Children with familial hypercholesterolemia (FH) might benefit from
early initiation of statin therapy, but whether this would be safe and efficacious
is not clear. Wiegman and colleaguesArticleassessed the efficacy
and safety of pravastatin therapy vs placebo in children aged 8 to 18 years
with heterozygous FH. After 2 years, the authors found a trend toward regression
of the carotid intima-media thickness (IMT) in the pravastatin group compared
with a trend toward progression in the placebo group. They found no evidence
that pravastatin had adverse effects on growth, sexual maturation, hormone
levels or liver or muscle tissue. In an editorial,ArticleGotto discusses the clinical challenges in determining appropriate preventive
therapy for children with FH.
Some studies have suggested that antidepressant medications of the selective
serotonin reuptake inhibitor (SSRI) class are associated with an increased
risk of suicidal ideation and behaviors, particularly in children and adolescents.
Jick and colleaguesArticleconducted a case-control study to
assess the risk of nonfatal suicidal behavior or suicide in first-time recipients
of an antidepressant. They compared the risks from the tricyclic antidepressant
amitriptyline, or the SSRIs fluoxetine or paroxetine, to the risk from the
tricyclic dothiepin. The authors found a significantly increased risk of suicidal
behavior in the first 1 to 9 days following initiation of antidepressant therapy,
which was similar for both the SSRIs and tricyclic antidepressants studied,
and no additional risk in patients 10 to 19 years of age. In an editorial,ArticleWessely and Kerwin discuss the difficulties of obtaining
high-quality evidence of the safety and efficacy of antidepressant therapies
to support regulatory and clinical decision making.
Roger and colleagues assessed trends in the incidence of heart failure
and survival following diagnosis using 1979 through 2000 data from the Rochester
Epidemiology Project in Olmsted County, Minnesota, to test their hypothesis
that incidence has increased, but survival improved, with some variation by
age and sex. They found no decline in the incidence of heart failure over
the past 2 decades. Five-year survival improved over time, but these improvements
were largely seen in younger men, with less improvement in women and the elderly.
Children receiving measles, mumps, and rubella (MMR) vaccine may experience
a vaccine-associated fever, and some may have a febrile seizure. To assess
the incidence of febrile seizures following MMR vaccination, Vestergaard and
colleagues conducted a population-based cohort study of children in Denmark.
They found that the rate of first febrile seizure increased during the first
and second week following MMR vaccination but thereafter was close to the
rate for unvaccinated children. The authors found no evidence of an increased
risk of epilepsy in children who experienced a febrile seizure following MMR
Reports in the media indicate that the US Food and Drug Administration
is reconsidering approving low-dose statins for over-the-counter use, but
critics say data supporting the free availability of these cholesterol-lowering
drugs are lacking.
Preliminary evidence from women with viral cirrhosis suggests vitamin
K2 (menaquinone) may reduce the risk of hepatocellular carcinoma.
A meta-analysis of data from 6 clinical trials revealed that administering
glycoprotein IIb/IIIa antagonists at the time of first medical contact and
before catheterization improves coronary patency compared with administration
in the catheterization laboratory in patients with acute ST-segment elevation
An evidence-based review of adult asthma therapy trials supports low-dose,
inhaled corticosteroids as first-line therapy.
For your patients: Information about adult asthma.
This Week in JAMA. JAMA. 2004;292(3):305. doi:10.1001/jama.292.3.305