In a population-based retrospective cohort study of older adults hospitalized for newly diagnosed heart failure, the composite outcome of subsequent death, acute myocardial infarction, or stroke occurred in 217 of 1146 new statin recipients (13.6 per 100 person-years) vs 12 299 of 27 682 nonrecipients (21.8 per 100 person-years), which is equivalent to an adjusted hazard ratio of 0.72. The principal benefit from statins was related to a reduction in all-cause mortality (adjusted HR, 0.67). Statin use is associated with a lower risk of death among seniors newly diagnosed as having congestive heart failure.
Some patients with cryoglobulinemic syndrome develop frank non-Hodgkin lymphoma (NHL), but the incidence and timing of this event are still poorly defined. This study retrospectively assessed the cumulative incidence and characteristics of NHL in a large series of patients with cryoglobulinemia syndrome observed in 11 centers belonging to the Italian Group for the Study of Cryoglobulinemia. The overall incidence of NHL after the diagnosis of cryoglobulinemia syndrome in 1255 hepatitis C virus–positive patients followed up for 8928 person-years was about 35 times higher than that in the normal population and was still 12 times higher considering only the aggressive NHL histotypes.
In the United States and many regions of the world, sudden cardiac death is one of the major public health concerns. The current guidelines for cardiopulmonary resuscitation recommend vasopressin as an alternative for the treatment of adult shock-refractory ventricular fibrillation. Aung and Htay present a systematic review and meta-analysis of clinical trials comparing vasopressin and epinephrine in the treatment of cardiac arrest. Evidence of benefit with vasopressin over epinephrine, with regard to return of spontaneous circulation, survival at different points after arrest, and neurologically normal survival, is lacking. At the same time, no harm with vasopressin was demonstrated. The authors recommend revising the guidelines for Advanced Cardiac Life Support to incorporate these findings.
It is now widely accepted that genetic variation is a major contributor to the interindividual variability in susceptibility to and outcome of disease. While the genetic cause of many rare Mendelian disorders has been ascertained, the role genetic variation plays in the pathogenesis of complex diseases that are the result of multiple genes, multiple biological pathways, and environmental factors (eg, infection) are just beginning to be understood. In this issue, Sutherland et al present their finding of an association of haplotype clades of the interleukin 6 gene with increased 28-day mortality in critically ill adults with systemic inflammatory response syndrome (SIRS). Interleukin 6 is a key proinflammatory cytokine in the pathogenesis of SIRS, and increased levels of interleukin 6 have been associated with fatal outcome in SIRS and sepsis. Associations of genetic variation with outcome from SIRS and sepsis will provide valuable insight into interindividual variability in the response to inflammatory stimuli, which could eventually lead to diagnostic tests to predict outcome. Therapy targeted to individuals at high risk by genotype for an excessive inflammatory response and poor outcome could vastly improve survival and quality of life. Patient-tailored therapy of complex disease is one promise of the human genome project.
Twenty-eight day mortality rates by interleukin 6 (IL-6) clade.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2005;165(1):12. doi:10.1001/archinte.165.1.12