In recent studies, hormone replacement therapy has been associated with
an early increase in risk of cardiovascular events in postmenopausal women
with cardiovascular disease. Raloxifene, a selective estrogen receptor modulator,
has been shown to have favorable effects on known cardiovascular risk factors,
but its effect on the risk of arterial cardiovascular events is not known.
In this secondary analysis of data from the MORE trial, a placebo-controlled
study of the effects of raloxifene on bone mineral density and vertebral fractures
in postmenopausal women with osteoporosis, Barrett-Connor and colleagues found
no early increase in coronary or cerebrovascular events associated with raloxifene
therapy, either 60 or 120 mg/d. Overall, the risk of cardiovascular events
was not significantly different in the raloxifene groups compared with the
placebo group during 4 years of therapy. Among women with increased cardiovascular
risk at study entry, however, those in the raloxifene groups had a significantly
reduced risk of cardiovascular events compared with those in the placebo group.
In this issue of THE JOURNAL, 3 articles describe recent cases of bioterrorism-related
anthrax infection that were not directly linked to occupational exposure.
In the 2 adult cases with fatal inhalational anthrax, reported by Mina and
colleaguesArticle and by Barakat and colleaguesArticle, the source of anthrax exposure has
not been identified despite epidemiologic investigation. The third case, cutaneous
anthrax in a 7-month-old infant reported by Freedman and colleaguesArticle, was complicated
by severe microangiopathic hemolytic anemia. The source of infection is thought
to be the workplace of the infant's mother, which the infant visited the day
before the onset of symptoms. In an editorial, Gerberding and coauthorsArticle discuss
the critical role of clinicians in all phases of bioterrorism preparedness
response programs and the importance of ongoing collaboration between clinicians
and public health agencies.
Reverend J, a 75-year-old man with widely metastatic adenocarcinoma,
was admitted to an acute palliative care unit in a teaching hospital where
he died 5 days after admission. von Gunten discusses the use of clinical palliative
care services in hospitals, illustrated by excerpts from interviews with Mrs
J and members of the palliative care team conducted after Reverend J's death.
The discovery of a genetic mutation apparently linked to one of the
most aggressive types of prostate cancer may point toward a new approach to
screening for this disease.
In part 1Article, the scientific basis for the use of β-blocker therapy
in heart failure is reviewed. Part 2Article presents selected cases of patients with
heart failure to illustrate nuances of β-blocker therapy and provides
clinical tools to assist use of β-blockers in practice.
JAMA acknowledgesArticle with gratitude the authors of the 4189 manuscripts
received in 2001 and extends sincere thanks to the 3483 peer reviewersArticle for
their scholarly contributions.
For your patients: Information about palliative care.
This Week in JAMA. JAMA. 2002;287(7):809. doi:10.1001/jama.287.7.809