De Lemos and colleaguesArticlereport results of a randomized
trial of patients following an acute coronary syndrome (ACS). The trial compares
early initiation of intensive simvastatin therapy (80 mg/d) vs delayed initiation
of 20-mg/d simvastatin on a composite end point of cardiovascular death, nonfatal
myocardial infarction, readmission for ACS, or stroke. In the initial 4 months
of follow-up, there was no significant difference in outcomes between the
2 groups. After 4 months, there was a trend toward reduced major cardiovascular
events in the early intensive statin therapy group although with a higher
risk of myopathy. In an editorial,ArticleNissen discusses
reasons intensive therapy did not demonstrate early benefit in this trial
and urges caution in prescribing 80-mg/d simvastatin.
Women with a BRCA1 or BRCA2 mutation are advised to have annual mammograms and biennial clinical
breast examinations (CBEs), but when detected, many of their tumors are advanced
stage. Whether breast magnetic resonance imaging (MRI) or ultrasound would
improve tumor detection is not known. In a cohort of women with BRCA mutations, Warner and colleaguesArticleassessed
the individual sensitivity and specificity of annual mammography, ultrasound,
and MRI and biennial CBE and the sensitivity of performing all 4 screening
modalities vs the combination of mammography and CBE. Twenty-two cancers were
detected in the study of 236 women. Of these, 17 were detected by MRI (7 by
MRI alone), 8 by mammography, 7 by ultrasound, and 2 by CBE. Sensitivity was
95% for all 4 modalities combined vs 45% for mammography and CBE. In an editorial,ArticleRobson and Offit discuss the potential value of MRI for breast
In animal studies, the β-blocker propranolol increases bone formation,
but whether a similar effect is seen in humans is not known. In a case-control
study, Schlienger and colleagues assessed the risk of fracture in patients
taking β-blockers alone or in combination with thiazides. They found
fracture risk was significantly reduced in patients currently taking β-blockers
or thiazides, alone or in combination, compared with patients who did not
take either drug.
To provide estimates of influenza severity, Thompson and colleagues
analyzed national hospital discharge and influenza surveillance data to determine
influenza-associated hospitalizations in the United States from 1979-1980
through 2000-2001. Overall, the numbers and rates of influenza-associated
hospitalizations increased over the study period. The highest rates were for
persons 85 years or older and the lowest rates for persons aged 5 through
49 years. Rates for children younger than 5 years were similar to those for
persons aged 50 to 64 years.
Researchers are finding that aspects of the fetal environment, such
as maternal nutrition and stress, may have important long-term consequences
for health. (Photo credit: Rubèn Quintero, MD
Genetic variants of long QT syndrome predict cardiac events in patients
Issues surrounding voting by persons with dementia.
Clinical Crossroads Knight discusses
substance abuse by physicians, the role of colleagues, and treatment options.
Recent developments in efforts to require clinical trial registration
and achieve wider dissemination of trial data.
For your patients: Information about opioid abuse.
This Week in JAMA. JAMA. 2004;292(11):1269. doi:10.1001/jama.292.11.1269