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A JAMA THEME ISSUE
Edited by J. Michael Gaziano, MD, MPH, and Eric D. Peterson, MD, MPH
Observational data on multivitamin use and cardiovascular disease incidence have been inconsistent. In the Physicians' Health Study II, involving 14 641 male US physicians aged 50 years or older and random assignment to a daily multivitamin supplement or placebo, Sesso and colleagues found that daily multivitamin use did not reduce major cardiovascular events after more than a decade of treatment and follow-up. In an editorial, Lonn discusses the evidence that cardiovascular disease cannot be prevented or treated with vitamin supplementation.
Prophylactic corticosteroids are often administered during cardiac surgery; however, evidence that routine corticosteroid use can prevent major adverse events is lacking. Dieleman and colleagues randomly assigned 4494 adult patients undergoing cardiac surgery with cardiopulmonary bypass to receive either a single intraoperative dose of dexamethasone or placebo and found no difference in the 30-day incidence of a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure between the 2 groups.
Two articles in this issue report results of studies that assessed disparities in cardiovascular disease (CVD) risk. Safford and colleagues examined incident coronary heart disease (CHD) by black and white race and sex in a prospective cohort of 24 443 individuals. Among their findings were higher rates of fatal incident CHD in blacks, which was associated with a greater CVD risk factor burden in blacks than in whites. In a multicenter prospective study of 15 079 US Hispanic and Latino adults of diverse backgrounds, Daviglus and colleagues found that the overall prevalence of major CVD risk factors was high, with some variance related to race/ethnicity, socioeconomic status, and level of acculturation. In an editorial, Lauer discusses the transformation of epidemiological investigation.
In a substudy of 2564 patients enrolled in a randomized trial comparing clopidogrel with prasugrel with background aspirin therapy in medically managed patients with acute coronary syndromes (ACS), Gurbel and colleagues examined the relationship between platelet function and outcomes. They found that compared with clopidogrel, prasugrel was associated with lower platelet reactivity but with comparable rates of a composite of cardiovascular death, myocardial infarction, and stroke through 30 months' follow-up. In an editorial, Price discusses implications of the study for clinical practice and future research.
In a pooled analysis of individual-level data (1964-2008) from 5 large community-based cohorts representing more than 900 000 person-years of follow-up, Wilkins and colleagues found that the lifetime risk of total cardiovascular disease exceeds 30% for all individuals, including those with an optimal risk factor profile in middle age.
Article AND AUTHOR AUDIO INTERVIEW
An advisory from several cardiology societies aims at reducing 8 cardiovascular disease factors and implementing drug therapy for at-risk individuals.
Transforming clinical trials in cardiovascular disease
Hypertension control and prevention: genomics and environment
The future of clinical cardiovascular research
“While educating our students through evidence has its place and brings us to each patient with a clearer process, it should complement the integration of experience and life lesson.” From “On Caring for Those Who Will Remain.”
Cardiovascular research: past, present and future generations
Join Nancy A. Rigotti, MD, Wednesday, November 14, from 2 to 3 PM eastern time to discuss strategies to help patients quit smoking. To register, go to http://www.ihi.org/Authorintheroom.
Dr Gaziano summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
For your patients: Information about stents to treat coronary artery blockages.
This Week in JAMA. JAMA. 2012;308(17):1711. doi:10.1001/jama.2012.3303