In the Heart and Estrogen/progestin Replacement Study (HERS), a randomized
trial among postmenopausal women with preexisting coronary heart disease (CHD),
the overall risk of CHD events in the hormone therapy group was not significantly
different from that in the placebo group during 4.1 years of follow-up. Two
articles in this issue of THE JOURNAL report on cardiovascular and noncardiovascular
outcomes during 2.7 years of additional unblinded follow-up (HERS II) of women
enrolled in HERS. Grady and colleagues found that the lower rates of CHD events
in the hormone therapy group observed during years 3 to 5 of HERS did not
persist during additional follow-up. Hulley and colleagues report that during
all 6.8 years of follow-up, rates of venous thromboembolism and biliary tract
surgery were significantly increased in the hormone therapy group compared
with the placebo group. Differences in cancer and fracture risk and total
mortality were not statistically significant. In an editorial, Petitti discusses
the growing body of evidence that has failed to show a benefit from HRT, and
outlines alternative interventions for disease prevention in postmenopausal
White matter lesions (WMLs) detected on cerebral imaging scans have
been hypothesized to be ischemic complications of cerebral microvascular disease
that may precede the development of clinical stroke. To examine the relationship
between WMLs, retinal microvascular abnormalities, and the incidence of clinical
stroke, Wong and colleagues analyzed data from participants in the Atherosclerosis
Risk in Communities (ARIC) Study who underwent cerebral magnetic resonance
imaging and retinal photography at the third ARIC examination when they were
aged 51 to 72 years. Persons with retinal microvascular abnormalities were
significantly more likely to have WMLs than those without retinal vascular
abnormalities. After a median follow-up of 4.7 years, the risk of clinical
stroke was 3.4 times higher in persons with WMLs compared with those without
WMLs, and in the presence of retinopathy, persons with WMLs were 18.1 times
more likely to develop stroke than those without either WMLs or retinopathy.
The epidemiology and clinical characteristics of infective endocarditis
have evolved since its first modern clinical description. In this population-based
survey conducted in 1999 in all hospitals in 6 regions in France, Hoen and
colleagues found that the annual incidence of infective endocarditis was 31
cases per million, consistent with other recent studies. Compared with results
of a similar survey in 1991, the incidence of infective endocarditis in patients
with underlying heart disease and with prosthetic valves decreased; the incidence
of infective endocarditis caused by oral streptococci decreased; the rate
of early valve surgery increased; and in-hospital mortality tended to decrease.
Latinos are now the largest racial/ethnic minority group of children
in the United States. Flores and colleagues summarize key research, health
care, and policy issues in Latino child health identified through a consensus
process by the Latino Consortium of the American Academy of Pediatrics Center
for Child Health Research.
"For the first time, I'm thinking about dating, getting married, having
children, where I want to live, and what I truly want to do with my life."
In a nation that existed in North America long before the birth of the
United States, the Navajo people—with some help from friendly health
professionals—work to maintain their well-being despite the increasing
incursion of the outside world.
Interviews with physicians and a home hospice social worker involved
in the care of Mr G, a 47-year-old man with rapidly progressive amyotrophic
lateral sclerosis, illustrate this discussion of how to respond to requests
for physician-assisted suicide.
For your patients: Information about endocarditis.
This Week in JAMA. JAMA. 2002;288(1):11. doi:10.1001/jama.288.1.11