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This Week in JAMA
December 18, 2002

This Week in JAMA

JAMA. 2002;288(23):2927. doi:10.1001/jama.288.23.2927
JAMA-EXPRESS: Cardiovascular Outcomes of Antihypertensive Treatments

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized trial that compared treatment with a drug from each of 3 classes of antihypertensive agents (amlodipine, a calcium channel blocker; lisinopril, an angiotensin-converting enzyme inhibitor; and doxazosin, an α-adrenergic blocker) with chlorthalidone, a thiazide diuretic, in adults with hypertension and at least 1 other coronary heart disease (CHD) risk factor. The doxazosin arm was terminated early because rates of cardiovascular disease events were significantly higher than in the chlorthalidone group. In this reportArticle of outcomes after a mean of 4.9 years of follow-up, the rate of combined fatal CHD or nonfatal myocardial infarction in the amlodipine and lisinopril groups was not significantly different from that in the chlorthalidone group, but the rate of heart failure was higher in the amlodipine group, and the rate of combined cardiovascular disease events was higher in the lisinopril group. In an editorial, AppelArticle concludes that thiazide diuretics should be considered the preferred initial therapy for hypertension.

Mortality, CHD Outcomes for Pravastatin vs Usual Care

The lipid-lowering trial (LLT) of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)Article, a nonblinded randomized substudy of the ALLHAT hypertension trial also reported in this issue of THE JOURNAL, compared the effect of pravastatin therapy with usual care on all-cause mortality and coronary heart disease (CHD) outcomes among ALLHAT participants with moderate hypercholesterolemia. After a mean of 4.8 years of follow-up, all-cause mortality and CHD event rates were not significantly different in the 2 study groups. In an editorial, PasternakArticle notes that the difference in cholesterol lowering between the study groups in this trial was small, indicating that cholesterol lowering is central to achieving the benefits of statin therapy.

Incidence of Out-of-Hospital Ventricular Fibrillation

In this analysis of cases of cardiac arrest who received advanced life support from Seattle Fire Department emergency medical services, Cobb and colleaguesArticle found that the annual incidence of cardiac arrest with ventricular fibrillation as the first identifiable rhythm decreased from 0.85 per 1000 population in 1980 to 0.38 per 1000 in 2000, whereas the incidence of asystolic arrest and cases of pulseless electrical activity did not decline. In a commentary, Weisfeldt and BeckerArticle identify 3 time-sensitive phases of ventricular fibrillation–mediated cardiac arrest (electrical, circulatory, and metabolic) and propose a 3-phase model of cardiopulmonary resuscitation with phase-specific interventions to treat the pathophysiology of ischemia and reperfusion as it progresses over time.

Hip Fracture Risk in Renal Transplant vs Dialysis Patients

In this cohort study of patients with end-stage renal disease placed on the renal transplant waiting list, Ball and colleagues found that soon after kidney transplantation, risk of hip fracture was significantly higher among transplant recipients than among patients who continued to undergo dialysis. However, hip fracture risk in transplant recipients then decreased until the estimated risk became equal approximately 630 days after transplantation.

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Licensure, Certifying Exam Scores and Practice Patterns

In a previously reported study, Tamblyn and colleagues found that scores on the Québec family medicine certification examination predicted resource use and quality of care in the first 18 months of practice. In this study of practice performance during the first 4 to 7 years of practice after family medicine certification, Tamblyn and colleagues found that the relationships between family medicine certification examination scores and practice performance persisted and that scores achieved on licensure examinations taken at the end of medical school were also predictive of practice performance.

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A Piece of My Mind

"Dearborn, Michigan, has the largest Arab American community in the United States. Since I am Jewish, I wondered what that would mean for my practice." From "Lessons in Friendship."

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Medical News & Perspectives

Researchers at an urban and a rural midwestern medical center have each begun to enroll 100 000 people whose DNA samples will be used to create gene banks to make possible the identification and treatment of diseases resulting from interactions between genes and environment.

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CLINICIAN'S CORNER

The Patient-Physician Relationship

Results of a randomized controlled trial indicate that use of standardized health-related quality-of-life assessments during palliative cancer chemotherapy increases discussion of health-related quality-of-life issues and physicians' awareness of patients' health-related quality of life.

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Molecular Basis of Brain Aging

From the Archives Journals

Rosenberg considers the molecular and genomic basis of brain aging in this discussion of a prospective cohort study recently reported in the Archives of Neurology that evaluated whether cerebrospinal fluid levels of tau and β-amyloid 42 proteins predict progression from mild cognitive impairment to Alzheimer disease.

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JAMA Patient Page

For your patients: Information about quality-of-life assessment.

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