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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2005;165(8):830. doi:10.1001/archinte.165.8.830.
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INCIDENTAL VERTEBRAL FRACTURES DISCOVERED WITH CHEST RADIOGRAPHY IN THE EMERGENCY DEPARTMENT

Vertebral fractures related to osteoporosis are common in the elderly and usually mandate aggressive secondary prevention with prescription medications, but current guidelines do not recommend routine screening for these fractures. Majumdar and colleagues examined the role that chest radiographs might have in opportunistic case findings by examining how common incidental vertebral fractures really are and exploring how commonly these fractures are officially recognized or treated with respect to osteoporosis.

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HEALTHY LIFESTYLE CHARACTERISTICS AMONG ADULTS IN THE UNITED STATES, 2000

The mounting clinical and epidemiological evidence of the benefits of following a healthy lifestyle are indisputable. We defined a healthy lifestyle as following a combination of the following 4 healthy lifestyle characteristics: nonsmoking, healthy weight (18.5 ≤ body mass index < 25 [calculated as weight in kilograms divided by the square of height in meters]), consuming 5 fruit and vegetable servings per day, and regular physical activity (≥30 minutes, ≥5 times per week). Using national data from more than 153 000 adults, the overall prevalence of following these 4 healthy lifestyle characteristics was only 3.0% (95% confidence interval, 2.8%-3.2%), with very little variation among subgroups (range, 0.8%-5.7%). These data illustrate that a healthy lifestyle is undertaken by a tiny fraction of adults in the United States and that no subgroup followed this combination to a level even remotely consistent with current clinical or public health recommendations.

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ASSOCIATION OF SLEEP TIME WITH DIABETES MELLITUS AND IMPAIRED GLUCOSE TOLERANCE

The cross-sectional relation of self-reported usual sleep time to diabetes mellitus (DM) and impaired glucose tolerance (IGT) was assessed in 1486 adult participants in the Sleep Heart Health Study. Median sleep time was 7 hours per night, with 27% of subjects sleeping 6 hours per night or less. Compared with those sleeping 7 to 8 hours per night, subjects sleeping 5 hours per night or less and 6 hours per night had adjusted odds ratios for DM of 2.51 and 1.66, respectively, after adjustment for age, sex, race, body habitus, and apnea-hypopnea index. Adjusted odds ratios for IGT were 1.33 and 1.58, respectively. Subjects sleeping 9 hours per night or more also had increased odds ratios for DM and IGT. These associations persisted when subjects with insomnia symptoms were excluded, suggesting that voluntary sleep restriction may contribute to the large public health burden of diabetes.

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ELEVATED BLOOD PRESSURE AND RISK OF END-STAGE RENAL DISEASE IN SUBJECTS WITHOUT BASELINE KIDNEY DISEASE

Many cases of kidney failure requiring dialysis or transplantation are believed to be due to high blood pressure (BP) damage. However, because early kidney disease itself can raise BP, some researchers remain skeptical about this, arguing that those with high BP who go on to develop kidney failure had underlying primary kidney disease to start with. This study found that even among patients who started without evidence for kidney disease—as assessed by estimated glomerular filtration rate or blood or protein in a dipstick urinalysis—those with higher BPs were more likely in the future to develop kidney failure. These data support the concept that high BP is a primary cause of kidney failure.

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RISK SCORES PREDICT ATHEROSCLEROTIC LESIONS IN YOUNG PEOPLE

The risk factors for adult coronary heart disease are associated with advanced coronary and aortic atherosclerosis in young people. This report presents risk scores to estimate the probability of advanced atherosclerotic lesions in young people aged 15 to 34 years using the following traditional coronary heart disease risk factors: age, sex, serum lipoprotein cholesterol concentrations, smoking, hypertension, obesity, and hyperglycemia. These risk scores discriminated well between subjects with and without lesions, and predicted lesion prevalence agreed with observed prevalence. Risk scores calculated from traditional risk factors identify young individuals with high probability of having advanced atherosclerosis years before the appearance of clinical disease.

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 Estimated probability of coronary artery target lesions.

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 Estimated probability of coronary artery target lesions.

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