This systematic review aimed to compare the relative benefits and harms of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) for perioperative thromboprophylaxis in patients with cancer. A meta-analysis of 14 trials showed no difference between LMWH and UFH for the outcomes of death, deep venous thrombosis diagnosed following clinical suspicion, pulmonary embolism, minor bleeding, or major bleeding. In a post hoc analysis, LMWH was superior to UFH for the outcome of deep venous thrombosis diagnosed using any diagnostic strategy.
Eradication of angina is a primary goal of post–myocardial infarction (MI) care, but the prevalence of the condition and factors associated with it are unknown. Maddox et al examined a multicenter cohort of 1957 patients with MI using the Seattle Angina Questionnaire and found that 389 (19.9%) reported anginal symptoms 1 year after their MI. Multivariable regression modeling was used to identify sociodemographic, clinical, and treatment factors associated with anginal symptoms, adjusted for site. Patients with anginal symptoms 1 year after MI were more likely to be younger, nonwhite men, to have had anginal symptoms before MI hospitalization, to have had coronary artery bypass graft surgery before MI hospitalization, and to experience recurrent rest angina during their MI hospitalization. In addition, these patients were more likely to continue smoking, to receive a revascularization procedure, and to have significant new, persistent, or transient depressive symptoms after their MI hospitalization.
In this study, Dobnig et al followed up a large cohort of patients referred for coronary angiography for more than 7 years. Patients with baseline 25-hydroxyvitamin D levels in the lower 2 quartiles were at significantly higher risk for all-cause and cardiovascular mortality. These effects were seen after adjustment for multiple cardiovascular risk factors and in patients with different degrees of physical activity levels, comorbidities, or coronary artery disease. Analyses of 1,25-dihydroxyvitamin D levels revealed comparable associations but were slightly weaker. These results do not prove causality between low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and mortality risk; however, they appear biologically plausible and fit into the enlarging picture of adverse effects that may evolve with suboptimal vitamin D status.
Kaplan-Meier plots of all-cause and cardiovascular mortality in the 25-hydroxyvitamin D quartiles (Q).
Inzitari et al investigated the effect of subtle neurological abnormalities detected with a simple neurological examination of cognitive and functional status, death, and cerebrovascular events in older community-dwelling adults without overt neurological diseases. The authors demonstrated that a higher number of neurological abnormalities independently predicted worsening cognitive and functional status after 4 years and increased the risk of death and of cerebrovascular events over 8 years. Screening for subtle neurological abnormalities may be important in older patients.
To identify sociocultural factors associated with lower hypertension control rates in non-Hispanic blacks, this study analyzed data from structured interviews and blood pressure measurements in the Dallas Heart Study. Despite extensive nationwide educational efforts to convey the importance of regular medical checkups to combat the “silent killer,” the authors found that a common perception of good health and lack of a regular physician remain the 2 factors most strongly associated with low rates of hypertension awareness, treatment, and control among young and middle-aged black and white adults in a contemporary urban community. Hypertensive men—especially hypertensive black men—were more likely than hypertensive women to lack a regular physician and to cite not needing a physician as the most common reason for not having one. These findings draw attention to a persistent disparity in hypertension control disproportionately affecting non-Hispanic black men and inform the development and evaluation of new public health programs designed to reduce this disparity.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2008;168(12):1246. doi:10.1001/archinte.168.12.1246