N Eng J Med Vol 352
1425 In stable coronary artery disease, giving 80 mg of atorvastatin daily resulted in fewer major cardiovascular events than giving 10 mg. Every new study shifts us a bit more towards bigger doses.
1519 ‘The brown one is the preventer, and it's very important to use it regularly twice a day’, we all tell our patients with mild persistent asthma. But this study shows that it doesn't matter whether they follow our advice, or just start using an inhaled steroid when they feel a wheeze coming on.
1637 It was such a neat idea: Chlamydia trachomatis sitting in arterial plaque like a sort of cardiovascular helicobacter, leading to plaque ulceration and acute coronary events. But two trials of anti-chlamydial antibiotics given intermittently to patients with known coronary disease show no benefit.
1655 Leflunomide is ousting methotrexate for various rheumatological conditions, though it is more expensive and needs as much monitoring: and this trial in juvenile rheumatoid found it slightly less effective.
1749 Respiratory syncytial virus kills many more elderly patients than children, and this thorough prospective study shows it to be an adult pathogen at least as important as influenza A. Vaccines may soon be with us (see editorial on page 1810).
1861 For chronic atrial fibrillation, forget your sentimental attachment to digoxin — sotalol and amiodarone are much better choices. They work equally well for maintaining sinus rhythm in patients with coronary disease after cardioversion; amiodarone works better in those without ischaemia.
Lancet Vol 365
1291 An editorial heralding the long-awaited arrival of a reliable diagnostic test for multiple sclerosis — matrix metalloproteinase-9 in cerebrospinal fluid.
1348 Do you need to mug up some epidemiology for an exam, or do you just want persuading that it could ever be relevant to you? Don't miss this series of articles by Schulz and Grimes — lucid, entertaining, and never ever boring.
1389 Block the cannabinoid-1 receptors, and people can generally lose weight easily: the name of the drug is rimonabant, and so far it seems safe.
1543 The Million Women Study looks at various forms of hormone replacement therapy, and finds that tibolone carries a risk of endometrial cancer, like other unopposed oestrogens.
1621 In elderly people who have had one low-impact fracture, calcium and vitamin D supplements make no difference to the future risk of fracture (RECORD): a similar message to the open-label study in at-risk women from the BMJ (330: 1003).
JAMA Vol 293
1595 Thiazide diuretics come out top for the prevention of stroke and heart failure in patients with raised blood pressure — the latest data from ALLHAT.
1609 When you are going to die, your heart begins to give up: when your heart gives up, you die. Another study confirming that B-type natriuretic peptide (BNP) is the best prognostic marker in the general population.
1861 ‘What's my ideal weight, doctor?’ For staying alive, aim for a BMI between 25 and 30 (data from NHANES III).
1868 NHANES-III shows a marked rise in US obesity, but also a marked drop in cardiovascular risk factors in all weight groups.
1995 A US study showing that doctors are very susceptible to patient requests for specific drugs or drug classes — actors went out simulating depression and generally got whatever they asked for. That could never happen in Britain, of course.
2095 An immensely useful study of the long-term outcome of prostate cancer in the days before PSA testing, graded by the Gleason score. If your Gleason is under 4, mortality is 6 per 1000 man-years: above 8, it is 121.
Other Journals
Arch Intern Med (165: 725) has a systematic review of lipid-lowering in relation to mortality. Diet makes no difference; statins definitely help, n-3 fatty acids probably do, and fibrates may shorten your life. The recent Cochrane review of ventilating tubes (grommets) for glue ear concluded that there was no firm evidence of benefit: Arch Dis Childhood (90: 480) looks at individual patient data from seven trials to see if there is an identifiable subgroup of children who benefit, but couldn't find one. QJM (98: 357) finds that benign positional vertigo is a common cause of falls in the elderly: well worth going to your local medical library to copy this paper for its photographs of the Epley manoeuvre, and also for John Launer's always excellent endpiece.
Plant of the Month: Cistus ladanifer
Grow this evergreen shrub — or one of its numerous hybrids — on a patch of poor, sun-baked soil for its papery maroon-blotched flowers and its fragrant leaves.
- © British Journal of General Practice, 2005.
