Obesity and the Risk of Heart Failure

Extreme obesity is a risk factor for heart failure. This analysis from the Framingham Heart Study assessed the risk associated with lesser degrees of obesity and overweight. There was a continuous increase in the risk of heart failure with increases in the body-mass index (an increase in risk of 5 percent for men and 7 percent for women for each increment of 1 in the body-mass index). Obesity accounts for about 11 percent of heart failure among men and 14 percent among women in the Framingham population.

Obesity may increase the risk of heart failure by virtue of its relation to established risk factors, such as hypertension, diabetes, and hyperlipidemia, but obesity may also have a direct negative effect on myocardial function.

Related Editorial

Risperidone in Children with Autism and Serious Behavioral Problems

Serious behavioral problems in children with autism are common and difficult to manage. Atypical antipsychotic medications are effective in treating adults with schizophrenia and have fewer side effects than traditional antipsychotic medications. This randomized trial examined whether risperidone improved behavior in children between the ages of 5 and 17 years who had autistic disorder with severe tantrums, aggression, or self-injurious behavior. At eight weeks, 69 percent of the children treated with risperidone had substantial improvement in behavior, as compared with 12 percent of those who received placebo. Fatigue, drowsiness, tremor, drooling, and increased appetite were mild but were more common among children taking risperidone.

This eight-week study suggests that atypical antipsychotic medications improve moderate-to-severe behavioral problems in children with autism. The long-term risks and benefits of treatment with risperidone in children with autistic disorder are not yet known.

Related Perspective

Inhaled Iloprost for Severe Pulmonary Hypertension

The number of effective, long-term treatments for pulmonary hypertension is limited. In this double-blind, randomized trial, an aerosolized form of iloprost, a stable analogue of the pulmonary vasodilator prostacyclin, was assessed over a 12-week period. Iloprost had a beneficial effect on the combined end point of the distance walked in six minutes and an improvement in the New York Heart Association functional class.

The advantage of iloprost is that it can be administered by inhalation, thus avoiding the intravenous infusion required for the administration of prostacyclin and allowing delivery of the drug directly to the lungs.

Bronchiolitis Obliterans in a Microwave-Popcorn Plant

Bronchiolitis obliterans results in irreversible obstruction of the small airways and has known environmental and occupational causes. An investigation was initiated at a plant that produces microwave popcorn after signs and symptoms of bronchiolitis obliterans developed in eight employees. Among current workers at the plant, those exposed to high levels of diacetyl (2,3-butanedione), the principal additive that is used to give the popcorn its butter flavor, had more than three times the expected rate of airway obstruction and more than twice the expected rate of cough. There were strong relations between the degree of airway obstruction and the level of exposure to diacetyl.

This study provides convincing evidence that occupational exposure to a substance in microwave popcorn, presumably diacetyl, can lead to severe and irreversible airway obstruction.

Related Editorial

Clinical Practice: Herpes Zoster

A 77-year-old man has a five-day history of burning and aching pain in his right side and a two-day history of erythema and clusters of clear vesicles, accompanied by headache and malaise. How should he be evaluated and treated?

Current Concepts: Bites of Venomous Snakes

At least 2000 persons are bitten by venomous snakes in the United States each year. This article reviews the diagnosis and management of bites from venomous snakes encountered in North America, but the same principles apply to management of snakebites elsewhere in the world. The review summarizes the complications of envenomation and explains the current recommendations for the use of antivenoms. It explains how to distinguish venomous from nonvenomous snakes.

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