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This Week in JAMA
November 20, 2002

This Week in JAMA

JAMA. 2002;288(19):2367. doi:10.1001/jama.288.19.2367
JAMA-EXPRESS: Dual Antiplatelet Therapy and Ischemic Events After PCI

The addition of short-term clopidogrel therapy to aspirin following percutaneous coronary intervention (PCI) has been shown to reduce thrombotic complications. Steinhubl and colleagues conducted a randomized placebo-controlled trial to evaluate the benefit of long-term treatment with clopidogrel after PCI and the benefit of a loading dose of clopidogrel prior to PCI. All patients received clopidogrel after PCI through day 28 and aspirin throughout the study. One year after PCI, the combined risk of death, myocardial infarction (MI), or stroke was significantly lower among patients who received long-term (12-month) therapy with clopidogrel. The combined risk of death, MI, or urgent target vessel revascularization at 28 days after PCI was not significantly reduced in the preprocedure clopidogrel group compared with the placebo group.

Hypertension Therapy and Progression of Renal Disease

In the African American Study of Kidney Disease and Hypertension (AASK) trial, Wright and colleaguesArticle compared 3 antihypertensive regimens (initial treatment with either a β-blocker, an angiotensin-converting enzyme inhibitor, or a calcium channel blocker) and 2 blood pressure goals (lower, mean arterial blood pressure 92 mm Hg or less vs usual, 102-107 mm Hg) in African American adults with hypertensive renal disease. Rate of change in glomerular filtration rate (GFR) was not significantly different in the 2 blood pressure goal groups, nor was a clinical composite outcome. In the drug group comparisons, there were no consistent significant differences in rate of GFR change, but risk of the clinical composite outcome was significantly lower in the angiotensin-converting enzyme inhibitor group compared with the other drug groups. In an editorial, AldermanArticle discusses how to integrate these findings into clinical practice.

HRT, Antioxidant Vitamins for Secondary Prevention

Hormone replacement therapy (HRT) and antioxidant vitamins are used for secondary prevention in postmenopausal women with coronary artery disease despite the lack of evidence from clinical trials supporting their use. In this placebo-controlled randomized trial, Waters and colleagues assessed the effects of HRT and antioxidant vitamins, alone and in combination, in postmenopausal women with at least one 15% to 75% coronary stenosis at baseline. The annualized mean change in lumen diameter of coronary arteries affected at baseline was not significantly different in the active treatment groups compared with placebo. When women with intercurrent death or myocardial infarction were included in the analysis, coronary disease progression was greater in the active treatment groups.

Oral Anticoagulants vs Aspirin for Atrial Fibrillation

The relative benefit of oral anticoagulants vs aspirin for reduction of thromboembolic events associated with nonvalvular atrial fibrillation (AF) is uncertain. van Walraven and colleagues conducted a meta-analysis using pooled individual patient data from all published randomized trials comparing oral anticoagulants and aspirin therapy for nonvalvular AF. Patients who received oral anticoagulants were significantly less likely to experience any stroke, ischemic stroke, or cardiovascular events, but were more likely to experience major bleeding. All-cause survival was not significantly different but appeared to improve for patients treated with oral anticoagulants about 3 years after therapy was started.

Profit Status of Dialysis Centers and Mortality Risk

In the United States, private for-profit and private not-for-profit facilities provide most hemodialysis care. Devereaux and colleagues conducted a systematic review and meta-analysis to determine whether the profit status of hemodialysis facilities influences patient mortality. Based on data from 8 observational studies, hemodialysis care in private for-profit centers was associated with a significantly increased risk of mortality.

A Piece of My Mind

"Abbreviations have an inherent potential for misinterpretation and misunderstanding with resultant clinical errors. Caution in their use is mandatory." From "The Long and the Short of It."

Medical News & Perspectives

Because the possibility of a new outbreak of deadly Hong Kong influenza still exists, researchers are calling for development of ready-to-go candidate vaccines and expedited research into advanced vaccine production methods.

CLINICIAN'S CORNER

Pedophilia, a chronic psychiatric disorder characterized by sexual attraction to prepubescent children, is a diagnosis applicable to only a portion of individuals who sexually abuse children. Fagan and colleagues review risk factors and behaviors associated with pedophilia, treatment, and recommendations for criminal and medical systems collaboration.

Patient Self-management: Innovations in Primary Care

This article, the fourth in the series, discusses self-management education for patients with chronic disease and examines whether self-management education can improve clinical outcomes or reduce health care costs.

JAMA Patient Page

For your patients: Information about hypertensive kidney disease.

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