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In This Issue of Archives of Internal Medicine
February 26, 2001

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2001;161(4):501. doi:10.1001/archinte.161.4.501
Cardiovascular Disease and Dyslipidemia in Women

Estrogen replacement lowers low-density lipoprotein cholesterol and raises high-density lipoprotein cholesterol in women with cardiovascular disease. The first 2 randomized trials of hormone replacement therapy showed no cardiovascular benefit in women. In contrast, randomized trials such as that of Welty suggest that statin drugs lower coronary disease risk equally well in women and men in both primary and secondary prevention.

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Diagnosis of Pulmonary Alveolar Proteinosis

The diagnosis of PAP is mainly based on histopathologic findings obtained with transbronchial lung biopsy (TBLB) or open lung biopsy specimens. However, the diagnostic yield of transbronchial lung biopsy is usually unsatisfactory. With the advent of improved bronchoscopic techniques, bronchoalveolar lavage (BAL) has proved to be valuable in providing a diagnosis of PAP; however, the ultrastructural examination of BAL fluid (BALF) specimens and/or specific stains are usually required. Clinically, it is impractical to process all routing specimens for electron microscopy or special stains. The findings of Chou et al suggest that globules stained green, orange, or orange in the center coated with a green rim as seen in Papanicolaou-stained smears of a BALF specimen can be of significant value in aiding the diagnosis of PAP.

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Is There a Negative Interaction Between Aspirin and ACE Inhibitors Among Elderly Survivors of Hospitalization for Acute Myocardial Infarction?

Aspirin and angiotension-converting enzyme (ACE) inhibitors are strongly recommended for secondary prevention after acute myocardial (AMI), but several studies have suggested that the combination of these medications may produce a negative interaction. Krumholz et al evaluated the effect and interaction of aspirin and ACE inhibitors on mortality in patients older than 65 years who survived hospitalization at an acute care, nongovernmental hospital in the United States with a confirmed AMI from 1994 to 1995 and who were ideal candidates for the therapies. In the multivariate analysis, patients who received both aspirin and ACE inhibitors alone had a significantly lower 1-year mortality compared with patients who received neither aspirin nor ACE inhibitors at discharge. Prescribing both aspirin and ACE inhibitors was associated with a greater reduction in mortality than that seen in aspirin-only or ACE inhibitor-only groups, but the benefit was not significantly different in patients who used either medication alone. In conclusion, the benefit of ACE inhibitors and aspirin is consistent with what would be expected from overall results of randomized trials; prescribed together, the outcome is slightly better than with either medication alone, but not significantly so. This study generally supports current treatment guidelines and does not indicate that the combination of aspirin and ACE inhibitors is harmful to patients.

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Smoking and Weight Control Efforts

Many adolescents smoke to control their weight, but whether adults also smoke to control their weight is not known. Based on a national household survey of over 17 000 adults conducted in 1995, Wee and colleagues found that adults 30 years and older were actually as likely or less likely to smoke if they were also trying to lose weight. Young adults (aged 18 to 30 years), however, were more likely to smoke if they were trying to lose weight, even after adjusting for sociodemographic factors and body mass index. Nevertheless, smokers of all ages expressed a desire to quit smoking whether or not they were actively try to lose weight. The authors suggest that young adults may be smoking to control their weight, and recommend that health efforts should target them for education about smoking and healthy weight control methods. The authors also believe that health providers should not be deterred from having discussions about smoking and smoking cessation with those who are trying to lose weight.

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