To examine how different financial incentives between Medicare Advantage and Medicare
fee-for-service (FFS) reimbursement structures might influence cardiovascular procedure use, Matlock
and colleagues analyzed data from 878 339 Medicare Advantage patients and
5 013 650 Medicare FFS patients across 32 hospital referral regions in 12 states. The
authors found that patients enrolled in Medicare Advantage programs had lower rates of angiography
and percutaneous coronary intervention procedures than those enrolled in Medicare FFS. Substantial
and similar geographic variation in procedure rates was observed among patients in both Medicare
Advantage and Medicare FFS programs. In an Editorial, Krumholz discusses steps to ensure
high-quality, patient-centered decision making.
To examine whether differences in the per capita rates of cardiac catheterization in New York
State and Ontario, Canada, are due to a difference in the burden of coronary artery disease (CAD) or
a difference in patient selection for the procedure, Ko and colleagues analyzed registry data from
18 114 New York patients and 54 933 Ontario patients who underwent elective cardiac catheterization.
The authors found that patients in Ontario were significantly more likely to have obstructive CAD
than patients in New York and that a higher percentage of New York patients with a low predicted
probability of CAD underwent catheterization.
Observational data suggest there is an inverse association between soy consumption and prostate
cancer risk. In a randomized, placebo-controlled trial that enrolled 177 men at high risk of
prostate cancer recurrence after radical prostatectomy, Bosland and colleagues found that daily
consumption of a soy protein–based supplement for 2 years after radical prostatectomy did not
reduce or delay the rate of biochemical recurrence.
Low serum levels of 25-hydroxyvitamin D have been associated with increased risk of coronary
heart disease (CHD) in white populations. Robinson-Cohen and colleagues analyzed data from 6436
participants in the Multi-Ethnic Study of Atherosclerosis who were free of known cardiovascular
disease at baseline and found that lower serum vitamin D concentration was associated with an
increased risk of incident CHD events among study participants who were white or Chinese but who
were not black or Hispanic during a median 8.5 years’ follow-up. In an Editorial, Norris and
Williams discuss the study findings and questions to explore in future research of the relationship
between race, ethnicity, vitamin D and CHD.
Percutaneous coronary intervention (PCI) with stent placement is the most commonly performed
coronary revascularization procedure. Brilakis and colleagues reviewed the contemporary literature
on optimal medical therapy after PCI and found that dual antiplatelet therapy with aspirin and a
P2Y12 inhibitor reduces the risk of stent thrombosis and subsequent cardiovascular events
after PCI (number needed to treat 33-53) and is the current standard of care. Aspirin should be
administered indefinitely, whereas the P2Y12 inhibitor is usually administered for 12
months. Adjustments in therapy are appropriate for patients at high risk of bleeding, such as
patients who need warfarin. Routine platelet function or genetic testing is not recommended.
Continuing Medical Education
A 43-year-old Asian man reports a 6-month history of generalized nonpuritic, nonpainful papules
and nodules. Microscopy of a biopsied lesion reveals foamy histiocytes with emperipolesis (engulfed
lymphocytes) in the dermis. What would you do next?
Highlights. JAMA. 2013;310(2):117-119. doi:10.1001/jama.2013.5196