Clinically significant long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss.

In this study, despite an 18-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI. JAMA. 2000;284:60-67

Writing Committee for the ENRICHD Investigators C ARDIOVASCULAR DISEASE IS THE leading cause of death and a major cause of morbidity and disability in the United States, with an estimated 6 million people having symptomatic coronary heart disease (CHD). 1 Recent studies 2-7 have shown that depression and low perceived social support (LPSS) are associated with increased cardiac morbidity and mortality in CHD patients. In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depression is approximately 27%. 8-10 After an acute myocardial infarction (MI), depression is a risk factor for mortality independent of cardiac disease severity. 4,6 A recent randomized clinical trial found that the antidepressant sertraline hydrochloride was effective in treating recurrent depression in patients with either an acute MI or an episode of unstable angina. 11 However, no clinical trial has examined whether treating depression with counseling or antidepressants after an acute MI improves survival or reduces cardiac risk. The absence of social support is also a risk factor for cardiac morbidity and mortality in patients with CHD. 2,3,5,7 No clinical trial has tested the effects of increasing social support on clinical end points following acute MI, although

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Although BP reactivity to all physical and mental stressors used in this study did not consistently predict 5-year change in BP in this young cohort, the results indicate that reactivity to a video game stressor predicts 5-year change in BP and early hypertension among young adult men. These findings are consistent with other studies showing the usefulness of stressors producing a primarily beta-adrenergic response in predicting BP change and hypertension. The results may be limited by the shortened initial rest and recovery periods used in the CARDIA protocol.

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Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback. Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification. Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African-American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African-American parents had significantly greater improvements than white parents (P < 0.0001). Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African-American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.