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This Week in JAMA
JAMA. 2005;294:3057.
Perioperative Amiodarone to Prevent Arrhythmias
Atrial tachyarrhythmias are a common postoperative complication of cardiac surgery. Results of several randomized trials of prophylactic amiodarone are inconsistent, and the trials did not reliably address important subgroups of patient or adverse effects. Mitchell and colleagues (SEE ARTICLE) report results of a randomized trial assessing the safety and effectiveness of perioperative oral amiodarone vs placebo in patients having coronary artery bypass graft surgery, valve replacement or repair procedures, or both. The authors found that compared with placebo, oral amiodarone safely and effectively reduced the risk of postoperative atrial tachyarrhythmias overall and in subgroups of patients defined by age, surgical procedure, or receipt of preoperative  -blocker therapy. In an editorial, Podgoreanu and Mathew (SEE ARTICLE) discuss benefits of perioperative amiodarone therapy and questions for future investigation.
Antioxidants and Age-Related Macular Degeneration
High-dose supplementation of beta carotene, vitamins C and E, and zinc in combination has been shown to reduce progression of age-related macular degeneration (AMD), but it is not known whether regular dietary intake of these antioxidants reduces the risk of incident AMD. In a population-based cohort study with a mean follow-up of 8 years, van Leeuwen and colleagues estimated the risk of incident AMD associated with dietary intake of antioxidant nutrients at baseline. They found that high dietary intake of beta carotene, vitamins C and E, and zinc was associated with a reduced risk of incident AMD.
(SEE ARTICLE)
Dosing of Antithrombotics in ACS
Appropriate dosing strategies for early antithrombotic therapy in patients with acute coronary syndromes (ACS) have been defined, but a significant number of patients experience bleeding complications. Using national registry data from patients with ACS admitted to academic and nonacademic hospitals, Alexander and colleagues assessed the frequency of antithrombotic dosing in excess of recommendations and the association between dosing and major outcomes. They found that more than 42% of patients received at least 1 dose of an antithrombotic exceeding the recommended range. Excess dosing was associated with higher risks of mortality and longer length of stay and was more common in patients with other risks for bleeding complications.
(SEE ARTICLE)
Sibling CVD and Personal Disease Risk
Having a parent with cardiovascular disease (CVD) is estimated to double an individual's own CVD risk, but whether CVD disease in a sibling is associated with increased personal risk is not clear. Murabito and colleagues used data from the Framingham Offspring Study to assess this question. They found that CVD in a sibling was associated with a personal risk of future CVD events, which exceeded the risks conferred by personal risk factors or parental CVD.
(SEE ARTICLE)
Noninvasive Ventilation in Acute Pulmonary Edema
In a systematic literature review and meta-analysis, Masip and colleagues assessed the short-term effect of noninvasive ventilation vs conventional oxygen therapy in patients with acute cardiogenic pulmonary edema. The authors found that compared with conventional therapy, noninvasive ventilation was associated with a near 45% reduction in mortality rate and a significant reduction in the need to intubate the patient.
(SEE ARTICLE)
Medical News & Perspectives
Some researchers argue that waist-to-hip ratio is superior to body mass index as a tool for assessing risk of cardiovascular disease.
(SEE ARTICLE)
CLINICIAN'S CORNER
Adrenoleukodystrophy
New insights regarding the presentation, prevention, and treatment of adrenoleukodystrophy.
(SEE ARTICLE)
The Frozen Section: 100-Year Anniversary
Celebrating the 100-year anniversary of Wilson's description of the frozen section technique for intraoperative diagnosis.
(SEE ARTICLE)
Technology Licensing
Licensing of new technology and policy implications in the United States and developing nations.
(SEE ARTICLE)
Author in the Room
Join Sandra Dial, MD, in a teleconference on January 18, 2006, to discuss new research on the use of gastric acid–suppressive agents and risk of community-acquired Clostridium difficile.
For more information and to register for "Author in the Room," please visit http://www.ihi.org/authorintheroom.
JAMA Patient Page
For your patients: Information about frozen section biopsies.
(SEE ARTICLE)
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