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This Week in JAMA
April 6, 2011

This Week in JAMA

JAMA. 2011;305(13):1269. doi:10.1001/jama.2011.395

When the Women's Health Initiative Estrogen-Alone trial was stopped after a mean of 7.1 years of follow-up, women with prior hysterectomy who had been randomly assigned to receive conjugated equine estrogens (CEE) had a higher risk of stroke, a lower risk of hip fracture, and a similar risk of coronary heart disease (CHD) as women who received placebo. LaCroix and colleagues Article examined health outcomes associated with randomization to CEE treatment through a mean of 10.7 years of follow-up and found that compared with placebo, CEE use for a median 5.9 years was not associated with either increased or decreased risk of CHD, deep vein thrombosis, stroke, hip fracture, colorectal cancer, or total mortality. A decreased risk of breast cancer among women randomly assigned to receive CEE persisted throughout the entire follow-up. In an editorial, Jungheim and Colditz Article discuss the risks and benefits of short-term unopposed estrogen therapy among women with prior hysterectomy.

Prescription opioid–related deaths have increased sharply in the United States over the past decade. Bohnert and colleagues Article examined the relationship between opioid prescribing patterns (dose and schedule) and risk of opioid-related deaths in a national sample of Veterans Health Administration patients who received opiates for a variety of medical conditions. The authors Article report that the risk of overdose-related death was directly related to the maximum prescribed daily dose but was not associated with the receipt of both as-needed and regularly scheduled doses.

Clusterin—also known as apolipoprotein J—may be involved in the pathogenesis of Alzheimer disease. In an analysis of data from a prospective population-based cohort study, Schrijvers and colleagues assessed the potential utility of plasma clusterin as a biomarker of the presence, severity, and risk of Alzheimer disease. The authors found that the plasma clusterin levels were significantly associated with the prevalence and severity of Alzheimer disease at baseline, but not the risk of incident disease.

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Minority, or low-frequency, human immunodeficiency virus 1 (HIV-1) drug–resistance mutations may adversely affect response to antiretroviral treatment. In a systematic review and pooled analysis of data from 10 studies of antiretroviral treatment–naive participants who were initiating nonnucleoside reverse transcriptase inhibitor (NNRTI)–based regimens, Li and colleagues found that the presence of minority HIV-1 resistance mutations—particularly those involving NNRTI resistance—was associated with a greater than 2-fold increased risk of first-line antiretroviral treatment failure.

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Ms W, a 61-year-old mildly obese woman, had an unprovoked episode of venous thromboembolism (VTE). An evaluation for thrombophilia was negative and anticoagulation was complicated by a postoperative hemorrhage. After 6 months of warfarin therapy, Ms W wonders whether she needs to continue treatment. Bauer discusses risk factors for VTE, and the evaluation and treatment of patients with unprovoked VTE.

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“I love practicing medicine. Unequivocally. Yet it sometimes seems as much a burden as a privilege.” From “Melancholy.”

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Despite the huge mass of genomic information generated since the launch of the Human Genome Project a decade ago, many questions remain about the future clinical implications of such data.

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Curtailing diversion and abuse of opioid analgesics

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Potential design flaw in vitamin supplement trials

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Glycemic control in older patients with diabetes

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Technology, diet, and chronic disease

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Freud, Koller, and cocaine

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Join Monica Morrow, MD, Wednesday, April 20, from 2 to 3 PM eastern time to discuss whether women with invasive breast cancer and sentinel node metastasis should or should not have axillary dissection. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a woman who developed severe sepsis? Go to www.jama.com to read the case, and submit your response by April 11.

Theme Issue on Infectious Disease and Immunology

For your patients: Information about thrombophlebitis.

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