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This Week in JAMA |

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JAMA. 2004;292(20):2439. doi:10.1001/jama.292.20.2439.
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OBESITY AND NEW-ONSET ATRIAL FIBRILLATION

Experimental and clinical data suggest that obesity is associated with atrial enlargement and ventricular dysfunction, but it is not known whether obesity is a risk factor for atrial fibrillation (AF). Wang and colleaguesArticle used longitudinal data from the Framingham Heart Study to examine the association between body mass index and the risk of developing AF. They found that overweight and obese men and women had an increased risk of developing AF compared with normal-weight study participants. In an editorial, CoromilasArticle discusses the public health significance of obesity as a risk factor for AF.

GUILLAIN-BARRÉ SYNDROME AND FLU VACCINATION

Guillain-Barré syndrome (GBS) has been the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS). Haber and colleagues reviewed VAERS data from 1990 through June 2003 to evaluate trends in GBS reports following influenza vaccination in adults. They found that annual reports of GBS have declined significantly, from a high of 0.17 per 100 000 vaccinees in 1993-1994 to 0.04 per 100 000 vaccinees in 2002-2003. The authors suggest that the timing of GBS relative to influenza vaccination and low prevalence of preexisting illnesses support a causal assocation between GBS and influenza vaccine rather than a decline in reporting.

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DIET, ENERGY EXPENDITURE, AND CARDIAC RISK

Physiological adaptations to weight loss, including a decline in resting energy expenditure (REE), have been documented; however, it is not known whether diet composition mediates these effects. Pereira and colleagues conducted a randomized trial to test the effect of an energy-restricted diet—either low-fat or low–glycemic load—on REE and cardiovascular disease risk factors in 39 overweight or obese adults. The authors found that compared with those on the low-fat diet, participants consuming the low–glycemic load diet experienced less decline in REE and more favorable changes in cardiovascular disease risk factors.

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EFFECTIVENESS OF MENINGOCOCCAL MASS IMMUNIZATION

During a 2001 outbreak of meningococcal disease in Quebec, Canada, a mass immunization campaign using a new protein-polysaccharide conjugate meningococcal vaccine was conducted. To assess vaccine effectiveness De Wals and colleagues conducted a population-based observational study of cases of invasive serogroup C meningococcal disease from 1996 through 2002. Vaccine coverage following the immunization campaign was high (82.1% of eligible persons) and the number of cases of serogroup C meningococcal disease decreased by more than half in the year following vaccination.

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CARDIOVASCULAR COMPLICATIONS IN DIABETES

Overall cardiovascular disease (CVD) mortality has declined in recent decades, but it is not clear whether adults with diabetes have experienced similar declines in CVD risk. Fox and colleagues analyzed data from the Framingham Heart Study and offspring cohorts to compare rates of incident CVD events in persons with and without diabetes during the years 1950-1966 with rates in 1977-1995. The authors found a 50% reduction in the rate of incident CVD events for adults with diabetes similar to the reduction documented in persons without diabetes during the later period.

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MEDICAL NEWS & PERSPECTIVES

Stem cells derived from umbilical cord blood are being used to treat a variety of malignancies and genetic disorders. But despite its usefulness as a therapeutic and research tool, cord blood is usually discarded as waste at delivery.

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OWNERSHIP AND USE OF TISSUE

Hakimian and Korn review legal, regulatory, and ethical issues in human tissue research.

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CLINICIAN’S CORNER

Carrozza and SellkeArticle discuss the case of a 69-year-old woman with angina pectoris and left main coronary artery disease (CAD) who is deciding whether to have a stenting procedure or coronary artery bypass graft surgery. In a commentary, McNuttArticle reviews the importance of facilitating patients’ informed medical decision making.

JAMA PATIENT PAGE

For your patients: Information about coronary heart disease.

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