Review

Journal rack: new evidence for primary care

From BMJ USA 2003;June337

This section calls attention to new studies and systematic reviews selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). Studies are noted that might directly influence clinical practice decisions in primary care. Journals hand-searched for the Journal rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, Obstetrics and Gynecology, Pediatrics

Cardiovascular — A cohort study of 3588 adults age 65 and older without known cardiovascular disease found that a high intake of cereal fiber was associated with a 21% reduction in the 9-year incidence of new cardiovascular events. (Mozaffarian et al. JAMA April 2, 2003;289:1659-1666.)

Cardiovascular — A randomized trial involving 8241 patients with hypertension and at least 1 other cardiovascular risk factor found no benefit from first-line therapy with controlled-onset extended-release verapamil compared with atenolol or hydrochlorothiazide. (Black and the CONVINCE Research Group. JAMA April 23-30, 2003;289:2073-2082.)

Cardiovascular — A randomized trial involving 810 adults who had hypertension and were not taking antihypertensive medication found that those who followed established recommendations for lifestyle modification did not achieve as great a reduction in blood pressure as did those who also implemented the DASH (Dietary Approaches to Stop Hypertension) diet. (Appel and the Writing Group of the PREMIER Collaborative Research Group. JAMA April 23-30, 2003;289:2083-2093.)

Cardiovascular — A nested randomized trial involving 10 305 patients who had hypertension and at least 3 other cardiovascular risk factors but normal cholesterol levels found that atorvastatin (10 mg per day) reduced the 3-year risk of cardiovascular events by 36%. It had no significant impact on all-cause mortality. (Sever et al. Lancet April 5, 2003;361:1149-1158.)

Cardiovascular — A randomized trial involving 508 patients who had a history of venous thromboembolism and had received full-dose anticoagulation therapy for a median of 6.5 months found that continued anticoagulation with low-intensity warfarin (to reach a target international normalized ratio of 1.5 to 2.0) reduced the 4-year incidence of venous thromboembolism by 64% and achieved a 48% reduction in the composite end point of recurrent venous thromboembolism, major hemorrhage, or death. (Ridker and the PREVENT Investigators. N Engl J Med April 10, 2003;348:1425-1434.)

Endocrinologic — A cohort study involving more than 50 000 women in the Nurses' Health Study found that each 2-hour per day increment of television viewing increased the risk of obesity and diabetes by 23% and 14%, respectively. The authors estimated that 30% of new cases of obesity and 43% of new cases of diabetes could be prevented by viewing television for less than 10 hours per week and by walking briskly for at least 30 minutes per day. (Hu et al. JAMA April 9, 2003;289:1785-1791.)

Endocrinologic — A randomized trial involving 423 overweight and obese adults found that mean weight loss at 2 years of follow-up was 2.9 kg among those in a structured commercial program and 0.2 kg among those who used a self-help method. (Heshka et al. JAMA April 9, 2003;289:1792-1798.)

Hematologic — An observational study involving 299 patients with frequent painful sickle cell crises found that treatment with hydroxyurea was associated with a 40% reduction in 9-year mortality. (Steinberg et al. JAMA April 2, 2003;289:1645-1651.)

Infectious diseases — An analysis of data from the National Ambulatory Medical Care Survey revealed that antibiotics were used less frequently in 1998-1999 than in 1991-1992, but the use of broad-spectrum agents increased from 24% to 48% of antibiotics prescribed. (Steinman et al. Ann Intern Med April 1, 2003;138:525-533.)

Infectious diseases — A cohort study involving more than 140 000 community-dwelling older adults found that influenza vaccination was associated with a significant decrease in hospitalizations and in all-cause mortality during influenza season. (Nichol et al. N Engl J Med April 3, 2003;348:1322-1332.)

Oncologic — A cohort study of more than 900 000 adults found an association between increased body weight and increased cancer-related mortality. Men and women who were overweight were 52% and 62% more likely, respectively, to die from cancer than were those of normal weight. (Calle et al. N Engl J Med April 24, 2003;348:1625-1638.)

Oncologic — An analysis conducted by the National Cancer Institute concluded that 10.2 million American women (16%) meet FDA eligibility criteria for taking tamoxifen for the chemoprevention of breast cancer, but the benefit-risk index would be favorable for less than 5% of these women. (Freedman et al. J Natl Cancer Inst April 2, 2003;95:526-532.)

Oncologic — An analysis of mammography service screening in 2 Swedish counties involving 210 000 women age 20 to 69 found that breast cancer mortality among screened women was reduced by 44%. (Tabar et al. Lancet April 26, 2003;361:1405-1410.)

Oncologic — A study in the Netherlands, where mammography screening was introduced more than a decade ago, found that mortality rates increased by 0.3% per year until screening was introduced but then declined by 1.7% per year among women age 55 to 74 and by 1.2% per year among women age 45 to 54. (Otto et al. Lancet April 26, 2003;361:1411-1417.)

Oncologic — A case-control study of 1668 patients found that the incidence of colorectal cancer was 76% lower among those with a history of screening sigmoidoscopy and that these reductions were sustained for up to 16 years. The authors suggested that current recommendations regarding the frequency of sigmoidoscopy may be overly aggressive. (Newcomb et al. J Natl Cancer Inst April 16, 2003;95:622-625.)

Orthopedic — A Dutch randomized trial involving 561 persons age 70 and older found no reduction in the incidence of hip fractures among the group that received external hip protectors. (van Schoor et al. JAMA April 16, 2003;289:1957-1962.)

Pediatric — A prospective cohort study of 172 children followed from age 6 to 60 months found that elevated blood lead levels, even those below the 10 µg/dL level targeted in current treatment guidelines, are associated with diminished IQ scores. (Canfield et al. N Engl J Med April 17, 2003;348:1517-1526.)

Primary care practice — A survey of 661 patients found that 25% had experienced an adverse drug event in ambulatory care; 13% of the events were serious, 28% were ameliorable, and 11% were preventable. (Gandhi et al. N Engl J Med April 17, 2003;348:1556-1564.)

Pulmonary — A telephone survey of households in Georgia found that 54% of school-age children with asthma and 30% of adults in such households missed school or work because of the child's asthma. (Mellinger-Birdsong et al. Am J Prev Med April 2003;24:242-248.)