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Bmj Usa: Editor's Choice

“Doc, how long will my heart go on?”

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E30

This article originally appeared in BMJ USA

In 1997 the theme song for Titanic—“My heart will go on”—won the Academy Award for best original song. The lyrics don't explain how to ensure that hearts go on, but this issue of BMJ USA does.

Hooper et al conducted a systematic review of 27 studies (involving 30 902 person-years of observation) on the link between dietary fat intake and cardiovascular mortality and morbidity (BMJ USA p 233). They found “a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake.” In an accompanying editorial (BMJ USA p 222), Kottke prescribes a “heart smart” diet: fruits, vegetables, whole grains with minimal animal fat, and fish high in omega 3 fatty acids (eg, salmon, albacore tuna, and mackerel).

In another editorial, Liu and Manson discuss the optimal weight for cardiovascular health (BMJ USA p 219). More than half of adults in the US are overweight, increasing their risk of heart disease as well as stroke, hypertension, and type 2 diabetes. Body mass index (BMI)—calculated as weight (kg)/height (m)2—is a reliable measure of obesity, but some people with a “normal” BMI may be considered overweight because of abdominal adiposity. Should we screen for abdominal obesity in primary care, using waist circumference or waist:hip ratio? Little and Byrne, in a third editorial, argue that the evidence is inadequate to justify routine documentation of waist circumference in all patients (BMJ USA p 220).

CDC investigators report a 10% increase in sudden cardiac deaths among adolescents and young adults between 1989 and 1996 (BMJ USA p 279). They attribute the finding to the increased prevalence among adolescents of cardiovascular risk factors, such as obesity. An editorial in the February 10th issue of the BMJ addressed the epidemic of obesity in young children (

Lawlor and Hopker reviewed 14 studies on the effectiveness of exercise in the management of depression (BMJ USA p 251). They found that the quality of the research was too poor to determine whether exercise reduces depressive symptoms. But it will protect the heart, so why not recommend it to those who are depressed?

Does sildenafil (Viagra) affect the heart? Reports of acute myocardial infarction following ingestion of the drug have raised concern. But in a study of 5600 users of sildenafil, Shakir et al found no evidence of a higher incidence of fatal MI or ischemic heart disease compared with that found in the general population of England (BMJ USA p 249).

Dietary fat intake (BMJ USA p 233)

What is the optimal diet? (Kottke) (BMJ USA p 222)

What is the optimal weight? (BMJ USA p 219)

Abdominal obesity (BMJ USA p 220)

Sudden cardiac deaths (BMJ USA p 279)

The effectiveness of exercise (BMJ USA p 251)

Cardiovascular events (BMJ USA p 249)

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