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This Week in JAMA
JAMA. 2004;292:1523.
Transfusion and Outcomes in Acute Coronary Syndrome
Patients with ischemic heart disease and anemia may be at increased risk of adverse outcomes, but there is limited evidence that blood transfusion is associated with improved survival. Rao and colleagues (SEE ARTICLE) analyzed data collected in 3 large trials of patients with acute coronary syndromes who developed bleeding, anemia, or both during hospitalization to examine the association between blood transfusion and 30-day mortality. In analyses adjusted for in-hospital events such as bleeding and invasive procedures, they found a significantly increased risk of mortality in patients receiving transfusions. In an editorial, (SEE ARTICLE) Hébert and Fergusson discuss the implications of this finding for clinical decision making.
Race and Ethnicity in Timing of Reperfusion Therapy
Nonwhite patients with acute myocardial infarction are reported to have longer waiting times from hospital arrival until reperfusion therapy compared with white patients, but the reasons for this are not clear. Bradley and colleagues (SEE ARTICLE) used national data to examine race and ethnicity differences in time to reperfusion in relation to sociodemographic factors, insurance status, clinical characteristics, and hospital features. They confirmed the treatment delay for nonwhite minorities but found that a substantial portion of the treatment time disparity was accounted for by the hospital in which care was received rather than treatment differences by race and ethnicity within the hospital. In an editorial, (SEE ARTICLE) Winker discusses the proper definition and analysis of race and ethnicity in biomedical research.
Hormone Therapy and Risk of Venous Thrombosis
Postmenopausal hormone therapy is known to increase the risk of venous thrombosis (VT). Two articles in this issue of JAMA further understanding of this association. First, Cushman and colleagues (SEE ARTICLE) report their analyses of data from the Women’s Health Initiative Estrogen Plus Progestin trial, which included assessment of the interaction of hormone therapy with other demographic and clinical risk factors for VT. The authors found that hormone therapy increased the risks of VT associated with age, overweight or obesity, and factor V Leiden. In a second article, Smith and colleagues (SEE ARTICLE) compared the risk of first VT among women taking esterified estrogen or conjugated equine estrogen with or without progestin vs nonusers of hormone therapy. They found that current use of conjugated equine estrogen but not esterified estrogen was associated with an increased risk of VT compared with nonuse, and the risk was increased with concomitant progestin use.
CVD Profile in Young Women and Mortality Risk
Cardiovascular risk factors measured in young adulthood are related to long-term cardiovascular and all-cause mortality in young men and middle-aged men and women, but the relationship for young women is not known. Using data from a prospective cohort study, Daviglus and colleagues examined the relationship of coronary heart disease (CHD) and cardiovascular disease (CVD) risk factors measured at baseline in women aged 18 to 39 years to CHD, CVD, and all-cause mortality at an average of 31 years’ follow-up. They found that women classified as low risk at baseline by virtue of favorable measures of blood pressure, serum cholesterol, body mass index, diabetes, and smoking status had significantly lower mortality in all 3 categories than the other women.
(SEE ARTICLE)
A Piece of My Mind
"Water is a blessing that brings life and lack of water delivers desert and death." From "Spectre of Noah."
(SEE ARTICLE)
Medical News & Perspectives
Researchers are linking abnormalities in aquaporins—proteins that function as channels for moving water in and out of cells—to conditions such as diabetes, brain edema, and glaucoma.
(SEE ARTICLE)
Improving Informed Consent
Efficacy of interventions intended to improve consent for research participation.
(SEE ARTICLE)
CLINICIAN’S CORNER
Diagnostic Test Accuracy
Review
Accuracy of diagnostic test reading with and without clinical information.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about blood transfusion.
(SEE ARTICLE)
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