To assess whether treatment with angiotensin-converting enzyme (ACE)
inhibitors or calcium channel blockers (CCBs) is superior to a thiazide-type
diuretic to reduce the incidence of cardiovascular disease (CVD) in blacks
vs nonblacks with hypertension, Wright and colleaguesArticle analyzed data from the ALLHAT study, in which participants were randomly assigned to a CCB (amlodipine), an ACE inhibitor (lisinopril), or a thiazide-type diuretic
(chlorthalidone) and followed up for a mean of 4.9 years. In both black and
nonblack participants, the authors found no significant differences by treatment
for the primary outcome of combined fatal coronary heart disease and nonfatal
myocardial infarction or for any other major CVD or renal outcome. In an editorial,Article Neaton and Kuller discuss previous hypertension treatment
trials and possible explanations for race-specific outcomes in ALLHAT.
Natriuretic peptide levels predict outcome for patients with established
heart disease, but no studies have assessed their prognostic value in healthy
individuals or in comparison with other biomarkers of cardiac risk. Kistorp
and colleaguesArticle assessed the risk of mortality and first
major cardiovascular event by baseline levels of N-terminal prohormone brain
natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and urinary albumin/creatinine
ratio in a cohort of older adults with no history of cardiovascular disease.
They found significant associations between increased baseline levels of NT-proBNP
and mortality and first cardiovascular event. These associations were stronger
than those for CRP and mortality or first cardiovascular event and were independent
of traditional risk factors. In an editorial,Article Schillinger
discusses the mechanisms of disease associated with NT-proBNP, CRP, and urinary
albumin/creatinine ratio, and their clinical utility.
Oral naltrexone is an effective treatment for alcohol dependence, but
adherence to daily therapy can be poor. Garbutt and colleagues assessed the
efficacy and tolerability of a long-acting intramuscular formulation of naltrexone,
at a dose of 380 mg or 190 mg administered monthly, compared with a placebo
injection and combined with a low-intensity psychosocial intervention in adult
alcohol-dependent patients. They found that patients receiving 380 mg of naltrexone
had significantly fewer heavy drinking days compared with patients receiving
placebo. Naltrexone injections appeared to be well tolerated and adverse events
were comparable across the 3 treatment groups.
Psychosocial factors are associated with an increased risk of ischemic
heart disease (IHD), but whether modifying these factors will reduce cardiovascular
risk is not clear. In a randomized trial, Blumenthal and colleagues studied
the effect of adding either exercise training or stress management training
to routine medical care vs routine medical care alone on psychosocial functioning
and cardiovascular risk in a cohort of patients with stable IHD. They found
that patients in both active treatment groups had greater improvements from
baseline in psychosocial functioning and intermediate markers of cardiovascular
risk compared with patients receiving only routine medical care.
An advisory panel to the US Food and Drug Administration recently recommended
that the agency allow continued marketing of cyclooxygenase 2 inhibitors but
urged physicians to use greater caution when prescribing all nonsteroidal
In a randomized trial, youth asked about suicidal ideation or behavior
did not have more distress or increased suicidal ideation after screening
compared with youth not asked these questions.
In a meta-analysis of 129 surgical studies, which included data on patients’
workers’ compensation status, patients who received compensation had
worse surgical outcomes.
Clinical Review A review of clinical
symptoms associated with the presence of cell-free hemoglobin suggests that
hemolysis and hemoglobinemia should be considered a novel mechanism
For your patients: Information about alcohol abuse and alcoholism.
This Week in JAMA . JAMA. 2005;293(13):1549. doi:10.1001/jama.293.13.1549