To assess whether daily low-dose aspirin reduces the incidence of cardiovascular events in patients aged 60 years and older with hypertension, dyslipidemia, or diabetes, Ikeda and colleagues randomly assigned 14 464 Japanese patients to receive either low-dose aspirin (100 mg/d) or no aspirin. The authors report that aspirin did not reduce the risk of a composite outcome of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction during a median 5-year follow-up. In an Editorial, Gaziano and Greenland discuss when aspirin should be used for prevention of cardiovascular events.
He and colleagues compared the efficacy of entecavir vs lamivudine to prevent hepatitis B virus (HBV) reactivation in 121patients seropositive for the hepatitis B surface antigen while receiving a rituximab-containing chemotherapy regimen for diffuse large B-cell lymphoma. The authors found that patients randomly assigned to receive entecavir had a lower incidence of HBV-related hepatitis and HBV reactivation. In an Editorial, Abramson and Chung discuss optimal prophylaxis against HBV reactivation for patients receiving rituximab-based chemotherapy.
In a randomized crossover-controlled feeding study that enrolled 163 overweight adults, Sacks and colleagues examined the effects of diets with high– vs low–glycemic index carbohydrate content on markers of cardiovascular disease and diabetes risk. Among the findings was that diets with low- vs high-glycemic index carbohydrates did not improve insulin sensitivity, lipid levels, or systolic blood pressure. In an Editorial, Eckel discusses the role of glycemic index in the context of a heart-healthy diet.
Author Video Interview
Recent guidelines endorsed hypofractionated whole breast irradiation (WBI) after breast conserving surgery for some women with early-stage breast cancer and permitted hypofractionated WBI for others. In a retrospective analysis of claims data from 14 commercial health care plans (15 643 patients), Bekelman and colleagues found that use of hypofractionated WBI increased between 2008 and 2013; however, only a minority of women were treated with hypofractionated WBI in 2013.
Langa and Levine review the evidence relating to the diagnosis and treatment of mild cognitive impairment (MCI)—the symptomatic predementia stage of cognitive decline. The authors discuss tests of cognitive function, assessment of functional status, medication review, and recommended laboratory testing. In the absence of effective drug therapy to treat MCI, optimizing patients’ general medical and functional status is advised, including control of cardiovascular risk factors and advice to engage in physical and mental activities.
Continuing Medical Education
A systematic review and meta-analysis published in JAMA Neurology concluded that 3 novel oral anticoagulants—dabigatran, rivaroxaban, and apixaban—uniformly reduce the risk of intracranial hemorrhage when used for stroke prevention in patients with atrial fibrillation. In this From the JAMA Network article, Vespa discusses advantages and lingering concerns related to these agents.
A patient from Kentucky, whose job involved lawn mowing, presented with a 1-month history of nasal pain and swelling. On physical examination his nose was red and swollen; small pustules were present and the septum was perforated. A computed tomography scan of the chest revealed multiple bilateral nodular opacities in the lungs. What would you do next?
The US Food and Drug Administration has approved a stool DNA test to screen average-risk adults aged 50 years and older for colorectal cancer. This Medical Letter on Drugs and Therapeutics article summarizes information regarding the test components, performance characteristics, administration, and cost.
Highlights. JAMA. 2014;312(23):2463–2465. doi:10.1001/jama.2013.279893