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In This Issue of JAMA
July 14, 2015

Highlights

JAMA. 2015;314(2):101-103. doi:10.1001/jama.2014.11851
Research

Pursnani and colleagues assessed whether the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for cholesterol treatment improve identification of individuals at risk of cardiovascular disease in a longitudinal study involving 2435 participants in the offspring and third-generation cohorts of the Framingham Heart Study. The authors found that compared with the National Cholesterol Education Program’s 2004 expert panel report (ATP III) guidelines, the ACC/AHA guidelines for determining statin eligibility were associated with greater accuracy and efficiency in identifying increased risk of incident CVD and subclinical coronary artery disease. In an Editorial, Greenland and Lauer discuss patient selection and strategies for cholesterol lowering.

Editorial and Related Article

Continuing Medical Education

The 2013 American College of Cardiology/American Heart Association cholesterol treatment guidelines are anticipated to substantially expand statin treatment in the United States. In a microsimulation model based on a hypothetical cohort of US adults aged 45 to 70 years, Pandya and colleagues assessed the cost-effectiveness of various 10-year atherosclerotic cardiovascular disease risk (ASCVD) thresholds for statin treatment. The authors’ findings suggest that the 10-year ASCVD risk threshold used in the cholesterol treatment guideline—statin treatment for all adults with an estimated 10-year ASCVD risk of 7.5% or higher—has an acceptable cost-effectiveness profile and that more lenient ASCVD thresholds may also be cost-effective.

Editorial and Related Article

Author Audio Interview

In a phase 2, multicenter, randomized trial that enrolled 306 outpatients with hyperkalemia and diabetic kidney disease, Bakris and colleagues found that patiromer—an investigational potassium-binding polymer—at a starting dose of 4.2 to 16.8 g twice daily resulted in significant decreases in serum potassium levels after 4 weeks of treatment. The effect persisted through 52 weeks of treatment. In an Editorial, Winkelmayer discusses important considerations in chronic treatment of hyperkalemia.

Editorial

Bianchi and colleagues report incidental detection of maternal malignancies in 10 of 125 426 asymptomatic pregnant women whose results from noninvasive prenatal testing (NIPT)—sequencing of cell-free DNA in maternal plasma to detect fetal aneuploidy—were discordant with the fetal karyotype. Findings from clinical follow-up, genome sequencing, and genome-wide bioinformatics analysis from 8 of the 10 women are presented. In an Editorial, Romero and Mahoney discuss implications for patient care.

Editorial and JAMA Patient Page

Author Video Interview

Clinical Review & Education

Whether treatment of hypertension among elderly patients—particularly those patients taking numerous medications (polypharmacy)—is beneficial is not clear. In this Care of the Aging Patient article, Benetos and colleagues summarize findings from 1 randomized trial involving 2223 patients and 6 post hoc analyses of another trial involving 3845 patients that address use of antihypertensive medications among octogenarians. The authors provide recommendations for hypertension treatment in this population—including considerations related to polypharmacy in frail, elderly patients with multiple comorbidities.

Continuing Medical Education

Dialectical behavioral therapy—a multicomponent, resource-intensive intervention—has proven efficacy in the treatment of individuals with borderline personality disorder. An article in JAMA Psychiatry reported that a variety of dialectical behavioral therapy interventions were effective in reducing suicide attempts and nonsuicidal self-injury acts in women with borderline personality disorder. In this From The JAMA Network article, Gunderson discusses implications of the study findings for patients with this disorder.

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