None.

The long-term survival advantages associated with improved drug adherence after AMI appear to be class-specific, suggesting that adherence outcome benefits are mediated by drug effects and do not merely reflect an epiphenomenon of "healthy adherer" behavioral attributes.

In the last decade, the prevalence of obesity has increased significantly in populations worldwide. A less dramatic, but equally important increase has been seen in our knowledge of its effects on health and the burden it places on healthcare systems. This systematic review aims to assess the current published literature on the direct costs associated with obesity. A computerized search of English language articles published between 1990 and June 2009 yielded 32 articles suitable for review. Based on these articles, obesity was estimated to account for between 0.7% and 2.8% of a country's total healthcare expenditures. Furthermore, obese individuals were found to have medical costs that were approximately 30% greater than their normal weight peers. Although variations in inclusion/exclusion criteria, reporting methods and included costs varied widely between the studies, a lack of examination of how and why the excess costs were being accrued appeared to be a commonality between most studies. Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions.

In the province of Ontario, despite Canada's universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services as well as on mortality one year after acute myocardial infarction.

N THE FACE OF THE FINANCIAL, practical, and ethical challenges inherent in undertaking randomized clinical trials (RCTs), investigators often use observational data to compare the outcomes of different therapies. These comparisons may be biased due to prognostically important baseline differences among patients, often as a result of unobserved treatment selection biases. Unmeasurable clinical and social interactions in the diagnostic-treatment pathway, and physicians' knowledge of unmeasured prognostic variables, may affect treatment decisions and outcomes. Physicians are frequently risk averse in case selection, performing interventions on lower-risk patients despite greater clinical benefit to higher-risk patients. [1][2][3] In some cases, especially when data are collected on detailed clinical risk factors, these differences can be controlled using standard statistical methods. In other cases, when unmeasured patients characteristics affect both the decision to treat and the outcome, these For editorial comment see p 314.

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ARDIOVASCULAR DISEASE IS AN important cause of morbidity and mortality among persons with type 2 diabetes mellitus. 1-3 The thiazolidinediones (TZDs), rosiglitazone and pioglitazone, are oral hypoglycemic agents that have been shown to improve glycemic control and may act to slow the progression of beta cell failure. 4 While improved glycemic control has been linked to better clinical outcomes in diabetes 5-7 and TZDs have been suggested as having potential cardiovascular benefits, 8-11 recent concerns have arisen regarding adverse cardiac effects of these drugs. Use of TZDs is associated with weight gain and edema, 12 and evidence suggests that both rosiglitazone and pioglitazone increase the risk of congestive heart failure (CHF). 8,10,13-19 A recent boxed warning for CHF was added for these agents recommending against the use of TZDs in persons with preexisting CHF. 20 Two meta-analyses have also suggested that rosiglitazone may be associated with an increased risk of acute myocardial infarction (AMI) and death. 18,21 These findings prompted a hearing by a US Food and Drug Administration advisory panel regarding the safety of rosiglitazone; however, the panel voted against removing rosiglitazone from the market because of insufficient data. 22 Most studies to date far have examined adverse cardiovascular outcomes associated with TZDs among clinical trial samples. However, the extent to which these adverse effects apply to real-world populations is less clear. In addition, older persons are traditionally underrepresented in clinical