This Week in JAMA

In the Heart and Estrogen/progestin Replacement Study (HERS), a randomized trial among postmenopausal women with preexisting coronary heart disease (CHD), the overall risk of CHD events in the hormone therapy group was not significantly different from that in the placebo group during 4.1 years of follow-up. Two articles in this issue of THE JOURNAL report on cardiovascular and noncardiovascular outcomes during 2.7 years of additional unblinded follow-up (HERS II) of women enrolled in HERS. Grady and colleagues found that the lower rates of CHD events in the hormone therapy group observed during years 3 to 5 of HERS did not persist during additional follow-up. Hulley and colleagues report that during all 6.8 years of follow-up, rates of venous thromboembolism and biliary tract surgery were significantly increased in the hormone therapy group compared with the placebo group. Differences in cancer and fracture risk and total mortality were not statistically significant. In an editorial, Petitti discusses the growing body of evidence that has failed to show a benefit from HRT, and outlines alternative interventions for disease prevention in postmenopausal women.

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White matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to be ischemic complications of cerebral microvascular disease that may precede the development of clinical stroke. To examine the relationship between WMLs, retinal microvascular abnormalities, and the incidence of clinical stroke, Wong and colleagues analyzed data from participants in the Atherosclerosis Risk in Communities (ARIC) Study who underwent cerebral magnetic resonance imaging and retinal photography at the third ARIC examination when they were aged 51 to 72 years. Persons with retinal microvascular abnormalities were significantly more likely to have WMLs than those without retinal vascular abnormalities. After a median follow-up of 4.7 years, the risk of clinical stroke was 3.4 times higher in persons with WMLs compared with those without WMLs, and in the presence of retinopathy, persons with WMLs were 18.1 times more likely to develop stroke than those without either WMLs or retinopathy.

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The epidemiology and clinical characteristics of infective endocarditis have evolved since its first modern clinical description. In this population-based survey conducted in 1999 in all hospitals in 6 regions in France, Hoen and colleagues found that the annual incidence of infective endocarditis was 31 cases per million, consistent with other recent studies. Compared with results of a similar survey in 1991, the incidence of infective endocarditis in patients with underlying heart disease and with prosthetic valves decreased; the incidence of infective endocarditis caused by oral streptococci decreased; the rate of early valve surgery increased; and in-hospital mortality tended to decrease.

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Latinos are now the largest racial/ethnic minority group of children in the United States. Flores and colleagues summarize key research, health care, and policy issues in Latino child health identified through a consensus process by the Latino Consortium of the American Academy of Pediatrics Center for Child Health Research.

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"For the first time, I'm thinking about dating, getting married, having children, where I want to live, and what I truly want to do with my life." From "Skydiving."

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In a nation that existed in North America long before the birth of the United States, the Navajo people—with some help from friendly health professionals—work to maintain their well-being despite the increasing incursion of the outside world.

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Interviews with physicians and a home hospice social worker involved in the care of Mr G, a 47-year-old man with rapidly progressive amyotrophic lateral sclerosis, illustrate this discussion of how to respond to requests for physician-assisted suicide.

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For your patients: Information about endocarditis.

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