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This Week in JAMA
February 6, 2002

This Week in JAMA

JAMA. 2002;287(5):551. doi:10.1001/jama.287.5.551
Hormone Therapy and Quality of Life

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.

Diet and Simvastatin Therapy in Hypercholesterol

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 with simvastatin.

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Trends in Varicella Disease After Vaccine Introduction

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%.

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Potential Conflicts of Interest in Practice Guidelines

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.

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Long-term Outcomes of Eptifibatide Therapy

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.

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Medical News & Perspectives

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.

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Nocebo and Nonspecific Side Effects

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.

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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.

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JAMA Patient Page

For your patients: Information about heart failure.

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