Cholesterol reduction and the risk for stroke in men. A meta-analysis of randomized, controlled trials

OBJECTIVE: Reducing serum cholesterol lowers the risk for ischemic heart disease, but its effects on other vascular diseases are unknown. Published trials were reviewed to determine the effect of cholesterol-lowering interventions on fatal and nonfatal stroke. DESIGN: Meta-analysis of randomized, controlled trials. DATA IDENTIFICATION: A literature search of English-language studies examining the effect of modified diets or medications on cardiovascular end points from 1965 to 1992 using MEDLINE and a review of references of five quantitative overviews of cholesterol reduction and coronary disease. DATA ANALYSIS: Thirteen studies met three eligibility criteria: patients randomized to intervention or control; fatal or nonfatal stroke reported separately; and end points assessed without knowledge of treatment status. Heterogeneity among studies and overall effects of treatment on fatal and nonfatal stroke were estimated using the Mantel-Haenszel-Peto method to combine independent study results. The influence of various study designs and interventions was explored using subgroup comparisons. RESULTS: For fatal stroke, the overall odds ratio associated with cholesterol-lowering interventions in 13 trials was 1.32 (95% Cl, 0.94 to 1.86), and the odds ratio for the 10 single-intervention trials was 1.34 (Cl, 0.91 to 1.96). Among eight trials reporting nonfatal events, the summary odds ratio for nonfatal stroke for treated participants compared with controls was 0.88 (Cl, 0.70 to 1.11), and the odds ratio for total strokes was 0.98 (Cl, 0.80 to 1.19). Among three trials using clofibrate, treatment significantly increased the risk for fatal stroke (odds ratio, 2.64; Cl, 1.42 to 4.92) but not for nonfatal stroke (odds ratio, 0.87; Cl, 0.61 to 1.26). Regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke. CONCLUSIONS: Lowering serum cholesterol through modified diets or medications does not reduce stroke mortality or morbidity in middle-aged men. Clofibrate appears to increase the risk for fatal strokes, but the mechanism for this effect is unknown.     

Diabetic thoracic polyradiculopathy: ten patients with abdominal pain

OBJECTIVES: Abdominal pain caused by diabetic thoracic polyradiculopathy is unfamiliar to many gastroenterologists. The aim of this study was to describe the clinical characteristics and outcome of the disorder. METHODS: Ten patients (six women) with diabetic thoracic polyradiculopathy were cared for in 20 yr. Electromyographic evidence of nerve root denervation was found in seven patients. Nine patients were followed-up at least until recovery, including four until death. RESULTS: The patients were 42-79 yr of age, had diabetes of various duration, and often had other diabetic complications, including two with previous polyradiculopathy. Pain of various types occurred. It was often worse at night and aggravated by light pressure. Pain was either unilateral or bilateral and was often accompanied by weight loss. All patients had a cutaneous sensory abnormality, and four had localized abdominal wall paresis with protrusion. Spontaneous recovery was documented in nine patients, but two had recurrent polyradiculopathy. CONCLUSIONS: Gastroenterologists should be familiar with diabetic thoracic polyradiculopathy, because its early recognition may prevent unnecessary and expensive diagnostic evaluation for a visceral cause of pain.     

Hick's Law versus a power law: Reply to Welford.

In this reply, we address Welford's (1987) criticisms of our article on exceptions to Hick's Law (Longstreth, El-Zahhar, & Alcorn, 1985). Welford argues that our power law is not a good replacement for Hick's law. We address each of hs criticisms in turn and conclude that the power law remains viable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Separation of home intellectual environment and maternal IQ as determinants of child IQ.

Measured both parental and child IQs with the Raven Standard Progressive Matrices and the Peabody Picture Vocabulary Test; Ss included 80 mothers, 35 fathers, and 80 children (mean age 12 yrs). Home intellectual environment was assessed through a 2-hr interview with the mother. Multiple regression analyses showed that for each IQ test and for the 2 scores combined, the addition of home environment ratings to the regression equations did not add a significant increment to the prediction of child IQ from that provided by maternal IQ, whereas the addition of maternal IQ to the regression equation did add a significant increment to that provided by home environment ratings. Thus, the correlation of home environment and child IQ is considerably overestimated when maternal IQ is allowed to covary. When maternal IQ was statistically controlled, the correlation between home environment ratings and child IQ was attenuated to nonsignificance. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)