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In This Issue of JAMA
April 7, 2015


JAMA. 2015;313(13):1291-1293. doi:10.1001/jama.2014.11665


Limited data suggest that folic acid supplementation may be efficacious in the primary prevention of stroke. In a randomized trial that enrolled 20 702 Chinese adults with hypertension and no history of stroke or myocardial infarction, Huo and colleagues tested the hypothesis that enalapril and folic acid would be more effective than enalapril alone in reducing incident stroke risk. During a median treatment duration of 4.5 years, the authors found that combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. In an Editorial, Stampfer and Willett discuss folate supplementation for stroke prevention.


Author Video Interview

In a multicenter, open-label, randomized trial that enrolled 2194 Chinese patients with acute myocardial infarction who were undergoing emergency primary percutaneous coronary intervention (PCI), Han and colleagues found that compared with heparin alone or heparin plus tirofiban, use of bivalirudin resulted in a decrease in adverse clinical events—a composite of major adverse cardiac or cerebral events or bleeding. In an Editorial, Cavender and Faxon discuss the safety and efficacy of bivalirudin in patients undergoing PCI.


In an international, multicenter observational study that involved more than 31 000 women who were carriers of disease-associated BRCA1 or BRCA2 mutations, Rebbeck and colleagues assessed associations between mutation characteristics—mutation type, function, and nucleotide position—and the risk of breast and ovarian cancer. The authors report identification of mutations in BRCA1 and BRCA2 that had varied by type and location, which were associated with significantly different risks of breast and ovarian cancer.

Continuing Medical Education

Clinical Review & Education

An article in JAMA Internal Medicine reported that frail nursing home residents who were aged 80 years and older and had low systolic blood pressure (<130 mm Hg) while being treated with 2 or more antihypertensive medicines had an increased risk of all-cause mortality compared with residents of similar age who were receiving no or 1 antihypertensive medication. In this From the JAMA Network article, Aronow discusses blood pressure treatment goals for elderly individuals and the risks of overtreatment.

Patients with cancer have an increased risk of venous thromboembolism when undergoing surgical procedures. This JAMA Clinical Evidence Synopsis by Akl and colleagues summarizes a Cochrane review of 16 clinical trials (12 890 patients) that compared clinical outcomes of patients with cancer who underwent surgical procedures with perioperative thromboprophylaxis using either unfractionated heparin or low-molecular-weight heparin (LMWH). The review found that rates of mortality, pulmonary embolism, deep venous thrombosis, bleeding, or thrombocytopenia were similar when either unfractionated heparin or LMWH was used for perioperative thromboprophylaxis.

A patient with a history of bronchiectasis presented with a painful rash and swelling of his foot of 1 day’s duration, which was not associated with fever, joint pain, or recent trauma to the area. Examination of the foot revealed a purpuric plaque with central vesicles. The rash was tender to palpation and the foot and ankle were edematous. Laboratory values were notable for an elevated leukocyte count with 38% eosinophils. A skin punch biopsy of the rash was performed. What would you do next?