Among patients with acute coronary syndromes (ACS) who undergo invasive procedures, administration of platelet glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors either upstream to all patients or deferred for selective use just prior to angiography is recommended. However, it is not known if one strategy is associated with improved outcomes. Stone and colleaguesArticle report results of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) Timing Trial, in which patients with moderate- and high-risk ACS who were having early invasive procedures were randomly assigned to receive either routine upstream or deferred selective Gp IIb/IIIa inhibitor therapy. The trial investigators found that deferred selective Gp IIb/IIIa inhibitor therapy was associated with a nonsignificant increase in ischemic events and did not meet the trial criterion for noninferiority. Selective deferred Gp IIb/IIIa use was associated with a lower risk of bleeding events. In an editorial, Mahaffey and HarringtonArticle discuss aspects of the ACUITY Timing Trial design, the trial outcomes, and potential application to clinical practice.
Several small studies have suggested an association of body iron stores in excess of physiological requirements with an increased risk of cardiovascular disease (CVD). In a multicenter randomized trial of patients with symptomatic peripheral arterial disease, Zacharski and colleaguesArticle tested the hypothesis that reducing body iron stores—while avoiding iron deficiency—through phlebotomy would be associated with a lower risk of all-cause mortality or a composite outcome of death plus nonfatal myocardial infarction and stroke. The authors found no overall differences in mortality, myocardial infarction, or stroke among patients having phlebotomy vs patients in the control group. In an editorial, HuArticle discusses the largely negative evidence for an association of body iron with cardiovascular disease risk and directions for future investigation.
Assessment of cardiovascular disease risk often relies on the presence or absence of traditional risk factors (age, hypertension, smoking, diabetes, and hyperlipidemia); however, among women, up to 20% of all coronary events occur in the absence of these major risk factors. In this issue of JAMA, Ridker and colleaguesArticle describe the development and validation of a global cardiovascular risk algorithm for women, the Reynolds Risk Score. The authors found that the Reynolds Risk Score, which includes traditional and novel risk factors, reclassified 40% to 50% of women who were categorized as having a 10-year intermediate risk of cardiovascular events based on the currently used algorithm into higher or lower risk categories. In an editorial, Blumenthal and colleaguesArticle discuss the advantages of the new algorithm and the need for models that will predict women's long-term (20 to 30 years) risk of cardiovascular events.
Effects of aging and menopause on female sexual response, the evaluation of postmenopausal sexual concerns, and the safety and efficacy of treatment options are discussed in the case of Ms B, a 60-year-old woman who has experienced sexual difficulties since entering menopause.
An increased suicide risk in children and adolescents taking antidepressants may extend into young adulthood, but not treating these individuals may also pose risks, according to an FDA panel that advised new warnings for the drugs.
Legal, ethical, and clinical concerns relating to the disclosure of health information after death.
Join Paul M Ridker, March 21, 2007, from 2 to 3 PM eastern time to discuss an algorithm to assess global cardiovascular risk in women. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about sexual concerns after menopause.
This Week in JAMA . JAMA. 2007;297(6):561. doi:10.1001/jama.297.6.561