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This Week in JAMA
JAMA. 2000;283:3165.
Statin Lipid-Lowering Drugs and Fracture Risk
Statin lipid-lowering drugs appear to increase bone formation and reduce bone resorption in animal studies, but whether they reduce the risk of bone fractures in older adults is not known. Based on a case-control analysis of data from a population of 91,611 individuals aged at least 50 years in the UK General Practice Research Database, Meier and colleagues (SEE ARTICLE) found that the total fracture risk among individuals using statins was 45% lower than among individuals not using lipid-lowering drugs. In a second case-control study among 6110 individuals aged 65 years or older, Wang and colleagues (SEE ARTICLE) found that use of statins was associated with a 43% to 50% reduction in hip fracture risk. Use of lipid-lowering drugs other than statins was not associated with reduction in fracture risk in either study. In an editorial, Cummings and Bauer (SEE ARTICLE) point out that the association between reduction of bone fracture risk and statin use suggested by these observational studies must be confirmed in randomized clinical trials before statins are prescribed to prevent fractures.
Clinical Specialty and Prostate Cancer Management
Recommendations for the detection and treatment of prostate cancer may differ depending on the specialty of the physician who is consulted. In this 1998 mail survey of US urologists and radiation oncologists, Fowler and colleagues (SEE ARTICLE) found that urologists and radiation oncologists agreed on several beliefs and practices regarding prostate cancer detection and management. For most tumor grades and prostate-specific antigen levels, however, urologists were more likely to recommend radical prostatectomy than external beam radiation, and radiation oncologists were more likely to recommend external beam radiation than radical prostatectomy. In an editorial, Wilt (SEE ARTICLE) discusses the important role of primary care physicians in helping patients with prostate cancer understand treatment options.
Myocardial Infarction Without Chest Pain
To determine whether treatment and mortality differ among patients with acute myocardial infarction (MI) who present without chest pain compared with patients with chest pain, Canto and colleagues analyzed data from 434,877 patients with confirmed MI enrolled in the National Registry of Myocardial Infarction 2 from June 1994 to March 1998. Thirty-three percent of patients in the registry did not have chest pain on presentation to the hospital. Compared with patients with MI who presented with chest pain, those without chest pain had longer delays before hospital presentation, were less likely to be diagnosed as having acute MI on initial evaluation or to receive thrombolysis or primary angioplasty, and had greater in-hospital mortality.
(SEE ARTICLE)
Nondementia Illnesses in Patients With Dementia
Management of common medical conditions in older individuals is complicated when dementia is also present. Brauner and coauthors present a case study of a patient with probable Alzheimer disease and osteoporosis and 2 composite vignettes to illustrate how dementia-related decreased cognition, communication difficulties, and reduced life expectancy alter the risk-benefit ratio and goals of routine care for coexisting medical illnesses.
(SEE ARTICLE)
A 33-Year-Old Woman With Severe Obesity
Ms C, a woman with severe obesity that began in adolescence, continued to gain weight despite many attempts at weight loss with a variety of interventions. She is being treated in a comprehensive weight loss program with a combination of diet, exercise, and phentermine, and lost 14.5 lb after 3 months in the program. Atkinson discusses etiology and complications of obesity and medical and surgical treatments.
(SEE ARTICLE)
A Piece of My Mind
"Oh, no! I thought to myself. What if he asks me a question that, in order to be answered, requires that I understand fully the connection between valvular heart disease and shopping?" From "The Patient's Heart."
(SEE ARTICLE)
Contempo Updates
A review of recent studies on the treatment of hypertension in patients with diabetes mellitus.
(SEE ARTICLE)
Medical News & Perspectives
Health care professionals who believe that investigators have tended to ignore the growing problem of heart disease and stroke in women met at the first international conference on the subject to plan research efforts.
(SEE ARTICLE)
Treatment of Tobacco Use and Dependence
A summary of key recommendations in the updated clinical practice guideline for treatment of tobacco use and dependence recently published as a US Public Health Service Report.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information on treatment of tobacco dependence.
(SEE ARTICLE)
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