This Week in JAMA

De Lemos and colleaguesArticlereport results of a randomized trial of patients following an acute coronary syndrome (ACS). The trial compares early initiation of intensive simvastatin therapy (80 mg/d) vs delayed initiation of 20-mg/d simvastatin on a composite end point of cardiovascular death, nonfatal myocardial infarction, readmission for ACS, or stroke. In the initial 4 months of follow-up, there was no significant difference in outcomes between the 2 groups. After 4 months, there was a trend toward reduced major cardiovascular events in the early intensive statin therapy group although with a higher risk of myopathy. In an editorial,ArticleNissen discusses reasons intensive therapy did not demonstrate early benefit in this trial and urges caution in prescribing 80-mg/d simvastatin.

Women with a BRCA1 or BRCA2 mutation are advised to have annual mammograms and biennial clinical breast examinations (CBEs), but when detected, many of their tumors are advanced stage. Whether breast magnetic resonance imaging (MRI) or ultrasound would improve tumor detection is not known. In a cohort of women with BRCA mutations, Warner and colleaguesArticleassessed the individual sensitivity and specificity of annual mammography, ultrasound, and MRI and biennial CBE and the sensitivity of performing all 4 screening modalities vs the combination of mammography and CBE. Twenty-two cancers were detected in the study of 236 women. Of these, 17 were detected by MRI (7 by MRI alone), 8 by mammography, 7 by ultrasound, and 2 by CBE. Sensitivity was 95% for all 4 modalities combined vs 45% for mammography and CBE. In an editorial,ArticleRobson and Offit discuss the potential value of MRI for breast cancer surveillance.

In animal studies, the β-blocker propranolol increases bone formation, but whether a similar effect is seen in humans is not known. In a case-control study, Schlienger and colleagues assessed the risk of fracture in patients taking β-blockers alone or in combination with thiazides. They found fracture risk was significantly reduced in patients currently taking β-blockers or thiazides, alone or in combination, compared with patients who did not take either drug.

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To provide estimates of influenza severity, Thompson and colleagues analyzed national hospital discharge and influenza surveillance data to determine influenza-associated hospitalizations in the United States from 1979-1980 through 2000-2001. Overall, the numbers and rates of influenza-associated hospitalizations increased over the study period. The highest rates were for persons 85 years or older and the lowest rates for persons aged 5 through 49 years. Rates for children younger than 5 years were similar to those for persons aged 50 to 64 years.

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Researchers are finding that aspects of the fetal environment, such as maternal nutrition and stress, may have important long-term consequences for health. (Photo credit: Rubèn Quintero, MD

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Genetic variants of long QT syndrome predict cardiac events in patients taking β-blockers.

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Issues surrounding voting by persons with dementia.

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Clinical Crossroads
Knight discusses substance abuse by physicians, the role of colleagues, and treatment options.

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Recent developments in efforts to require clinical trial registration and achieve wider dissemination of trial data.

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For your patients: Information about opioid abuse.

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