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This Week in JAMA
November 23/30, 2011

This Week in JAMA

JAMA. 2011;306(20):2187. doi:10.1001/jama.2011.1713

Individuals who carry the CYP2C19*2 gene variant have diminished platelet inhibition and higher rates of cardiovascular events when treated with the standard maintenance dose (75 mg/d) of the antiplatelet medication clopidogrel. Mega and colleagues assessed the effects of higher clopidogrel doses on platelet reactivity in a randomized trial that enrolled 333 patients with stable cardiovascular disease. The authors report that among CYP2C19*2 heterozygotes, tripling the clopidogrel dose to 225 mg/d reduced platelet reactivity to levels achieved with the standard 75-mg/d dose in noncarriers of a CYP2C19*2 allele. In contrast, clopidogrel doses as high as 300 mg/d did not result in comparable degrees of platelet inhibition among individuals homozygous for the CYP2C19*2 allele.


Uncertainty exists regarding the optimal daily intake of sodium and potassium for cardiovascular (CV) risk reduction. In an analysis of data from 28 881 individuals at high risk of CV events, O’Donnell and colleagues examined the association between sodium and potassium excretion (surrogates for intake) at baseline and CV events during a median of 56 months of follow-up. The authors found a J-shaped association between estimated urinary sodium excretion and CV events and a lower risk of stroke among persons with higher estimated potassium excretion. In an editorial, Whelton discusses the evidence for CV health benefits from reductions in dietary sodium.


In a multicenter cohort study that enrolled 4075 patients with definite native-valve or prosthetic-valve endocarditis, Kiefer and colleagues assessed factors associated with the development of heart failure and the risk of mortality. The authors report that one-third of the patients with endocarditis developed heart failure. Valve surgery was performed in 62% of these patients and was associated with significantly lower mortality than medical therapy alone.


The clinical significance of new-onset atrial fibrillation (AF) in patients with severe sepsis is uncertain. In a retrospective analysis of administrative claims data from 49 082 patients with severe sepsis, Walkey and colleagues found that new-onset AF occurred in 2896 patients (5.9%), and that these patients had an increased risk of in-hospital stroke and death compared with patients with preexisting or no atrial fibrillation. In an editorial, Goss and Carson discuss limitations of administrative data for assessing the temporal relationship of events occurring during hospitalization and the implications for patient care.


Two weeks after starting lisinopril, a 62-year-old woman presented with a reticulated rash on her lips and violaceous, flat-topped papules and plaques on her palms and back. What would you do next?


“I came to realize . . . that the process of bringing together a donor and recipient is one of the fantastically complex and genuinely interesting aspects of kidney transplantation.” From “The Perfect Match.”


Scientists are searching for antibiotic adjuvants that can help make existing antibiotics more effective or render drug-resistant bacteria more susceptible.


Hospital participation in Medicare and Medicaid: revised rules


Prescription drug monitoring programs and opioid abuse


Protecting research participants


Join Daniel Leffler, MD, MS, on Wednesday, December 21, at 2 PM eastern time to discuss celiac disease diagnosis and management. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Gaziano summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

How would you manage an 86-year-old woman with upper gastrointestinal bleeding who is receiving warfarin and aspirin? Go to www.jama.com to read the case. Submit your response by December 4 for possible online posting

For your patients: Information about carpal tunnel syndrome.