Lipid-lowering agents such as fibrates and statins can have adverse
effects on muscle, including rhabdomyolysis; however, reliable risk estimates
for rhabdomyolysis are lacking. Graham and colleagues reviewed 1998-2001 pharmacy
and hospital claims data and medical records for patients prescribed statins
and fibrates, alone or in combination, to estimate the incidence of hospitalization
for rhabdomyolysis. They found that rhabdomyolysis risk was low for monotherapy
with atorvastatin, pravastatin, or simvastatin, but the risk increased for
patients prescribed combined statin-fibrate therapy, particularly older patients
with diabetes mellitus. Patients taking cerivastatin plus a fibrate had a
10% annual risk of rhabdomyolysis.
The relationship of subclinical thyroid dysfunction to morbidity and
mortality in older individuals is unclear. To assess the long-term impact
of subclinical thyroid dysfunction on performance and survival, Gussekloo
and colleaguesArticle conducted a prospective, population-based
study of persons aged 85 through 89 years in Leiden, the Netherlands. Comparing
participants with subclinical or overt hypothyroidism at baseline with those
having normal thyroid function, the authors found no differences in activity,
depressive symptoms, or cognitive function. However, persons with increased
thyrotropin levels had a lower risk of mortality over 3 years of follow-up.
In an editorial,Article Cooper discusses the implications
of these findings for the care of elderly patients.
Between 1944 and 1957, large amounts of sodium iodide 131 (131I) were released into the atmosphere near the Hanford Nuclear Site in
Washington state, and there has been concern that exposed individuals may
have an increased risk of thyroid disease. Davis and colleagues report results
of a retrospective cohort study involving individuals born from 1940 through
1946, with presumed exposure to the Hanford 131I releases. In this
cohort of individuals with low-dose and protracted environmental 131I exposure during infancy and childhood, the authors found no association
of exposure with thyroid neoplasia, benign thyroid nodules, autoimmune thyroiditis,
Recent reports of serious harms associated with approved medications
have raised concerns about the drug approval and postmarketing surveillance
systems and about potential conflicts of interest in the evaluation of adverse
drug reactions. Several articles in this issue of JAMA explore
these issues. Psaty and colleaguesArticle report results
of a literature review and related internal Bayer Corporation documents, which
documented a clear and known association of cerivastatin with an increased
risk of rhabdomyolysis. An article by StromArticle discusses
the role of voluntary adverse event reporting in monitoring drug safety and
the limits of pharmacoepidemiologic analyses for triggering investigation
of potentially serious events. Piorkowski, in an invited response,Article describes
Bayer Corporation’s premarketing and postmarketing knowledge of and
response to reports of rhabdomyolysis related to cerivastatin use and critiques
the assertions of Psaty and colleagues,Article who
provide a response to those critiques. In an editorial,Article Fontanarosa,
Rennie, and DeAngelis describe the circumstances surrounding this collection
of articles and endorse measures to improve postmarketing drug surveillance
and patient safety.
A new initiative by the Centers for Disease Control and Prevention is
designed to promote research into how to develop HIV/AIDS prevention strategies
that are tailored to minority communities as well as to mentor young investigators
with ties to these underserved communities.
An altered and exaggerated immune response to arthropod bites may be
the cause of a pruritic papular eruption common in persons with human immunodeficiency
virus (HIV) infection in sub-Saharan Africa.
Clinical Crossroads Mandel reviews the
evaluation of a 64-year-old woman with a history of multinodular goiter and
partial thyroidectomy who has a new thyroid nodule.
For your patients: Information about thyroid nodules.
This Week in JAMA . JAMA. 2004;292(21):2547. doi:10.1001/jama.292.21.2547