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This Week in JAMA
JAMA. 2004;291:2911.
JAMA-EXPRESS
Estrogen Therapy and Cognitive Function in Women
Previous analyses from the Women's Health Initiative Memory Study (WHIMS) showed that conjugated equine estrogen (CEE) and medroxyprogesterone vs placebo increased risk of dementia but not mild cognitive impairment or changes in global cognition in women aged 65 to 70 years. Whether estrogen therapy alone protects women from cognitive decline is unknown. This issue of JAMA reports results from the CEE-alone arm of the WHIMS. In one article, Shumaker and colleagues (SEE ARTICLE) report that women taking CEE had similar risks of dementia and mild cognitive impairment as women taking placebo. When data from the CEE-alone and the CEE-plus-progestin arms were combined, a significant increase in the risk for a combined outcome of dementia and mild cognitive impairment was found. In a second article that describes results for global cognitive function over a mean 5.4 years of follow-up, Espeland and colleagues (SEE ARTICLE) report that women taking CEE had greater decline in cognitive function than women taking placebo. In an editorial, (SEE ARTICLE) Schneider reviews the evidence linking estrogen therapy to cognitive decline and suggests what might be learned from long-term follow-up of the WHI participants.
Estrogen Receptor Gene Polymorphisms and CVD
Variations in the estrogen receptor  gene (ESR1) have been associated with an increased cardiovascular disease (CVD) risk. Schuit and colleagues (SEE ARTICLE) investigated whether specific estrogen receptor gene polymorphisms are associated with myocardial infarction (MI) and ischemic heart disease (IHD) in a population-based, prospective cohort study in the Netherlands. They found that in women, presence of 1 ESR1 haplotype (–397 T allele and –351 A allele) was associated with a 2-fold increased risk of MI and IHD events, which was independent of known cardiovascular risk factors, whereas no association was found in men. In an editorial, O'Donnell and Newton-Cheh (SEE ARTICLE) discuss criteria to assess the validity and strength of genetic epidemiologic associations.
Lifestyle Changes and Erectile Dysfunction
Prior studies have found that men who are lean and physically active are at lower risk of erectile dysfunction (ED). Esposito and colleagues (SEE ARTICLE) sought to determine the effect of a program incorporating intensive advice about weight reduction and increased physical activity on erectile and endothelial function in obese men with ED. After 2 years, men randomized to the intervention had lost significantly more weight, increased their physical activity, experienced favorable changes in physiologic measures of endothelial dysfunction, and had significant improvement in their ED score compared with men in the control group. In an editorial, Saigal (SEE ARTICLE) discusses the potential benefits of weight loss and exercise as a first-line treatment for ED.
Unnecessary Pap Smears
In 1996 the US Preventive Services Task Force recommended that Papanicolaou (Pap) smear screening for cervical cancer is not necessary for women who have had a complete hysterectomy for benign disease. To investigate whether screening practices have changed in response to the recommendation, Sirovich and Welch reviewed national data on Pap smears for 1992-2002 and found no change in the estimated 50% of women with a hysterectomy who continued to have Pap smears.
(SEE ARTICLE)
A Piece of My Mind
"Only from a place of such hopelessness and suffering can I fully cherish the sunlight, hear the music of the wind, and know the sacredness of birds singing at sunrise." From "Normal Is a Place I Visit."
(SEE ARTICLE)
Medical News & Perspectives
A clinical trial is under way to determine whether using gene chips to generate gene-expression profiles of tumors can help guide therapy for patients with breast cancer.
(SEE ARTICLE)
Genetics and Health Disparities
An emphasis on genetics to explain racial and ethnic disparities in health status may reinforce racial stereotyping and contribute to, rather than resolve, disparities.
(SEE ARTICLE)
CLINICIAN'S CORNER
Male Sexual Dysfunction
Clinical Crossroads
Mr G is a 66-year-old man with decreased libido and erectile dysfunction (ED). Morgentaler discusses the causes and pathophysiology of ED, patient evaluation, and treatment options.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about male sexual dysfunction.
(SEE ARTICLE)
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