ShortCuts-This week in the Journals

May 29, 2007

The big bomb this past week was the Rosiglitazone Effect. Resulting in front page news in various newspapers (on multiple days), the meta-analysis in last week’s NEJM is causing quite the stir. For more information, see the post.

What’s old is what’s new. An interesting editorial on Medpage reviewed the reason that HCTZ is the most commonly prescribed thiazide, and it’s not efficacy. HCTZ is 4 letters and takes a second to write on a pad, chlorthalidone is 14 letters and, while possibly the better agent (see accompanying article), takes a good bit longer to write on a prescription. Earlier this month in the NEJM was a terrific review on sodium and potassium regulation in the kidney – and it brings home the importance of conscientious potassium supplementation in a modern diet that tends to be significantly depleted of such. It also offers a theoretical explanation for the possibility, that adding a K+ sparing agent to a diuretic enhances the M&M efficacy of the diuretics.

This week’s Lancet focuses on the various international nutritional issues facing the modern world. A lead article focuses on the benefit of supplementing cereals in the third world with high dose NaFeEDTA – supplementation, which modestly reduced Fe deficiency anemia as compared to supplementation with electrolytic Fe therapy or no supplementation at all. On the other end of the spectrum, a review article reports on the available evidence in adolescents with type 2 Diabetes that suggests that this group may be at increased risk for early complications from this disease.

The WHO released its 2007 compendium of health statistics. Among the highlights: Life expectancy at birth in 2005 ranged from 37 in Sierra Leone to 80 in San Marino for men, and from 37 in Swaziland to 86 in Japan for women. U.S. life expectancy was 75 for men and 80 for women. The leading causes of death in 2030 are projected to be cancers, ischemic heart disease, stroke, HIV/AIDS, and chronic obstructive pulmonary disease. Tobacco-related deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030. According to 2005 data, ten percent of the world’s children under age 5 years of age suffer wasting as a result of malnutrition. In 2004, the world spent $4.1 trillion on health. In 2002, depression accounted for 4.5% of the total burden of disease worldwide.

The New York Times has the latest in the series of Six Killers in America (heart disease, cancer, stroke, chronic obstructive pulmonary disease, diabetes and Alzheimer’s disease). Worth noting because patient’s questions are often correlated with NY times articles…A conference report from the American Academy of Neurology presented an early finding of the BASIC study: a significantly increased risk for siblings of previous stroke sufferers (and that this risk is even more notable for Mexican-Americans). Because this is a population based study, potential confounders were not controlled for. More hopefully, a new analysis of the SPARCL study documents a significant decrease in risk of second stroke in patients who had a rapid decrease in serum LDL (each 10% decrease in LDL decreased the risk of ischemic stroke by 4%).

-Sean Cavanaugh MD, Associate Editor Clinical Correlations

Image courtesy of Wikimedia Commons