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In This Issue of JAMA |

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JAMA. 2013;310(11):1091-1093. doi:10.1001/jama.2013.5312.
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Renin inhibition has a protective effect against atherosclerosis in animal models. To assess the effect of renin inhibition on progression of coronary atherosclerosis in humans, Nicholls and colleagues randomly assigned 613 patients with coronary artery disease and systolic blood pressure in the prehypertensive range (between 125 and 139 mm Hg) to receive aliskiren—a renin inhibitor—or placebo for 2 years. Participants underwent coronary intravascular ultrasound at baseline and after treatment to assess change in atheroma volume, and the authors found that compared with placebo, use of aliskiren did not result in regression or slowing of progression of coronary atherosclerosis. In an Editorial, Tardif and Grégoire discuss renin-angiotensin system inhibition and secondary prevention of cardiovascular disease.

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The optimal anticoagulant for patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) managed with an invasive strategy is not clear. In a randomized trial that enrolled 13 229 patients with NSTE-ACS who were undergoing planned early percutaneous coronary intervention (PCI), Steg and colleagues found that otamixaban—a novel intravenous direct factor Xa inhibitor—did not reduce the rate of ischemic events but did increase bleeding compared with unfractionated heparin plus eptifibatide.

Chronic care management (CCM)—a multidisciplinary and patient-centered model with proven efficacy for some chronic medical and mental health conditions—has been proposed as a potentially effective approach to treatment of patients with substance dependence. In a randomized trial involving 563 patients with alcohol and other drug dependence, Saitz and colleagues found that compared with usual primary care, CCM—which included longitudinal care, motivational therapy, relapse prevention counseling, and medical, addiction, and psychiatric treatment—did not increase self-reported abstinence over 12 months. In an Editorial, O’Connor discusses the management of substance dependence as a chronic disease.

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CLINICAL REVIEW & EDUCATION

Mobility limitation is common in older adults. In this Care of the Aging Patient article, Brown and Flood discuss risk factors for mobility limitation among community-dwelling older individuals and describe several validated tools to assess mobility in the ambulatory setting. The authors also consider the role of physical therapists in patient assessment and treatment planning; summarize the evidence relating to the efficacy of exercise interventions to improve strength and balance; and review the prescription and use of devices such as canes, walkers, wheelchairs, and scooters to improve function, safety, and quality of life among older patients with mobility limitations.

Oxidative stress has been implicated in the etiology of a variety of diseases including Alzheimer disease and cardiovascular disease. Whether antioxidant supplements are associated with higher or lower all-cause mortality is not clear. In this JAMA Clinical Evidence Synopsis, Bjelakovic and colleagues report results of a meta-analysis of data from 78 randomized trials (296 707 adult patients) that compared the effect of oral antioxidant supplementation (beta carotene, vitamin A, vitamin C, vitamin E, and selenium) vs placebo or no intervention on all-cause mortality. The authors report that antioxidant supplements are not associated with a lower risk of all-cause mortality. Beta carotene, vitamin E, and higher doses of vitamin A may be associated with higher risks of all-cause mortality.

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