Trends in the use of inferior vena cava (IVC) filters in the United States over the last 2 decades were analyzed using the National Hospital Discharge Survey database. Use of IVC filters increased markedly during this period. In 1999, 45% of IVC filter insertions were in patients with deep venous thrombosis alone, 36% were in patients with pulmonary embolism, and 19% were in patients at high risk, who did not have deep venous thrombosis or pulmonary embolism. Randomized controlled trials may improve risk stratification and limit unnecessary IVC filter insertions.
Stafford and colleagues investigated patterns of pharmacotherapy for osteoporosis from 1988 to 2003 using nationally representative data available from the IMS HEALTH National Disease and Therapeutic Index. Annual physician visits for osteoporosis quadrupled between 1994 (1.3 million visits) and 2002 (5.3 million visits), coinciding with the availability of oral daily bisphosphonates. Between 1994 and 2003, the percentage of osteoporosis visits when bisphosphonates were prescribed increased from 14% to 76% and from 0% to 10% for raloxifene, while the use of all other medications declined. These findings suggest that the availability of new drug therapy contributed to increased recognition and treatment of osteoporosis.
Wagner and colleagues report results of a large claims data-based cohort study of the risk of hip fracture associated with benzodiazepine use in elderly patients. After adjustment for a number of potential confounders, the authors found that the benzodiazepine use moderately but significantly increased the incidence rate of hip fracture compared with no benzodiazepine use (incidence rate ratio, 1.24; 95% confidence interval, 1.06-1.44). Incidence of hip fracture was particularly high during the first 2 weeks after starting benzodiazepine therapy (incidence rate ratio, 2.05; 95% confidence interval, 1.28-3.28) and declined thereafter. However, residual confounding remains an explanation of these findings.
Koo and colleagues aimed to determine the impact of excessive anticoagulation on morbidity and mortality in hospitalized patients with major bleeding occurring during administration of warfarin, unfractionated heparin, or low-molecular-weight heparin. In a prospective cohort of 101 consecutive hospitalized patients with major anticoagulation-related bleeding, 50% had excessive levels of anticoagulation. The authors identified excessive levels of anticoagulation as an independent predictor of 60-day mortality (adjusted hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.39-12.49; P = .01), along with intracranial hemorrhage (adjusted HR, 6.16; 95% CI, 1.75-21.67; P = .005) and active cancer (adjusted HR, 3.79; 95% CI, 1.13-12.70; P = .03). Excessive anticoagulation was also a predictor for a set of major nonfatal outcomes (HR, 2.41; 95% CI, 1.36-4.26; P = .002).
The role of elevated uric acid level as a cardiovascular risk factor has been controversial. It has established correlations with individual components of metabolic syndrome and manifest cardiovascular disease (CVD). In a population-based 12-year prospective cohort study of 1423 middle-aged Finnish men initially without CVD, cancer, or diabetes, serum uric acid levels in the upper third were associated with a greater than 2.5-fold higher risk for death from CVD compared with levels in the lower third. Taking into account cardiovascular risk factors and variables associated with gout increased the relative risk to 3.73, and adjustment for factors related to metabolic syndrome strengthened the risk to 4.77. Uric acid level was also associated with total mortality. Thus, serum uric acid level is a strong independent predictor of cardiovascular mortality in middle-aged men without clinical CVD, diabetes, or cancer.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2004;164(14):1479. doi:10.1001/archinte.164.14.1479