In This Issue of Archives of Internal Medicine FREE

This study by Fraser and Shavlik, examines the effects of 5 health behaviors and body mass index (BMI) on life expectancy in subjects in the Adventist Health Study. Diet, exercise, BMI, past smoking habits, and hormone replacement therapy influenced life expectancy: Adventist men lived 7.28 years longer than non-Adventist men, and Adventist women lived 4.42 years longer.

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In this study, Krishnan et al studied 5062 adults with asthma enrolled in managed care organizations and assessed the relationship between race, sex, and asthma care. Compared with whites, significantly fewer African Americans reported care consistent with the National Asthma Education and Prevention Guidelines. Sex-specific differences were mixed.

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Mild hyperhomocysteinemia has been suggested to indicate an increased risk of cardiovascular disease. This study by Knekt et al focuses on serum homocysteine concentration as a predictor of coronary heart disease. The study was conducted as case-control study in a Finnish cohort of 3741 men. During a follow-up of 13 years, 166 major coronary events (defined as death from coronary heart disease or nonfatal myocardial infarction) occurred in men with evidence of heart disease at baseline and in 272 men without a previous history of heart disease. Among men with known heart disease at baseline, the risk of coronary events was 2-fold for those in the highest serum homocysteine quintile compared with those in the lowest quintile. Among the men free from baseline heart disease, no association was observed between serum homocysteine and the incidence of coronary events. This study suggests that mild hyperhomocysteinemia predicts secondary events rather than the incidence of coronary heart disease.

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Patients with asthma commonly have other medical problems, such as obesity, but it is unclear if obesity independently relates to asthma occurrence. Young and colleagues examined the association between asthma and obesity from January 1997 to December 1998 in this population-based prevalence case-control study of TRICARE region 11, a military managed care program encompassing Washington, Oregon, and northern Idaho. They compared 2788 patients with asthma and 39 637 controls, using logistic regression to estimate associations between asthma and body mass index (BMI), and variables such as demographics, lifestyle, and comorbid risk factors. They included a similar comparison in a verified substudy on the use of asthma medications. The results show that BMI, age, sex, beneficiary status, and arthritis are significant independent predictors of asthma prevalence in both the larger analysis and the verified substudy. Stomach ulcer, depression, hypertension, and white race were also independent predictors of asthma prevalence in the larger analysis.

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Qureshi et al determined the adequacy of risk factor modification among 1252 survivors of myocardial infarction (MI), stroke, or both in a nationally representative sample of US adults and identified factors contributing to inadequate control of risk factors. Among the 738 known hypertensive persons, hypertension was uncontrolled in 388 (53%). Previously undiagnosed hypertension was detected in 138 others (11%). Of the 1252 survivors, 225 (18%) were currently smokers. Hypercholesterolemia was poorly controlled in 185 (46%) of the 405 patients with known hypercholesterolemia. Undetected hypercholesterolemia was observed in 160 persons (13%). In the multivariate analysis, high-risk profiles (defined as presence of 2 or more poorly controlled risk factors) were more likely to be observed in persons aged 45 to 85 years, women, and African Americans. This report highlights the high prevalence of inadequate secondary prevention in the subset of the US population that is at the highest risk for stroke and MI. Considerable efforts are needed to effectively implement risk factor modification strategies after MI or stroke, particularly in middle-aged persons, African Americans, and women.

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