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The addition of short-term clopidogrel therapy to aspirin following
percutaneous coronary intervention (PCI) has been shown to reduce thrombotic
complications. Steinhubl and colleagues conducted a randomized placebo-controlled
trial to evaluate the benefit of long-term treatment with clopidogrel after
PCI and the benefit of a loading dose of clopidogrel prior to PCI. All patients
received clopidogrel after PCI through day 28 and aspirin throughout the study.
One year after PCI, the combined risk of death, myocardial infarction (MI),
or stroke was significantly lower among patients who received long-term (12-month)
therapy with clopidogrel. The combined risk of death, MI, or urgent target
vessel revascularization at 28 days after PCI was not significantly reduced
in the preprocedure clopidogrel group compared with the placebo group.
In the African American Study of Kidney Disease and Hypertension (AASK)
trial, Wright and colleaguesArticle compared 3 antihypertensive regimens (initial
treatment with either a β-blocker, an angiotensin-converting enzyme inhibitor,
or a calcium channel blocker) and 2 blood pressure goals (lower, mean arterial
blood pressure 92 mm Hg or less vs usual, 102-107 mm Hg) in African American
adults with hypertensive renal disease. Rate of change in glomerular filtration
rate (GFR) was not significantly different in the 2 blood pressure goal groups,
nor was a clinical composite outcome. In the drug group comparisons, there
were no consistent significant differences in rate of GFR change, but risk
of the clinical composite outcome was significantly lower in the angiotensin-converting
enzyme inhibitor group compared with the other drug groups. In an editorial,
AldermanArticle discusses how to integrate these findings into clinical practice.
Hormone replacement therapy (HRT) and antioxidant vitamins are used
for secondary prevention in postmenopausal women with coronary artery disease
despite the lack of evidence from clinical trials supporting their use. In
this placebo-controlled randomized trial, Waters and colleagues assessed the
effects of HRT and antioxidant vitamins, alone and in combination, in postmenopausal
women with at least one 15% to 75% coronary stenosis at baseline. The annualized
mean change in lumen diameter of coronary arteries affected at baseline was
not significantly different in the active treatment groups compared with placebo.
When women with intercurrent death or myocardial infarction were included
in the analysis, coronary disease progression was greater in the active treatment
The relative benefit of oral anticoagulants vs aspirin for reduction
of thromboembolic events associated with nonvalvular atrial fibrillation (AF)
is uncertain. van Walraven and colleagues conducted a meta-analysis using
pooled individual patient data from all published randomized trials comparing
oral anticoagulants and aspirin therapy for nonvalvular AF. Patients who received
oral anticoagulants were significantly less likely to experience any stroke,
ischemic stroke, or cardiovascular events, but were more likely to experience
major bleeding. All-cause survival was not significantly different but appeared
to improve for patients treated with oral anticoagulants about 3 years after
therapy was started.
In the United States, private for-profit and private not-for-profit
facilities provide most hemodialysis care. Devereaux and colleagues conducted
a systematic review and meta-analysis to determine whether the profit status
of hemodialysis facilities influences patient mortality. Based on data from
8 observational studies, hemodialysis care in private for-profit centers was
associated with a significantly increased risk of mortality.
"Abbreviations have an inherent potential for misinterpretation and
misunderstanding with resultant clinical errors. Caution in their use is mandatory."
From "The Long and the Short of It."
Because the possibility of a new outbreak of deadly Hong Kong influenza
still exists, researchers are calling for development of ready-to-go candidate
vaccines and expedited research into advanced vaccine production methods.
Pedophilia, a chronic psychiatric disorder characterized by sexual attraction
to prepubescent children, is a diagnosis applicable to only a portion of individuals
who sexually abuse children. Fagan and colleagues review risk factors and
behaviors associated with pedophilia, treatment, and recommendations for criminal
and medical systems collaboration.
This article, the fourth in the series, discusses self-management education
for patients with chronic disease and examines whether self-management education
can improve clinical outcomes or reduce health care costs.
For your patients: Information about hypertensive kidney disease.
This Week in JAMA. JAMA. 2002;288(19):2367. doi:10.1001/jama.288.19.2367