and then compared by race. In participants with multiple affected first-degree relatives or relatives whose conditions were diagnosed before age 50 years, 27.3% (95% confidence interval [CI], 23.5%-31.1%) of African Americans reported a colonoscopy within the past 5 years compared with 43.1% (95% CI, 37.0%-49.2%) of white participants (P < .001). In these individuals, African Americans had an adjusted odds ratio of 0.51 (95% CI, 0.38-0.68) of having undergone recommended screening procedures compared with white participants. African Americans with strong family histories of colon cancer were less likely to undergo colonoscopy screening compared with whites.
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Definition of Kidney Dysfunction as a Cardiovascular Risk Factor
Data from the Gubbio Population Study show that in middle-aged men and women, urinary albumin excretion and estimated glomerular filtration rate provide complementary information for cardiovascular risk assessment because they cluster in different individuals and predict cardiovascular disease independently of each other. Concomitant evaluation of both markers should be considered to adequately assess kidney dysfunction and cardiovascular risk.
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Kaplan-Meier plot of incident cardiovascular events in individuals aged 45 to 64 years. UAE indicates urinary albumin excretion; eGFR, estimated glomerular filtration rate.
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