Pharmacotherapy of Autism Spectrum Disorder: Results from the Randomized BAART Clinical Trial.

The objective of this trial, Biomarkers in Autism of Aripiprazole and Risperidone Treatment (BAART), was to provide support and guidance for an evidence-based approach for the selection and monitoring of initial pharmacotherapy in patients with autism by assessing predictors of efficacy, tolerability, and safety. This randomized double-blind parallel-group study was conducted in three academic medical centers and a single private pediatric practice. Eighty children or adolescents (aged 6-17 yrs) with autistic disorder were enrolled, and 61 patients were randomized to the study drug. Of those patients, 51 completed the 10-week trial, and 31 completed an optional 12-week blinded extension phase. All patients were treated with 2 weeks of placebo before random assignment to receive aripiprazole (31 patients) or risperidone (30 patients) for 10 weeks. Sixteen placebo responders (20%) were excluded from further analysis. Drug dosing followed U.S. Food and Drug Administration (FDA) labeling, and weekly dosage adjustments were allowed until week 4; patients were then maintained on a fixed dose for 6 additional weeks. Safety, physical, and psychological assessments were recorded weekly or every 2 weeks. No significant differences in severity of illness between the aripiprazole and risperidone groups were noted at baseline. All patients significantly improved on the Aberrant Behavior Checklist-Irritability subscale after 1 week and continued for the remaining 9 weeks and the extension phase. Improvement was greatest in the risperidone group at every assessment period and was statistically significantly better than that in the aripiprazole group at weeks 3 and 6 (p<0.05). No dose-limiting adverse events occurred during the dose-titration period. Mean weight gain in the aripiprazole group was significantly less than that in the risperidone group at week 4 (0.62 vs 1.38 kg, p=0.033) and week 10 (1.61 vs 3.31 kg, p<0.001), but the difference became nonsignificant for the 31 patients completing the 3-month extension phase (4.36 vs 5.55 kg, p=0.26). Pharmacotherapy of patients with autism spectrum disorder resulted in behavioral improvement within 1 week and lasted at least 22 weeks. Weight gain occurred to a greater degree with risperidone than aripiprazole initially, but the differences became nonsignificant by the end of the trial. Our trial supports previous results of drug efficacy and safety in patients with autism spectrum disorder from other trials and extends the evidence-based support for choosing an FDA-approved drug for initial pharmacotherapy for autism spectrum disorder.

Gender differences in traumatic event exposure and mental health among veteran primary care patients.

OBJECTIVE: This study evaluated gender differences in lifetime traumatic events, PTSD, and depression among VA primary care patients. METHOD: Participants were 865 adults attending primary care at one of four VA health centers (n = 681 males, 184 females). RESULTS: Mental health findings included: male PTSD 12.3% vs. female PTSD 9.2% (p > 0.05); male depression 15.9% vs. female depression 29.3% (p < 0.001). Men reported more war zone exposure (p < 0.001). Women reported more physical and sexual victimization (p < 0.001). Male logistic regression equations determined PTSD was associated with disability (OR = 3.42; 1.74-6.72, 95% CI) and war zone exposure (OR = 7.14; 3.82-13.30, 95% CI); depression was associated with war zone exposure (OR = 2.27; 1.40-3.68, 95% CI) and interpersonal violence (OR = 1.75; 1.10-2.79, 95% CI). Female PTSD was associated with sexual victimization (OR = 4.50; 1.20-16.80, 95% CI); depression was not predicted. CONCLUSIONS: We discuss findings in terms of the crucial need to improve identification and management of PTSD within VA primary care settings.

Aripiprazole brain concentration is altered in P-glycoprotein deficient mice.

P-glycoprotein (P-gp) is a transporter that mediates the tissue disposition of numerous drugs. To evaluate the role of P-glycoprotein (P-gp) in aripiprazole tissue distribution and penetration across the blood-brain barrier, mice deficient in the P-gp gene (Abcb1a/b-/-) were dosed intraperitoneally with 2 microg/g mouse of the antipsychotic drug aripiprazole. Wildtype FVB mice were administered the same dose as transgenic animals. At one, two, and three hours after dosing, blood and tissue samples were collected and assayed for aripiprazole concentration by HPLC. Deficiency of P-gp did not result in significantly altered plasma drug concentrations but had dramatic effects on drug concentrations in brain tissue. At 1, 2, and 3 h after dosing, aripiprazole brain concentrations in the Abcb1a/b-/- mice were 4.6-, 4.1- and 3.0-fold higher, respectively (P<0.01), compared with the wildtype mice. Increases in drug concentration were also observed in testes and muscle in Abcb1a/b -/- mice. All other tissues including gut, lung, heart, kidney, liver, and spleen did not show significant differences between the two groups. These data provide evidence that aripiprazole is a transportable substrate of P-gp. Thus, factors influencing P-gp activity within the blood brain barrier in humans may have implications for the therapeutic effects and tolerability of aripiprazole.

Variation in L-arginine intake follow demographics and lifestyle factors that may impact cardiovascular disease risk.

Little is known regarding the patterns of dietary intake of the amino acid L-arginine in the general population and, particularly, whether intake varies according to race or the presence of cardiovascular risk factors. This study is an analysis of adults 18 years and older who participated in the Third National Health and Nutrition Examination Survey, a national public-use nutrition survey of noninstitutionalized persons. Mean arginine intake for the US adult population was 4.40 g/d, with 25% of people consuming less than 2.6 g/d. Minorities, obese individuals, and people with diabetes consumed more arginine per 4.19 kJ than people without those characteristics. Whites had consistently lower intake than African Americans and Hispanics. Smokers had lower intake than nonsmokers. After adjustment for demographic factors and energy intake, women and smokers remained more likely to be in the lowest quartile of arginine consumption. Hypertension status was not significantly related to arginine consumption. In conclusion, L-arginine intake varies according to demographic and cardiovascular risk factors in the population. These results may have implications for cardiovascular risk.

Factors influencing physician referrals of patients to clinical trials.

PURPOSE: Initial trials in the NIH Parkinson's disease (PD) network (NET-PD) included 91% Caucasian non-Latino patients, although PD is thought to be as common among African Americans and Latinos. Our purpose was to assess physicians' attitudes and beliefs about patient recruitment, particularly minorities, into clinical trials. METHODS: We surveyed 200 physicians from areas near the NET-PD clinics with > or =40% African Americans or Latinos. Physicians were asked about attitudes toward research, likelihood of referring patients to PD trials and past research participation, and administered the Trust in Medical Researchers Scale (TIMRS). Using logistic regressions, we identified physician characteristics associated with patient referral to clinical trials. RESULTS: The TIMRS was lower among African-American physicians and physicians with high proportions of minority patients. Likelihood of trial referral was associated with previous referral to trials (OR=4.24, 95% CI: 2.09-8.62) and higher TIMRS (OR=1.06, 95% CI: 1.001-1.12). TIMRS results were similar among physicians not previously referring to trials. CONCLUSIONS: Study results emphasize the importance of developing a trusting relationship with local physicians if investigators expect these physicians to refer their patients to clinical trials. The trust-related barriers for minority-serving physicians, regardless of their own race/ethnicity, seem to mirror the trust-related issues for their minority patients.

Impact of the foundations of clinical medicine course on USMLE scores.

BACKGROUND: The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations. OBJECTIVES: We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores. DESIGN: In 2001-2002, all third year students met weekly in groups of 8-12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases. PARTICIPANTS: Students completing USMLE step 2 between 1999 and 2004 (n = 743). MEASUREMENTS: Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders. RESULTS: Students' average course evaluation score rose from 66 to 77 (2001-2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002-2004; n = 361) mean step 2 scores topped pre-FCM (1999-2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002). CONCLUSIONS: A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.

Adopting moderate alcohol consumption in middle age: subsequent cardiovascular events.

PURPOSE: Moderate alcohol use is part of a healthy lifestyle, yet current guidelines caution nondrinkers against starting to drink alcohol in middle age. The purpose of this study was to evaluate whether adopting moderate alcohol consumption in middle age would result in subsequent lower cardiovascular risk. METHODS: This study examined a cohort of adults aged 45-64 years participating in the Atherosclerosis Risk in Communities study over a 10-year period. The primary outcome was fatal or nonfatal cardiovascular events. RESULTS: Of 7697 participants who had no history of cardiovascular disease and were nondrinkers at baseline, within a 6-year follow-up period, 6.0% began moderate alcohol consumption (2 drinks per day or fewer for men, 1 drink per day or fewer for women) and 0.4% began heavier drinking. After 4 years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently nondrinking counterparts. This difference persisted after adjustment for demographic and cardiovascular risk factors (odds ratio 0.62, 95% confidence interval, 0.40-0.95). There was no difference in all-cause mortality between the new drinkers and persistent nondrinkers (odds ratio 0.71, 95% confidence interval, 0.31-1.64). CONCLUSION: People who newly begin consuming alcohol in middle age rarely do so beyond recommended amounts. Those who begin drinking moderately experience a relatively prompt benefit of lower rates of cardiovascular disease morbidity with no change in mortality rates after 4 years.

Effect of psyllium fiber supplementation on C-reactive protein: the trial to reduce inflammatory markers (TRIM).

PURPOSE: Recent evidence supports a significant association between the intake of dietary fiber and levels of inflammatory markers. The objective of this study was to determine whether daily fiber supplementation would reduce levels of inflammatory markers. METHODS: This study was a prospective randomized controlled trial at a single university medical center. Participants were overweight or obese adults with no history of heart disease. The intervention was psyllium supplementation at either 7 or 14 g/d for 3 months compared with no supplements in a control group. The main outcome measure was change in level of high-sensitivity C-reactive protein (hsCRP) concentration; secondary outcomes included changes in interleukin-6 (IL-6) levels, fibrinogen levels, and white blood cell (WBC) count. Protocol completers attended at least 2 visits and took more than 75% of the prescribed fiber dose. RESULTS: In this intent-to-treat analysis (n = 158), there were no significant differences between either of the 2 treatment groups and the control group in the amount of change in CRP, fibrinogen, or IL-6 levels or in WBC count (P>.05). In the analysis of protocol completers (n = 132), there also were no significant differences between the groups except for a small decrease in fibrinogen level in the high-fiber group (-6 mg/dL [-0.18 micromol/L] compared with 13 mg/dL [0.38 micromol/L] in the control group, P<.05). CONCLUSION: Psyllium fiber supplementation did not significantly reduce CRP levels in overweight or obese individuals in this trial, and changes in other markers were not consistent. Further research is needed to determine whether other fibers or nutrients can reduce inflammatory markers.

Acculturation and healthy lifestyle among Latinos with diabetes.

PURPOSE: Latinos have a high prevalence of diabetes and disproportionately experience diabetic complications. We sought to examine the association of acculturation on healthy lifestyle habits among the Latino population in the United States with diabetes. METHODS: We studied Latino adults (aged >or=20 years) with previously diagnosed diabetes in the 1999-2004 National Health and Nutrition Examination Survey (unweighted N = 467; weighted N = 1,957,778). Healthy lifestyle habits were those consistent with recommendations of the American Diabetes Association (ADA) regarding exercise, smoking, obesity, and diet. Acculturation was measured with the Short Acculturation Scale, a validated 5-item scale assessing use of the Spanish language. Logistic regression analyses of acculturation and healthy behaviors were computed controlling for access to care, demographics, and disease characteristics. RESULTS: In bivariate analyses, compared with their less-acculturated counterparts, individuals who were more-acculturated to any extent were less likely to have a higher fiber intake (9.4% vs 35.4%, P = .001) and lower saturated fat intake (17.2% vs 46.5%, P = .03). More-acculturated individuals were more likely to report leisure time exercise (59.2% vs 19.3%, P <.001), whereas the proportion of individuals who smoked did not differ. In logistic regression analyses using the 1994 ADA dietary guidelines, more-acculturated individuals were less likely than their less-acculturated counterparts to meet dietary criteria for saturated fat consumption (odds ratio, 0.13; 95% confidence interval [CI], 0.04-0.41). When using the stricter 2006 ADA dietary guidelines, more-acculturated individuals were less likely to have recommended consumption of both saturated fat (odds ratio, 0.06; 95% CI, 0.02-0.20) and fiber (odds ratio, 0.19; 95% CI, 0.08-0.48). Acculturation did not significantly influence exercise and smoking status in logistic regression analyses. CONCLUSIONS: These results suggest that acculturation among diabetic Latinos to the general US culture is associated with adoption of some less desirable dietary habits.

Inpatient care in a community hospital: comparing length of stay and costs among teaching, hospitalist, and community services.

INTRODUCTION: Specific patient care measures and cost of hospitalization are being studied as health care providers and payers are seeking methods to improve the hospital care of patients. This study's purpose was to examine the length of stay and cost of inpatient care by a family medicine teaching service in comparison with the hospitalists' and community physicians' services in the same community hospital. METHODS: We analyzed inpatient admissions to either a family medicine teaching service (FMTS), hospitalist physician group, or the patient's own primary care community physician in a 290-bed, for-profit, community hospital over a 12-month period. Outcome variables investigated included length of stay, fixed costs, variable costs, and readmission rate. RESULTS: A total of 5,453 hospital admissions were analyzed. Patients admitted to the FMTS experienced a significantly shorter length of stay and had significantly lower fixed, variable, and total costs per admission. No significant differences in readmission rates were noted. CONCLUSIONS: The care provided by a teaching service as indicated by length of stay, costs, and readmission rates compared favorably with the care provided by other physicians.

Prenatal care initiation among pregnant teens in the United States: an analysis over 25 years.

PURPOSE: To examine changes in the initiation of prenatal care by teenage girls in the United States between 1978 and 2003. METHODS: Using birth certificate data collected by the National Center for Health Statistics from 1978, 1983, 1988, 1993, 1998, and 2003 we described initiation of prenatal care in preteens (aged 10-14 years), young adolescents (aged 15-16), and older adolescents (aged 17-19) by the trimester in which care began. RESULTS: Although all three age groups showed trends toward earlier prenatal care, shifts to earlier prenatal care were mainly the result of more girls starting care in the first trimester and fewer in the second trimester. Younger teens were more likely to delay prenatal care or to receive no prenatal care for every year studied. Less education and prior births were also associated with increased likelihood of receiving delayed care. CONCLUSIONS: Shifts in timing of prenatal care initiation occurred in the U.S from 1978 to 2003. Much of the change corresponded to expanded eligibility in Medicaid coverage, suggesting that lack of health care coverage was a significant impediment to early prenatal care.

Factors affecting research participation in African American college students.

BACKGROUND AND OBJECTIVES: African American participation in research trials must increase. This study evaluates factors affecting participation of African American college students in medical research. METHODS: A total of 200 students attending South Carolina State University (SCSU), a historically black college, completed surveys evaluating the likelihood of participation within 6 months in three types of noninvasive research studies (surveys with or without questions regarding sensitive information and collection of DNA with a buccal swab). Likelihood of participation by investigator's race (African American, white, Asian) or institution (SCSU, historically black college, predominantly white college, government) was compared with Wilcoxon signed-rank tests. Logistic regressions evaluating likelihood of participation included gender, Trust in Medical Researchers Scale score, prior participation, and family/friend participation. RESULTS: Fewer respondents would participate in a survey asking about sensitive information than would provide DNA. Respondents were more likely to participate in a study if conducted by a historically black college or African American investigator. Respondents with more trust and without prior participation were more likely to participate. Just more than half of respondents (52.0%) stated that their physician's encouragement would increase their likelihood of participation. CONCLUSIONS: Collaboration with African American investigators, historically black colleges, and community physicians may improve African American participation. Trust in researchers and participant's past research experience should also be considered.

Influence of residency training on procedures performed by South Carolina family medicine graduates.

BACKGROUND AND OBJECTIVES: Guidelines regarding procedure training in family medicine residencies are nonspecific. This study describes procedure practices of South Carolina family medicine residency graduates. METHODS: Of 1,416 surveys mailed to graduates of South Carolina Area Health Education Consortium (SC AHEC) family medicine residency programs, 144 were undeliverable. A total of 717 respondents (response rate 56.4%) were stratified by community size and year of graduation. Percentage performing 18 procedures (from a list developed by SC AHEC program directors) and stating lack of training affected their procedural practice was compared using chi square tests. Logistic regressions evaluating procedure performance included year of graduation, community size, region of country, and gender as independent variables. RESULTS: Joint aspiration/injection (81%), skin biopsy (81%), and Intensive Care Unit (ICU) care (48%) were the most common procedures. Physicians in smaller communities were more likely to perform joint aspiration/injection, skin biopsy, ICU care, and respirator management while recent graduates were more likely to perform exercise stress testing, ICU care, and respirator management. Lack of training was a common reason not to perform esophagogastroduodenoscopy, colonoscopy, nasopharyngoscopy, and vasectomy. CONCLUSIONS: Increasing performance of exercise stress testing and ICU care by recent graduates and reported lack of training for several outpatient procedures may reflect evolving roles for family physicians. New residency training modalities may improve training for these roles.

Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the United States.

BACKGROUND: Recent debate suggests that general racial/ethnic categories may obscure potentially important subgroup differences within minority groups. The purpose of this study was to examine the quality of diabetes care among ethnic subgroups of the Latino population in the United States while accounting for aspects of acculturation and access to care. METHODS: We evaluated adults (> or =18 years old) with previously diagnosed diabetes in the 2003 National Health Interview Survey (n = 2136; United States population estimate = 13,471,587). The Latino subgroups (n = 373; United States population estimate = 1,556,259) were Mexicans, Puerto Ricans, and Other Latinos. Through a series of logistic regressions we examined ethnic group and quality of care for diabetes while controlling for demographics, access to care, and acculturation. RESULTS: Among Latinos, 43% conducted their interview in Spanish and 59% were immigrants to the United States. Ethnic group differences were apparent in the analyses. In a logistic regression analysis including all Latinos, with Puerto Ricans as the reference group, Mexicans (odds ratio, 0.24; 95% CI, 0.07-0.85) and Other Latinos (odds ratio, 0.15; 95% CI, 0.04-0.58) were significantly less likely to have only one doctor for their diabetes care. Mexicans were less likely than Puerto Ricans (odds ratio 0.39; 95% CI, 0.18- 0.84) to know about glycosylated hemoglobin. Similarly, among Latino immigrants, Mexicans (odds ratio, 0.13; 95% CI, 0.02-0.81) and Other Latinos (odds ratio, 0.09; 95% CI, 0.01-0.63) were significantly less likely than Puerto Ricans to have only one doctor for their diabetes care and management. Measures of acculturation and immigration were not independent predictors of diabetes quality of care. CONCLUSIONS: Differences in diabetes management exist between Latino ethnic subgroups; treating Latinos in the United States as one homogenous category may be a barrier to the appropriate provision of care.

Use of statins and blood pressure.

BACKGROUND: Markers of inflammation such as high-sensitivity C-reactive protein (CRP) were shown to be elevated in patients with hypertension. Small trials using statin therapy showed blood-pressure (BP) reductions, but it is unknown whether this association extends to larger populations. The objective of this study was to determine whether statin use was associated with better blood-pressure control in adults with hypertension and whether inflammation levels mediated this relationship. METHODS: This was a cross-sectional study of 2584 hypertensive adults aged >or=40 years with no known cardiovascular disease from the National Health and Nutrition Examination Survey 1999-2002. Logistic regression models were calculated to determine whether there was an association between statin use and blood-pressure control. C-reactive protein was added to the full model to determine its impact on the association. RESULTS: Compared with people not using statin medication, significantly more statin users had their blood pressure under control (52.2% v 38.0%). After adjustment for demographic factors, statin users were two times (95% confidence interval [CI], 1.46 to 2.72) more likely to have their blood pressure under control (<140/90 mm Hg) than nonusers. After further adjustment for body mass index, diabetes, smoking, exercise, low-salt diet, and antihypertensive medications, the likelihood of having blood pressure under control remained more likely among statin users (odds ratio, 1.46; 95% CI, 1.05 to 2.05). The association between statin use and lower BP was most evident among participants who used antihypertensive medication as well as statins and was unchanged with the addition of CRP to the model. CONCLUSIONS: Statin use was associated with a BP level <140/90 mm Hg in a representative sample of US adults with hypertension. Levels of CRP did not attenuate the association. Further studies are needed to explore the effects of statin use on blood pressure and to determine how best to apply this knowledge in clinical care.

Psychosocial factors and progression from prehypertension to hypertension or coronary heart disease.

PURPOSE: This study explored the influence of trait anger and long-term psychological stress on progression to hypertension and incident coronary heart disease (CHD) in persons with prehypertension. METHODS: A secondary data analysis was performed using the Atherosclerosis Risk in Communities (ARIC) study, a cohort of men and women aged 45 to 64 years at enrollment. Participants with blood pressures in the prehypertension range at the second visit conducted between 1990 and 1992, free of heart disease or stroke, and observed through the end of the ARIC study (1996-1998) were included (N = 2,334). The main outcomes were progression from prehypertension to hypertension and prehypertension to CHD or CHD death. RESULTS: After adjusting for various covariates, high levels of trait anger, compared with low/moderate levels (odds ratio [OR] 1.53; 95% confidence interval [CI], 1.05-2.24), were associated with progression from prehypertension to hypertension. After stratifying on sex, trait anger was predictive for men only (OR 1.71; 95% CI 1.04-2.83). In survival analysis, trait anger was associated with progression to CHD for men (hazard ratio [HR] 1.92; 95% CI, 1.07-3.54). Long-term psychological stress was also associated with risk of incident CHD (HR 1.68; 95% CI 1.18-2.40). CONCLUSIONS: High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD. Long-term stress was also associated with increased risk of incident CHD in both men and women.

Insulin resistance in adolescents.

OBJECTIVES: To investigate the relationship of other body mass index (BMI) ranges with Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), a surrogate marker for insulin resistance in adolescents. STUDY DESIGN: Cross-sectional analysis of a nationally representative sample of 1837 nondiabetic, nonpregnant 12 to 19 year old persons from the National Health and Nutrition Examination Survey, 1999-2002. The main outcome measurement of insulin resistance was calculated as HOMA-IR > 3.16. RESULTS: Having a BMI > or = 75th percentile is associated with a high HOMA-IR levels. As the BMI percentile increases, the odds of high HOMA-IR levels increase (BMI percentile 75-84.9, OR 4.277, 95% CI 2.090-8.752; BMI percentile 85-94.9, OR 4.299, 95% CI 2.158-8.563; BMI > or = 95th percentile, OR 17.907, 95% CI 11.360-28.228). CONCLUSION: Adolescents with BMI percentile of 75 to 84.9, which represents approximately 1.2 million US adolescents, have not previously been identified as having higher HOMA-IR levels.

Turning back the clock: adopting a healthy lifestyle in middle age.

PURPOSE: To determine the frequency of adopting a healthy lifestyle (5 or more fruits and vegetables daily, regular exercise, BMI 18.5-29.9 kg/m2, no current smoking) in a middle-aged cohort, and determine the subsequent rates of cardiovascular disease (CVD) and mortality among those who adopt a healthy lifestyle. METHODS: We conducted a cohort study in a diverse sample of adults age 45-64 in the Atherosclerosis Risk in Communities survey. Outcomes are all-cause mortality and fatal or non-fatal cardiovascular disease. RESULTS: Of 15,708 participants, 1344 (8.5%) had 4 healthy lifestyle habits at the first visit, and 970 (8.4%) of the remainder had newly adopted a healthy lifestyle 6 years later. Men, African Americans, individuals with lower socioeconomic status, or a history of hypertension or diabetes were less likely to newly adopt a healthy lifestyle (all P <.05). During the following 4 years, total mortality and cardiovascular disease events were lower for new adopters (2.5% vs 4.2%, chi2P <.01, and 11.7% vs 16.5%, chi2P <.01 respectively) compared to individuals who did not adopt a healthy lifestyle. After adjustment, new adopters had lower all-cause mortality (OR 0.60, 95% Confidence Interval [CI], 0.39-0.92) and fewer cardiovascular disease events (OR 0.65, 95% CI, 0.39-0.92) in the next 4 years. CONCLUSIONS: People who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality. Strategies to encourage adopting healthy lifestyles should be implemented, especially among people with hypertension, diabetes, or low socioeconomic status.

Magnesium intake and serum C-reactive protein levels in children.

The objective of this study was to determine whether magnesium consumption is associated with inflammation (C-reactive protein [CRP]) in children. The study was an analysis of child (age 6-17 years) participants in the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES). Children consuming less than 75% of RDA were 1.94 times more likely (p < 0.05) to have elevated serum CRP levels than children consuming above the RDA. In adjusted analyses controlling for demographics, cardiovascular risk factors, and BMI, children with consumption of less than 75% RDA were 58% more likely to have elevated CRP (OR 1.58, 95% CI 1.07-infinity). Children with intakes below the RDA are more likely to have elevated CRP levels.

Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk.

Obesity is a risk factor for cardiovascular disease, whereas high cardiorespiratory fitness (CRF) is cardioprotective. This study evaluated the competing effect of weight and fitness on biomarkers of cardiovascular risk in a nationally representative sample of 2,112 adults (20 to 49 years of age; body mass index [BMI] > or =18.5 kg/m(2)) without previously diagnosed cardiovascular disease from the National Health and Nutrition Examination Survey 1999 to 2002. CRF levels were assigned using age- and gender-specific reference points of estimated maximal oxygen consumption calculated from submaximal graded exercise treadmill testing. CRF was also categorized by sample-specific tertiles of maximal oxygen consumption. Weight was categorized using BMI. Fasting insulin level >12.2 mU/L, C-reactive protein level > or =3.0 mg/L, and total cholesterol/high-density lipoprotein ratio (TC/HDL) >5 characterized increased cardiovascular risk. CRF and BMI were independently associated with increased fasting insulin and C-reactive protein (p <0.05). When patients with low, moderate, and high CRF were further stratified as normal, overweight, or obese, weight remained significantly associated with increased fasting insulin, C-reactive protein, and TC/HDL (p <0.001), but CRF did not. Logistic regressions evaluating increased fasting insulin, C-reactive protein, and TC/HDL demonstrated no significant differences in overweight/obese patients by CRF level after adjustment for other factors. Significant differences were present between normal-weight and overweight or obese patients regardless of fitness level. Analyses using tertiles of CRF yielded similar results. In conclusion, patients who are "fat but fit" require weight-loss interventions to improve their cardiovascular risk profiles. Future interventions should emphasize weight control, even for those with high CRF.