Atherosclerosis-related vascular stiffness increases with age and is associated with hypertension. In an analysis of data from the 1759 participants in the Framingham Offspring study, Kaess and colleagues examined temporal relationships between blood pressure progression and 3 measures of vascular stiffness over 7 years of follow-up. The authors found that higher aortic stiffness—reflected by higher carotid-femoral pulse wave velocity, forward wave amplitude, and augmentation index—was associated with a higher risk of incident hypertension; however, initial blood pressure was not associated with progressive aortic stiffening. In an editorial, Mukherjee discusses whether vascular stiffness is a cause rather than an effect of hypertension.
The increased risk of adverse ischemic events in patients with diabetes may be related to heightened platelet reactivity. In an analysis of data from 58 851 patients, Andersson and colleagues examined the relationship between antiplatelet treatment with clopidogrel and risk of mortality and cardiovascular events following myocardial infarction in patients with and without diabetes. The authors found that clopidogrel treatment was associated with less reduction in the risk of all-cause and cardiovascular death among patients with diabetes. In an editorial, Bhatt discusses antiplatelet therapy for patients with diabetes.
In an analysis of data from 936 community-dwelling, older Icelandic individuals, including 266 with diabetes, Schelbert and colleagues compared the prevalence and prognosis of recognized and unrecognized myocardial infarction detected with cardiac magnetic resonance or electrocardiography (ECG). The authors report that the prevalence of unrecognized myocardial infarction detected with cardiac magnetic resonance was higher than the prevalence of clinically recognized myocardial infarction and was higher than the prevalence of unrecognized myocardial infarction detected on ECG. Unrecognized myocardial infarction was associated with an increased mortality risk.
A substantial number of patients with rheumatoid arthritis use biologic response-modifying therapies, which may increase the risk of infections and malignancies. Lopez-Olivo and colleagues analyzed data from 63 randomized trials that included 29 423 patients with rheumatoid arthritis and compared at least 6 months' use of any of 9 approved biologic modifying therapies with placebo or traditional disease-modifying antirheumatic drugs. The authors report that use of biologic modifying therapy was not associated with an increased risk of malignancy.
Article AND AUTHOR AUDIO INTERVIEW
Depression is a common and disabling condition encountered in older patients. Unützer and Park present an evidence-based approach to the detection and treatment of late-life depression in a discussion of the case of a 69-year-old woman who experienced severe, treatment-resistant depression. Pharmacotherapy, electroconvulsive therapy, and nonpharmacological interventions are discussed.
A controversial House subcommittee recommendation calls for eliminating the Agency for Healthcare Research and Quality and discretionary spending on patient-centered outcomes research.
Preexposure prophylaxis for HIV infection
Safety issues in expedited drug development
Clinical trial data as a public good
“I’ve never been under general anesthesia, and the thought of being completely knocked out frightens me.” From “Worries.”
Call for Papers
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
Join Philip Greenland, MD, Wednesday, September 19, from 2 to 3 PM eastern time to discuss novel risk markers to improve assessing patients at intermediate risk of cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about antibiotics to prevent infective endocarditis.
This Week in JAMA. JAMA. 2012;308(9):839. doi:10.1001/jama.2012.3183