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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2009;169(6):542. doi:10.1001/archinternmed.2009.37.
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Meat intake in relation to total mortality and deaths due to cancer, cardiovascular disease, unintentional injury and sudden death, and other causes were evaluated in a study of half a million people aged 50 to 71 years. There were 47 976 male deaths and 23 276 female deaths during 10 years of follow-up. Men and women in the highest vs lowest quintile of red and processed meat intake had modest elevated risks for overall mortality, as well as cancer and cardiovascular disease deaths. In contrast, there was an inverse association for total mortality and cancer mortality, as well as deaths due to other causes, for both men and women in the highest quintile of white meat intake. These results complement the recommendations by the American Institute for Cancer Research and the World Cancer Research Fund to reduce red and processed meat intake to decrease cancer incidence. Future research should investigate the relation between subtypes of meat and specific causes of mortality.

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Studies suggest that hypertriglyceridemia may be an independent risk factor for cardiovascular disease. However, the prevalence of hypertriglyceridemia and its treatment among US adults remains incompletely characterized. The data from a national sample of US participants collected from 1999 through 2004 show that 33% of adults had a triglyceride concentration of 150 mg/dL or higher and 18% had a concentration of 200 mg/dL or higher. Sizeable percentages of participants with hypertriglyceridemia were overweight or obese, currently smoking, and inadequately active. Only 1.3% of adults reported being treated with fenofibrate, gemfibrozil, or niacin.

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Established risk factors for pancreatitis include alcohol use and gallstone disease, factors that are both associated with smoking. In this prospective cohort study comprising 9573 women and 8332 men, Tolstrup et al show that smoking is associated with the risk of pancreatitis independently of alcohol use and gallstones. For example, the hazard ratio of developing pancreatitis was 2.6 (95% confidence interval, 1.5-4.7) among women and 2.6 (95% confidence interval, 1.1-6.2) among men who smoked 15 to 24 cigarettes per day. These results imply that smoking should be considered a risk factor for pancreatitis that is just as important as alcohol use and gallstone disease.

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Although a positive family history of venous thrombosis (VT) suggests the presence of genetic risk factors, family history and known genetic risk factors correspond poorly. In addition, it is not known whether family history is of additional value in predicting an individual's risk once a genetic risk factor is identified. Bezemer et al studied the family history and known risk factors for VT among 1605 patients with a first VT and 2159 control subjects participating in the Multiple Environmental and Genetic Assessment of risk factors for VT (MEGA study). Individuals with a positive family history had a more than 2-fold increased risk of VT and up to a 4-fold increased risk when more than 1 relative was affected. Family history was a risk indicator both in those with and without known genetic or environmental risk factors. A positive family history represents increased susceptibility due to unknown or unmeasured risk factors, on top of the risk due to known factors. In clinical practice, family history may therefore be more useful for risk assessment than thrombophilia tests.

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The red blood cell distribution width (RDW), an automated measure of red blood cell size heterogeneity routinely performed as part of a complete blood cell count, is often overlooked except in the evaluation of anemia. Based on new provocative but limited data suggesting that the higher RDW may be associated with mortality risk, Perlstein et al examined the association of RDW with mortality in a nationally representative survey, the National Health and Nutrition Examination Survey. Among 15 852 participants followed up for a mean of 8.7 years, the authors found that higher RDW strongly and independently predicted all-cause mortality, as well as cardiovascular, cancer, and chronic lung disease mortality. These data suggest that a better understanding of RDW may offer unique and broad pathophysiologic insights into disease and that consideration of RDW may provide a novel means of patient risk assessment.

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