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Background: Little information is available about factors associated with racial differences across a broad spectrum of post-myocardial infarction outcomes, including patients' symptoms and quality of life. Objective: To determine racial differences in mortality, rehospitalization, angina, and quality of life after myocardial infarction and identify the factors associated with these differences. Design: Prospective cohort study. Setting: 10 hospitals in the United States. Patients: 1849 patients who had myocardial infarction, 28% of whom were black. Measurements: Demographic, economic, clinical, psychosocial, and treatment characteristics and outcomes were prospectively collected. Outcomes included time to 2-year all-cause mortality, 1-year rehospitalization, and Seattle Angina Questionnaire--assessed angina and quality of life. Results: Black patients had higher unadjusted mortality (19.9% vs. 9.3%; P < 0.001) and rehospitalization rates (45.4% vs. 40.4%; P: 0.130), more angina (28.0% vs. 17.8%; < 0.001), and worse mean quality of life (80.6 [SD, 22.5] vs. 85.9 [SD, 17.2]; P 0.001). After adjustment for patient characteristics, black patients trended toward greater mortality (hazard ratio, 1.29 [95% CI, 0.92 to 1.81]; P = 0.142), fewer rehospitalizations (hazard ratio, 0.82 [CI, 0.66 to 1.02]; P = 0.071), and higher likelihood of angina at 1 year (odds ratio, 1.41 [CI, 1.03 to 1.94]; P = 0.032) but similar quality of life (mean difference, -0.6 [CI, -3.4 to 2.2]). Adjustment for site of care further attenuated mortality differences (hazard ratio, 1.04 [CI, 0.71 to 1.52]; P = 0.84). Adjustment for treatments had minimal effect on any association. Limitation: Residual confounding and missing data may have introduced bias. Conclusion: Although black patients with myocardial infarction have worse outcomes than white patients, these differences did not persist after adjustment for patient factors and site of care. Further adjustment for treatments received minimally influenced observed differences. Strategies that focus on improving baseline cardiac risk and hospital factors may do more than treatment-focused strategies to attenuate racial differences in myocardial infarction outcomes. Funding: The National Heart, Lung, and Blood Institute Specialized Center of Clinically Oriented Research in Cardiac Dysfunction and Disease, CV Therapeutics, and Cardiovascular Outcomes.

Background: n-3 Fatty acids (FAs) have been shown to be beneficial for cardiovascular health. Whether n-3 FAs from oily fish consumed weekly or from fish-oil capsules taken daily are equally bioavailable is not clear. Objective: The purpose of this study was to compare the rate and extent of enrichment of blood cell membranes [ie, red blood cells (RBCs)] and plasma phospholipids with n-3 FAs from these 2 sources. Design: Healthy premenopausal female volunteers were randomly assigned to consume a daily average of 485 mg eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids either from 2 servings of oily fish (ie, salmon and albacore tuna) per week or from 1-2 capsules/d. Results: After 16 wk, EPA+DHA in RBCs in the fish group (n = 11) increased from 4.0 [+ or -] 0.6% of total FAs to 6.2 [+ or -] 1.4%, whereas it rose from 4.3 [+ or -]1.0% to 6.2 [+ or -]1.4% in the capsule group (P < 0.0001 for both; NS for group effect). Similar results were observed in plasma phospholipids. EPA + DHA stabilized in the latter after 4 wk but continued to rise through week 16 in RBCs. EPA in RBCs increased significantly (P = 0.01) more rapidly in the fish group than in the capsule group during the first 4 wk, but rates did not differ significantly between groups thereafter. Total FA variances were less in RBCs than in plasma phospholipids (P = 0.04). Conclusion: These findings suggest that the consumption of equal amounts of EPA and DHA from oily fish on a weekly basis or from fish-oil capsules on a daily basis is equally effective at enriching blood lipids with n-3 FAs. KEY WORDS n-3 Fatty acids, eicosapentaenoic acid, docosahexaenoic acid, fish, fish oil, erythrocytes, phospholipids

Background: Margination occurs when blood borne particles attach to the vessel wall. Triacylglycerol-rich lipoprotein (TRL) particles marginate when they bind to endothelial lipoprotein lipase (LpL). Objective: This study was undertaken to determine whether TRL margination reflects in vivo LpL activity and whether n-3 fatty acids affect fasting and fed TRL margination. Design: Healthy subjects (n = 33) began with a 4-wk, placebo (olive oil; 4 g/d) run-in period and were then randomly assigned to 4 wk of treatment with 4 g/d of ethyl esters of either safflower oil (SAF; control), eicosapentaenoic acid (EPA), or docosahexaenoic acid (DHA). Margination volume (MV) was calculated by subtracting true from apparent plasma volume. Results: MVs were 3 times as great during the fasting state as during the fed state (P < 0.0001). In both the fasting and the fed states, MV was significantly correlated with plasma triacylglycerol and TRL half-lives. In the fed state, MV was also correlated with preheparin LpL, whereas in the fasting state it was not. There was no significant correlation between preheparin LpL and postheparin LpL in the fasting state. Relative to SAF, EPA and DHA supplementation resulted in higher MVs by 64% and 53% (both P < 0.001), respectively, in the fasting state, without significantly reducing fasting triacylglycerol concentrations. In the fed state, DHA doubled the MV (P < 0.05), whereas EPA had no significant effect. Conclusions: The correlations between MV and TRL half-lives and preheparin LpL suggest that MV could be a reflection of whole-body LpL binding capacity. The increases in MVs with EPA and DHA supplementation suggest that these fatty acids may increase the amount of endothelial-bound LpL or its affinity for TRL. KEY WORDS Eicosapentaenoic acid, docosahexaenoic acid, margination, chylomicrons, lipoprotein lipase, n-3 fatty acids

Giving pregnant women magnesium sulfate will not increase the risk of neonatal death. In fact, in a study of 12,876 deliveries, antenatal magnesium sulfate was associated with a reduction in neonatal death.

Brain hemorrhage in newborn babies has decreased substantially since 1980, even in extremely premature babies. Nevertheless, premature babies are about twice as likely to develop brain hemorrhage as term babies. Prenatal corticosteroids do not reduce this risk.

OBJECTIVE--To evaluate the relationship between A1C and glucose therapy intensification (GTI) in patients with diabetes mellitus (DM) hospitalized for acute myocardial infarction (AMI). RESEARCH DESIGN AND METHODS--A1C was measured as [...]

Context: Intercessory prayer (praying for others) has been a common response to sickness for millennia, but it has received little scientific attention. The positive findings of a previous controlled trial of intercessory prayer have yet to be replicated. Objective: To determine whether remote, intercessory prayer for hospitalized, cardiac patients will reduce overall adverse events and length of stay. Design: Randomized, controlled, double-blind, prospective, parallel-group trial. Selling: Private, university-associated hospital. Patients: Nine hundred ninety consecutive patients who were newly admitted to the coronary care unit (CCU). Intervention: At the time of admission, patients were randomized to receive remote, intercessory prayer (prayer group) or not (usual care group). The first names of patients in the prayer group were given to a team of outside intercessors who prayed for them daily for 4 weeks. Patients were unaware that they were being prayed for, and the intercessors did not know and never met the patients. Main Outcome Measures: The medical course from CCU admission to hospital discharge was summarized in a CCU course score derived from blinded, retrospective chart review. Results: Compared with the usual care group (n = 524), the prayer group (n = 466) had lower mean [+ or -] SEM weighted (6.35 [+ or -] 0.26 vs 7.13 [+ or -] 0.27; P = .04) and unweighted (2.7 [+ or -] 0.1 vs 3.0 [+ or -] 0.1; P=.04) CCU course scores. Lengths of CCU and hospital stays were not different. Conclusions: Remote, intercessory prayer was associated with lower CCU course scores. This result suggests that prayer may be an effective adjunct to standard medical care. Arch Intern Med. 1999; 159:22 73-22 78