In the randomized and placebo-controlled Physicians' Health Study II, Sesso and colleagues assessed the individual effects of vitamin E (400 IU every other day) and vitamin C (500 mg daily) supplements on the risk of major cardiovascular disease (CVD) events among 14 641 male physicians who were 50 years or older and at low risk of CVD at baseline. The authors report that compared with placebo, neither vitamin E nor vitamin C supplementation reduced the risk of major cardiovascular events during a mean follow-up of 8 years.
To assess the efficacy of low-dose aspirin for primary prevention of cardiovascular events among patients with type 2 diabetes, Ogawa and colleagues Article from 163 institutions in Japan randomly assigned patients with type 2 diabetes and no history of atherosclerotic disease either to low-dose aspirin therapy (81 or 100 mg/d) or to a nonaspirin control group. During a median 4.37 years of follow-up, the investigators found that low-dose aspirin therapy was not associated with a significant reduction in the risk of cardiovascular events. In an editorial, Nicolucci Article discusses the role of aspirin in the primary prevention of cardiovascular disease.
Elevated levels of nonfasting triglycerides are associated with an increased risk of ischemic heart disease. The role of triglycerides in the risk of ischemic stroke is not clear. Freiberg and colleagues hypothesized that increased levels of nonfasting triglycerides increase the risk of ischemic stroke and tested their hypothesis in analyses of data from a population-based cohort study of Danish adults. In prospective and cross-sectional analyses of the study data, the authors found that increased nonfasting triglyceride levels were associated with higher risks of ischemic stroke.
Emergence of extensively drug-resistant tuberculosis (XDR-TB) is a global public health concern. To examine the epidemiology and clinical course of XDR-TB, Shah and colleagues analyzed TB cases that were reported in the United States from 1993 to 2007. The authors report risk factors, clinical features, and survival rates for XDR-TB compared with multidrug-resistant TB and drug-susceptible TB cases. Among the authors' findings is that 83 cases of XDR-TB have occurred in the United States since 1993. Recent declines in annual cases parallel improvements in TB and HIV/AIDS control.
Several practice guidelines recommend that patients with cardiovascular disease be evaluated for depression. However, whether depression screening benefits patients with cardiovascular disease is not known. To address this question, Thombs and colleagues systematically reviewed the literature on the accuracy of depression screening in cardiovascular care and the effects of depression treatment on cardiac outcomes. The authors found that depression screening tools have reasonable accuracy and that treatment of depression is associated with modest improvement in depressive symptoms but does not improve cardiac outcomes.
“And then I see it. There is stool everywhere: on his sheets, his VA pajamas, even his socks.” From “A Lesson Learned by Accident.”
Studies illuminating how a gene-regulating process called methylation can sometimes play a role in cancer are beginning to lead to clinical applications.
Shifts in thinking about dementia
Human oocyte research: ethics of oocyte donation
Population-based outcome studies of new therapies
The “discovery” of ether anesthesia, and its “re-discovery” by Hollywood
Join Rita F. Redberg, MD, MSc, November 19 from 2 to 3 PM eastern time to discuss stress testing to document ischemia before PCI. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you manage a 24-year-old woman with intractable seizures since age 10 years? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is November 26.
For your patients: Information about depression.
This Week in JAMA . JAMA. 2008;300(18):2095. doi:10.1001/jama.2008.629