Among men with localized but unfavorable-risk prostate cancer,
it is not clear whether androgen suppression therapy (AST) combined with external beam radiation therapy (RT) is associated with a survival advantage compared with RT alone. To explore this question, D’Amico and colleagues assessed all-cause mortality in a cohort of men who were randomly assigned to receive RT alone or RT and 6 months of AST.
The authors report that during the median 7.6-year follow-up, treatment with RT and AST vs RT alone was associated with higher survival among men with no or minimal comorbidities; however, no survival benefit was observed among men with moderate or severe comorbidities.
In an analysis of data from hypertensive participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), Lynch and colleagues assessed the association of variants in the NPAA gene, which codes for the precursor of atrial natriuretic peptide, with cardiovascular disease (CVD) rates and blood pressure changes in patients randomized to a diuretic (chlorthalidone),
calcium antagonist (amlodipine), angiotensin-converting enzyme inhibitor (lisinopril), or α-blocker (doxazosin). Among the authors' findings was that patients with the NPAA-T2238C variant had lower CVD event rates and larger reductions in blood pressure when randomly assigned to a diuretic, and participants with the TT genotype had better outcomes when randomly assigned to receive a calcium antagonist.
Some evidence links poor nutrition with reduced physical function in older persons, but whether there is a relationship between a low concentration of specific micronutrients with subsequent declines in physical function is not clear. In an analysis of data from a longitudinal study of community-dwelling adults who were 65 years or older and had assessments of nutritional status and physical function, Bartali and colleagues found that a low concentration of vitamin E at baseline was associated with a decline in physical function during a 3-year follow-up.
In a clinical trial to assess the effect of surgically induced weight loss on control of type 2 diabetes, Dixon and colleaguesArticle randomly assigned 60 patients with obesity (body mass index >30 and <40) and type 2 diabetes (<2 years' duration)
to conventional medical and behavioral therapy or laparoscopic adjustable gastric banding plus medical and behavioral therapy. The authors report that 22 patients (73%) in the surgical group and 4 (13%) in the conventional medical and behavioral group achieved diabetes remission. Patients in the surgical group lost more weight, which was associated with a higher likelihood of remission. In an editorial, Cummings and FlumArticle discuss surgical vs nonsurgical treatment options for diabetes.
An estimated 10% of patients with hereditary hemolytic anemias and 0.5% of patients with human immunodeficiency virus (HIV) infection develop moderate to severe pulmonary hypertension. Barnett and colleagues discuss what is known about the epidemiology and pathogenesis of pulmonary hypertension in patients with these underlying diseases and therapeutic strategies to reduce morbidity and prolong survival.
“[R]ace has been a prominent factor in a fair number of the encounters I have had with new patients.” From “How Deep the Bias.”
New research is helping explain why gay and bisexual black men carry such a disproportionate burden of HIV infection in the United States.
Examining physician supply concerns
How would you manage a 32-year-old woman with a 1-year history of chronic abdominal pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is January 30.
Join Mark J. Pletcher, MD, February 20, 2008, from 2 to 3 PM eastern time to discuss opioid prescribing by race/ethnicity.
To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
For your patients: Information about pulmonary hypertension.
This Week in JAMA . JAMA. 2008;299(3):253. doi:10.1001/jama.299.3.253