ShortCuts-This Week in the Journals

July 30, 2007

Commentary by Henry Tran, MD

This week we will be highlighting a few articles examining risk factors for the development of obesity & the metabolic syndrome, a treatment for hypertrophic cardiomyopathy, and hospital rankings.

Many people think that soft drink consumption has been a major contributing factor to the global epidemic of obesity.  So is there an association between drinking soda and metabolic risk factors for heart diseases?  A study by Dhingra et al. published online by Circulation examined a cohort of patients enrolled in the Framingham Heart Study (6039 person, 3470 women, average age 52.9, 100% white).  The authors found that people who drank >1 soda a day had a higher risk of developing the metabolic syndrome (abdominal obesity, high triglycerides, low HDL, increased blood pressure, and impaired glucose tolerance) than people who drank <1 soda a day.  It did not matter if participants reported drinking diet or regular soda; either kind of soda consumption increased the risk of developing the metabolic syndrome. The reason for this increased risk remains unclear, although additional dietary and lifestyle confounders likely played a role.  Therefore this study raises provocative questions about the physiologic mechanisms behind the development of obesity and the metabolic syndrome.

Your best friend just bought a new BMW, which makes you want to get a new German car as well.  What if your best friend becomes obese, does that make you more likely to be obese?  A very interesting published by the New England Journal Medicine examined the development and spread of obesity in the Framingham Offspring Study.  By using known social and familial relationships documented on questionnaires, the researchers of the study were able to construct a social network.   The study found that if a subject had a friend who became obese, the subject’s likelihood of becoming obese increased by 57%.  Similarly if a subject’s spouse became obese, the risk of the other spouse becoming obese increased by 37%.  This same relationship was not observed between neighbors. 

JAMA reported a study on the use of ICD’s for the prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM).  The study was a retrospective analysis of a register of 503 patients with HCM.   They found that 20% of the patients had an appropriate intervention by the ICD (5.5% per year).  They also found that 27% had an inappropriate shock.  Fortunately this study validated general clinical practice and affirmed the protective benefits of ICD in these high risk patients, both for primary prevention and secondary prevention.

And finally, US News & World Report released their annual “Best Hospitals” rankings for 2007.  This year’s version ranks 173 hospitals in 16 different specialties, such as endocrinology, digestive disease, and cancer.  The magazine also ranked 18 centers as being in the “honor roll” for having high scores in six different specialties.  Many hospital leaders dismiss these ranking as being disproportionately dependent on a hospital’s reputation- the general public loves to read these rankings.   So take a look for your favorite medical center in the rankings, you might be surprised!

One Response to ShortCuts-This Week in the Journals

  1. Zackary Berger on July 30, 2007 at 2:29 pm

    When I look at the Circulation study, I don’t think of provocative questions about physiologic mechanisms. I think “Unmeasured confounders!” I would imagine that soft drink consumption (like the metabolic syndrome) has a lot to do with socioeconomic class. Difficult to measure, but it’s still a pity that this isn’t to be found among the covariates. Interesting result, though.

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