OPULAR DIETS HAVE BECOME INcreasingly prevalent and controversial. 1 More than 1000 diet books are now available, 2 with many popular ones departing substantially from mainstream medical advice. 3 Cover stories for major news magazines, televised debates, and cautionary statements by prominent medical authorities 4,5 have fueled public interest and concern regarding the effectiveness and safety of such diets. 6-8 Although some popular diets are based on long-standing medical advice and recommend restriction of portion sizes and calories (eg, Weight Watchers), 9 a broad spectrum of alternatives has evolved. Some plans minimize carbohydrate intake without fat restriction (eg, Atkins diet), 10 many modulate macronutrient balance and glycemic load (eg, Zone diet), 11 and others restrict fat (eg, Ornish diet). 12 Given the growing obesity epidemic, 13 many patients and clinicians are interested in using popular diets as individualized eating strategies for disease prevention. 14 Unfortunately, data regarding the relative benefits, risks, effectiveness, and For editorial comment see p 96.

The percentage of patients who present to the emergency department with acute myocardial infarction or unstable angina who are not hospitalized is low, but the discharge of such patients is associated with increased mortality. Failure to hospitalize is related to race, sex, and the absence of typical features of cardiac ischemia. Continued efforts to reduce the number of missed diagnoses are warranted.

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Infarct size, measured by CMR or technetium-99m sestamibi SPECT within 1 month after primary PCI, is strongly associated with all-cause mortality and hospitalization for HF within 1 year. Infarct size may, therefore, be useful as an endpoint in clinical trials and as an important prognostic measure when caring for patients with STEMI.

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Use of ACI-TIPI was associated with reduced hospitalization among emergency department patients without acute cardiac ischemia. This result varied as expected according to the CCU and cardiac telemetry unit capacities and physician supervision at individual hospitals. Appropriate admission for unstable angina or acute infarction was not affected. If ACI-TIPI is used widely in the United States, its potential incremental impact may be more than 200000 fewer unnecessary hospitalizations and more than 100000 fewer unnecessary CCU admissions.

Background and Purpose-Women experience worse outcomes after stroke compared with men. Prior work has suggested sex-based differences in coagulation and fibrinolysis markers in subjects with acute stroke. We explored whether sex might modify the effect of recombinant tissue plasminogen activator (rtPA) on outcomes in patients with acute ischemic stroke. Methods-Using a combined database including subjects from the National Institute of Neurological Disorders and Stroke (NINDS), Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) A and B, and the Second European Cooperative Acute Stroke Study (ECASS II) trials, we examined 90-day outcomes in patients randomized to rtPA versus placebo by sex. We used logistic regression to control for potential confounders. Results-Among 988 women treated between 0 and 6 hours from symptom onset, patients receiving rtPA were significantly more likely than those receiving placebo to have a modified Rankin Score Յ1 (40.5% versus 30.3%, PϽ0.0008). Among 1190 men, the trend toward benefit in the overall group did not reach statistical significance (38.5% versus 36.7%, Pϭ0.52). An unadjusted analysis showed that women were significantly more likely to benefit from rtPA compared with men (Pϭ0.04). Controlling for age, baseline National Institutes of Health Stroke Scale, diabetes, symptom onset to treatment time, prior stroke, systolic blood pressure, extent of hypoattenuation on baseline computed tomography scan and several significant interaction terms (including onset to treatment time-by-treatment and systolic blood pressure-by treatment) did not substantially change the strength of the interaction between gender and rtPA treatment (Pϭ0.04). Conclusions-In this pooled analysis of rtPA in acute ischemic stroke, women benefited more than men, and the usual gender difference in outcome favoring men was not observed in the thrombolytic therapy group. For patients presenting at later time intervals, when the risks and benefits of rtPA are more finely balanced, sex may be an important variable to consider for patient selection.