JAMA : the journal of the American Medical Association
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Editorial Comment
Mental disorders. Quality of life and inequality of insurance coverage.
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Clinical Trial
Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet.
To assess the effects of a diet restricted in fat, saturated fat, and cholesterol, under weight-maintenance and ad libitum conditions on body weight and plasma lipid levels in hypercholesterolemic subjects. ⋯ Our results indicate that a low-fat ad libitum diet promotes weight loss and LDL-C lowering without adverse effects on triglycerides or the TC/HDL-C ratio in middle-aged and elderly men and women with moderate hypercholesterolemia.
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Chronic heart failure is the leading cause of hospital admissions in patients older than 65 years. Heart failure due to systolic dysfunction is accompanied by activation of the sympathetic nervous system that contributes to progressive symptoms and an increased risk of death. While several clinical trials have suggested that antagonizing this sympathetic activation with beta-blocking agents may provide clinical benefit, no clear consensus exists regarding use of beta-blockers for congestive heart failure. Therefore, we review the pathophysiology of the sympathetic nervous system as a basis for examining these clinical trials in order to understand the rationale for beta-blockade as a treatment for heart failure. ⋯ Sympathetic nervous system activation in patients with chronic heart failure is a major contributor to the severity of disease as well as its progression over time. Antagonism of its effects, via beta-blocker therapy, appears overall to improve both quality of life and survival. However, its place as a cornerstone in the therapy of this disease depends on the results of large-scale, randomized, placebo-controlled trials.