Mursu et al assessed the self-reported use of 15 vitamin and mineral supplements in relation to total mortality in 38 772 women in the Iowa Women's Health Study. Several commonly used dietary vitamin and mineral supplements, including multivitamins, vitamins B6 and folic acid, and the minerals iron, magnesium, zinc, and copper, were associated with a higher risk of total mortality. Supplemental iron was strongly and dose-dependently associated with increased risk. In contrast, self-reported use of supplemental calcium was associated with a decreased risk of mortality, contradicting meta-analyses of calcium supplementation in randomized clinical trials.
The 2 major factors associated with skeletal fracture in older people are intrinsic bone strength and the risk of falling. Zhu et al examined Timed Up and Go (TUG) test performance, a validated predictor of falling, and hip areal bone mineral density at fracture prediction in a 10-year longitudinal study with 1126 older women (mean [SD] age at baseline, 75.0 [2.6] years). Compared with those with normal TUG and bone mineral density (BMD), risks for nonvertebral fracture were 84% higher in subjects who had low TUG but normal BMD and 1.5 times higher in those with both low TUG and low BMD. The TUG test is an independent risk factor for incident nonvertebral fracture in older women.
Based on a lack of benefit in the Occluded Artery Trial (OAT) and similar smaller trials, national guidelines now recommend against performing percutaneous coronary intervention (PCI) targeting persistently occluded infarct-related arteries 1 or more days after myocardial infarction unless clinical instability or advanced multivessel disease is present. Deyell et al examined the prevalence of PCI for this type of patient over time, from 2005 through 2008, using the American College of Cardiology CathPCI Registry. The authors found that neither publication of the OAT nor the resulting guideline revisions were followed in the subsequent 1 to 2 years by a significant overall decline in PCI for this indication, and only marginal decreases in selected patient subsets could be detected. These findings, based on a large cross-section of hospitals in the United States, suggest that the clear results of the OAT and consequent guideline revisions defining such procedures as not indicated have failed to be fully incorporated into practice over this period.
Hospital-acquired anemia (HAA) is common in patients with acute myocardial infarction (AMI) admitted with normal hemoglobin level, is associated with greater mortality and worse health status, and commonly occurs in the absence of recognized bleeding. Salisbury et al studied whether diagnostic blood loss from phlebotomy, a potentially modifiable risk factor, was associated with HAA in 17 676 patients with incident AMI from 57 US hospitals. Moderate to severe HAA developed in 1 in 5 patients, and these patients experienced greater intensity of diagnostic phlebotomy than patients who did not (mean [SD] 173.8 [139.3] mL v. 83.5 [52.0] mL; P < .001). After adjusting for potential confounders, each 50 mL of diagnostic blood loss was associated with a 15% higher risk of developing HAA. Strategies that reduce diagnostic blood loss, including greater use of pediatric blood tubes in adult patients, more frequent use of stored serum samples, and efforts to group blood draws for laboratory tests to eliminate unnecessary blood draws, should be studied to understand whether reducing diagnostic blood loss prevents HAA and improves clinical outcomes.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2011;171(18):1621. doi:10.1001/archinternmed.2011.480