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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2003;163(4):391. doi:10.1001/archinte.163.4.391.
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TRENDS IN THE MORTALITY BURDEN ASSOCIATED WITH DIABETES MELLITUS

Trends in mortality associated with diabetes mellitus (DM) are unclear. Thomas et al analyzed population-based data from Rochester, Minn, to address this issue. The authors found that the percentage of 10 152 Rochester decedents who had DM increased by 48% between 1970 and 1994 and that mortality rates declined less dramatically for persons with DM (14%) than for persons without DM (21%). This increase in the mortality burden associated with DM is probably due to previously reported increases in DM incidence and to the smaller declines in mortality the authors observed for persons with DM relative to those without DM. These results highlight the need for effective DM prevention and treatment efforts.

COLON POLYP RECURRENCE IN A MANAGED CARE POPULATION

Using computerized medical encounter data, Yood and colleagues studied 8865 members of a large health maintenance organization 50 years or older who underwent a polypectomy from January 1, 1989, through December 31, 1999. About 50% of these patients were found to have recurrent polyps in the years following their initial polypectomy. However, only 52% of patients with initial polypectomies underwent additional colon screening during the study follow-up period. Among those who underwent additional screening, 50% were found to have a recurrent polyp detected within 3.9 years. These results suggest that in real-world clinical practice, there is a high risk of recurrence and low rate of additional screening, which may increase the risk of undetected recurrent polyps.

THE METABOLIC SYNDROME

Factors associated with an increased risk of developing coronary heart disease (CHD) tend to cluster in individuals and are referred to as the metabolic syndrome. To evaluate the prevalence and demographic lifestyle factors associated with the metabolic syndrome in a representative sample of US adults, data were evaluated from adults participating in the NHANES III conducted between 1988 and 1994. The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively. The age-specific prevalence was highest in Mexican Americans and lowest in black Americans of both sexes. The metabolic syndrome prevalence increased with body mass index (Figure). Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome. The metabolic syndrome is present in over 20% of the adult US population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variable, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of CHD prevention.

ACUTE MYOCARDIAL INFARCTION IN HUMAN IMMUNODEFICIENCY VIRUS–INFECTED PATIENTS

Matetzky et al describe the clinical courses of 24 human immunodeficiency virus (HIV)–infected patients with acute myocardial infarction. The patients were young (47 ± 9 years) and had a high prevalence of 3-vessel disease (76%). Their lipid profile was similar to the age- and sex-matched non-HIV–infected patients with acute myocardial infarction, irrespective of treatment with protease inhibitors. Their in-hospital course was relatively benign: none died and 83% had revascularization procedure before discharge. During the 14 ± 8 months of follow-up, the HIV-infected patients had a high rate of reinfarction and rehospitalization for recurrent coronary event, 20% and 45%, respectively.

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