In This Issue of Archives of Internal Medicine

Erectile dysfunction (ED) shares similar modifiable risks factors with coronary artery disease. In this meta-analysis of 740 men from 6 clinical trials from 4 countries, lifestyle modification and pharmacotherapy targeting cardiovascular risk factors have shown statistically significant improvement in sexual function measured by International Index of Erectile Function (IIEF score): weighted mean difference of 2.7 (95% CI, 1.86-3.47). Overall, a mean IIEF score of 2.7 is consistent with significant improvement in mild ED and lesser magnitude of improvement in more advanced ED. This study further strengthens the evidence of improvement in ED and maintenance of sexual function with lifestyle intervention and cardiovascular risk factors reduction.

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The joint effects of different lifestyle factors on stroke risk are still to some extent unclear. Zhang et al prospectively investigated the association of different indicators of lifestyle (smoking, body mass index, physical activity, and vegetable and alcohol consumption) with total and type-specific stroke incidence among 36 686 Finnish participants. During a mean follow-up of 13.7 years, 1478 people developed an incident stroke event (1167 ischemic and 311 hemorrhagic). The authors found that healthy flifestyle factors are associated with a lower risk of stroke, and there is a graded inverse association between the number of healthy lifestyle indicators and the risks of total, ischemic, and hemorrhagic stroke in both men and women. These findings suggest the important role of promoting healthy lifestyle in the primary prevention of both ischemic and hemorrhagic stroke.

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How age and health status influence mortality risk after hip fracture is unknown. Among 5580 women from a large community-based, multicenter US prospective cohort of 9704 (Study of Osteoporotic Fractures) who were observed prospectively for almost 20 years, LeBlanc et al age-matched 1116 hip fracture cases with 4 control participants (n = 4464). To examine the effect of health status, the authors examined a healthy older subset (n = 960) 80 years or older who attended the 10-year follow-up examination and reported good or excellent health. The authors found that risk of death after hip fracture differed by age and health status. Overall, women aged 65 to 69 years had a 5-fold increased mortality risk in the first year after hip fracture, while women who were 80 years or older had no increased risk. However, when the authors only examined women who were 80 years or older with good or excellent health, risk of death was increased nearly 3-fold in the first year. Women aged 65 to 69 years continued to have increased mortality risk for up to 5 to 10 years after hip fracture, while women 70 years or older return to previous risk levels after a year.

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In this observational analysis of fee-for-service Medicare beneficiaries 65 years or older undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs), Nallamothu et al determined how frequently carotid stenting was performed by different specialists within each HRR and used multivariable regression models to compare population-based utilization rates and 30-day outcomes for it across HRRs based on the proportion performed by cardiologists, surgeons, radiologists, or a mix of specialists. In 272 HRRs where at least 15 cases were performed during the study period, the authors identified 28 700 carotid stenting procedures performed by 2588 operators. While cardiologists made up approximately one-third of these operators, they were responsible for 14 919 procedure (52.0%). Population-based utilization rates were significantly higher in HRRs where cardiologists performed most procedures relative to HRRs where most were done by other specialists or a mix of specialists (P < .001). In contrast, risk-standardized outcomes did not differ across HRRs based on physician specialty.

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Pham et al evaluated the cost-effectiveness of evidence-based strategies to improve current pressure ulcer prevention practice in long-term care facilities. The quality improvement strategies were (1) pressure-redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. According to the authors' results, the clinical and economic evidence supports pressure-redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.

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