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In This Issue of Archives of Internal Medicine
June 28, 2004

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2004;164(12):1264. doi:10.1001/archinte.164.12.1264
Antipsychotics and the Risk of Sudden Cardiac Death

In Western society, sudden cardiac death is one of the major causes of cardiovascular mortality. Although sudden cardiac death has been reported in association with the use of antipsychotics, only a few epidemiological studies have addressed this issue. Straus et al performed a case-control study to investigate the association between use of antipsychotics and sudden cardiac death in a well-defined community-dwelling population. The results of their study indicate that current use of antipsychotics in a general population is associated with an increased risk of sudden cardiac death, even at a low dose, and in persons who use antipsychotics for indications other than schizophrenia. The risk of sudden cardiac death was highest among recent starters but remained elevated during long-term use.

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Clinical Manifestations and Early Diagnosis of Sjögren Syndrome

Although classically defined by the cardinal symptoms of dry mouth and dry eyes, Sjögren syndrome is a disease with multiple manifestations affecting nonexocrine organ systems as well as the exocrine glands. It is a heterogeneous condition that probably remains undiagnosed in most of those who have it, and when the diagnosis is made, it is usually long delayed. Sjögren syndrome is not a life-threatening disease, but its symptoms and the associated complications can seriously impair the patient's well-being. A variety of interventions are possible that can alleviate the symptoms of Sjögren syndrome and reduce the risk for complications. This article reviews the varied manifestations of Sjögren syndrome, diagnostic criteria and methods, and treatment options.

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A Randomized Trial of Chinese Herbal Medicines for the Treatment of Symptomatic Hepatitis C

Although treatment with recombinant interferons can eradicate hepatitis C virus (HCV), a substantial portion of patients will either be intolerant of these therapies or fail to be cleared of the virus. The absence of fully acceptable therapy has led an unknown but presumably large number of patients to use herbal medicines for HCV, although data on efficacy and safety are sparse. Jakkula et al performed a randomized controlled trial of Chinese herbal medicines in patients with HCV and symptomatic fatigue. They found no effect on liver enzymes, viral load, or health-related quality of life. Given the presently available data, patients and practitioners should remain cautious about the use of herbal preparations for treatment of HCV.

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Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events

Strategies for primary prevention of coronary heart disease (CHD) should be guided by individual assessment of a patient's risk for having a CHD event. The coronary artery calcium (CAC) score, usually measured by electron beam computed tomography, has been proposed as a way to improve risk assessment, but it is unknown whether it adds predictive information or merely reflects damage caused by established risk factors. Pletcher et al conducted a systematic search of the literature and summarized the results in a meta-analysis. The adjusted relative risk associated with a CAC score of 1 to 100 is 2.1 compared with a person without detectable CAC. Relative risks associated with higher calcium scores varied widely between studies, probably as a result of differing study characteristics, but increased significantly in all studies. This study demonstrates that the CAC score is an independent predictor of CHD events.

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Change in Cognitive Function by Glucose Tolerance Status in Older Adults

Kanaya et al examined the 4-year change in cognitive performance among older adults according to glucose tolerance status (normal [NGT, n = 632], impaired [IGT, n = 249], or diabetic [DM, n = 118]). Three cognitive tests were measured 4 years apart in 999 white men and women aged 42 to 89 years, enrolled in the Rancho Bernardo Study. Participants were classified with sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E ϵ4 allele, and current estrogen use. At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes had a 4-fold increased risk of a major cognitive decline on the test of Verbal Fluency after 4 years compared with nondiabetic women (Figure 1). Glycohemoglobin attenuated this effect, but lipids, blood pressure, and microvascular or macrovascular disease did not. Performance on the Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status.

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