Subject: Journal Watch General Medicine Alert for April 10, 2007

From: [email-masked]
Date: Tue, 10 Apr 2007 16:19:46 -0700

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GENERAL MEDICINE for April 10, 2007

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Hormone Therapy, Age, and Risk for Heart Disease
[Summary and Comment | Free]

Hormone therapy use soon after menopause does not seem to confer increased 
risk for CHD.
   By Thomas L. Schwenk, MD
   April 10, 2007
   Covering: Rossouw JE et al. JAMA 2007 Apr 4; 297:1465-77
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/1?q=etoc

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Does Aspirin Lower Mortality in Women?
[Summary and Comment | Subscription Required]

The positive results of this observational study do not trump the ambiguous
results of primary prevention clinical trials.
   By Jamaluddin Moloo, MD, MPH
   April 10, 2007
   Covering: Chan AT et al. Arch Intern Med 2007 Mar 26; 167:562-72
   Baron JA. Arch Intern Med 2007 Mar 26; 167:535-6
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/2?q=etoc

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Diagnosing Venous Thromboembolism
[Clinical Practice Guideline Watch | Subscription Required]

Recommendations from the American Academy of Family Physicians and the 
American College of Physicians
   By Richard Saitz, MD, MPH, FACP, FASAM
   April 10, 2007
   Covering: Qaseem A et al. Ann Intern Med 2007 Mar 20; 146:454-8
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/3?q=etoc

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Initial Seizure Monotherapy: Lamotrigine for Partial Seizures, and 
Valproate When Generalized
[Summary and Comment | Subscription Required]

Two trials compared standard drugs with increasingly popular new 
antiseizure medications.
   By Bruce Soloway, MD
   April 10, 2007
   Covering: Marson AG et al. Lancet 2007 Mar 24; 369:1000-15
   Marson AG et al. Lancet 2007 Mar 24; 369:1016-26
   French JA. Lancet 2007 Mar 24; 369:970-1
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/4?q=etoc

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Predicting Serious Consequences of Minor Head Injury
[Summary and Comment | Subscription Required]

Dutch researchers develop a rule for predicting who needs CT.
   By Richard Saitz, MD, MPH, FACP, FASAM
   April 10, 2007
   Covering: Smits M et al. Ann Intern Med 2007 Mar 20; 146:397-405
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/5?q=etoc

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Adding Inhaled Steroids and Long-Acting {beta}-Agonists to Tiotropium for 
COPD
[Summary and Comment | Subscription Required]

The combination improved lung function, hospitalization rates, and 
quality-of-life scores.
   By Richard Saitz, MD, MPH, FACP, FASAM
   April 10, 2007
   Covering: Aaron SD et al. Ann Intern Med 2007 Feb 19; 
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/6?q=etoc

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TNF Antagonists and Risk for Bacterial Infection
[Summary and Comment | Subscription Required]

Patients taking TNF antagonists had significantly higher risk than those 
taking methotrexate alone.
   By Allan S. Brett, MD
   April 10, 2007
   Covering: Curtis JR et al. Arthritis Rheum 2007 Apr 56:1125-33
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/7?q=etoc

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A New Approach to Disk Disease: Cadaveric Transplantation
[Summary and Comment | Subscription Required]

Orthopedists report on the first five intervertebral disk transplants in 
humans.
   By Bruce Soloway, MD
   April 10, 2007
   Covering: Ruan D et al. Lancet 2007 Mar 24; 369:993-9
   http://general-medicine.jwatch.org/cgi/content/full/2007/410/8?q=etoc

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FREE FULL-TEXT ARTICLE

Summary and Comment

Hormone Therapy, Age, and Risk for Heart Disease
Hormone therapy use soon after menopause does not seem to confer increased 
risk for CHD.

Women's Health Initiative (WHI) data have suggested that the greatest risk 
for coronary heart disease associated with hormone therapy -- with 
conjugated equine estrogen (CEE) alone or CEE plus medroxyprogesterone 
acetate (MPA) -- might occur in older women. Because the number of younger 
women with CHD events was small, the WHI researchers pooled data from both 
arms of the trial, encompassing a total of 27,347 women aged 50 to 79 who 
were randomized to CEE or CEE/MPA (depending on uterine status) or placebo.

There was a slight, nonsignificant trend toward decreased CHD risk with HT 
use (compared with placebo) among younger women and those closer to 
menopause. For example, there was an absolute decrease of 6 CHD events per 
10,000 person-years in women within 10 years of menopause, compared with an
absolute increase in risk of 17 events for women 20 or more years since 
menopause, and a decrease of 2 events per 10,000 person-years for women 
aged 50 to 59, compared with an increase of 19 events for women aged 70 to 
79. The trend toward decreased CHD risk in the early years after menopause 
was driven mainly by event rates in the CEE-alone arm (and not the CEE/MPA 
arm). Risk for stroke increased significantly across all categories of age 
and time since menopause (absolute increase, 9 events per 10,000 
person-years). 

Comment: The trend for CHD seen in these analyses, although nonsignificant,
supports the current practice of many clinicians, who counsel patients that
HT to control postmenopausal symptoms appears to be acceptable (in terms of
CHD risk) for a few years but should then be stopped unless the symptoms 
are unmanageable. Of course, other risks associated with HT (breast cancer,
stroke, and venous thrombosis) also should be kept in mind. 

-- Thomas L. Schwenk, MD 

Published in Journal Watch General Medicine April 10, 2007 

Citation(s):

Rossouw JE et al. Postmenopausal hormone therapy and risk of cardiovascular
disease by age and years since menopause. JAMA 2007 Apr 4; 297:1465-77. 
(Subscription may be required) (Free)

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