In this 3-year follow-up of the Heart and Estrogen/Progestin Replacement
Study, a placebo-controlled trial of hormone therapy (HT) in postmenopausal
women with coronary artery disease, Hlatky and colleaguesArticle found that the effects
of HT on quality of life and depressive symptoms depended on whether menopausal
symptoms were present at study entry. Among women with flushing, those in
the HT group had significant improvements in mental health and fewer depressive
symptoms compared with those in the placebo group, but among women without
flushing, those in the HT group had greater declines in physical dimensions
of quality of life. In an editorial, Rexrode and MansonArticle discuss the benefits, risks, and uncertain outcomes associated with HT.
In secondary prevention trials, both dietary treatment and HMG-CoA reductase
inhibitors have been shown to reduce cardiovascular morbidity and mortality.
Jula and colleagues conducted a crossover trial in men with untreated hypercholesterolemia
to evaluate the effects of a modified Mediterranean-type diet and simvastatin
therapy on serum levels of lipids, lipoproteins, antioxidants, and insulin.
The effects of dietary treatment and simvastatin were independent and additive.
Dietary therapy potentiated the cholesterol-lowering effect of simvastatin
treatment and counteracted the elevation of fasting insulin levels associated
The Centers for Disease Control and Prevention, in collaboration with
state and local health departments, conducted an active surveillance project
in 3 US communities from 1995 through 2000 to monitor trends in varicella
disease after licensure of the varicella vaccine in 1995. Seward and colleagues
report that in 1999, the number and rates of varicella cases and hospitalizations
declined markedly in all 3 communities. By 2000, vaccine coverage among children
aged 19 to 35 months ranged from 74% to 84%.
To study the extent and nature of interactions between authors of clinical
practice guidelines and the pharmaceutical industry, Choudhry and colleagues
conducted a cross-sectional survey of authors of clinical practice guidelines
published between 1991 and 1999. Although the survey response rate was low
(52%), the results from authors representing 37 of the 44 clinical practice
guidelines indicate that most clinical practice guideline authors have interactions
with pharmaceutical companies. More than a third of respondents worked as
employees or consultants for a pharmaceutical company, and 59% had relationships
with companies whose drugs were considered in the guideline they authored.
In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin
Therapy (ESPRIT) trial, ischemic complications of nonurgent percutaneous coronary
intervention with stent implantation were significantly reduced at 48 hours
and 30 days among patients who received eptifibatide compared with those who
received placebo. In this analysis of outcomes during the 12 months after
study enrollment, O'Shea and colleagues found that ischemic complications
continued to be significantly lower in the eptifibatide group.
D. A. Henderson, MD, MPH, head of the new Office of Public Health Preparedness,
talks with JAMA about the national response to bioterrorism. Reports from
other experts address prevention and treatment of smallpox and anthrax.
The nocebo phenomenon, in which placebos produce adverse side effects,
may help explain the occurrence of nonspecific side effects in patients taking
active medications. This focused literature review identifies factors associated
with the occurrence of nonspecific medication side effects and presents clinical
strategies to manage them.
This review of current medical therapy for advanced heart failure focuses
on reducing elevated filling pressures and emphasizes individualized therapy
based on clinical and hemodynamic profiles.
For your patients: Information about heart failure.
This Week in JAMA. JAMA. 2002;287(5):551. doi:10.1001/jama.287.5.551