This Week in JAMA FREE

High levels of lipoprotein(a) are associated with an increased risk of myocardial infarction (MI). To determine whether elevated levels of lipoprotein(a) are a cause of MI, Kamstrup and colleagues Article analyzed data collected in 3 unique studies of white residents of Copenhagen, Denmark. The authors assessed the association of lipoprotein(a) levels with risk of MI; examined whether a specific lipoprotein(a) polymorphism, the kringle IV type 2 (KIV-2) size polymorphism, is associated with increased lipoprotein(a) levels; and assessed whether the KIV-2 size polymorphism genotype is associated with an increased risk of MI. Among their findings was that lipoprotein(a) KIV-2 genotype was associated with increased risk of MI in this population, which is consistent with a causal association between elevated lipoprotein(a) levels and increased risk of MI. In an editorial, Thanassoulis and O’Donnell Article discuss the advantages and limitations of using a “mendelian randomization” approach to improve the evidence for causality derived from observational studies.

Cardiac computed tomography (CT) angiography is useful in the diagnosis of coronary artery disease, but there are concerns about procedure-related radiation exposure. In a prospective, nonrandomized, multicenter study, the Advanced Cardiovascular Imaging Consortium co-investigators developed best-practice recommendations for radiation dose reduction during cardiac CT angiographic scan acquisition and assessed the effect of this best-practice model on radiation dose received and image quality. Raff and colleagues report that compared with a control period, application of the dose-reduction techniques was associated with a marked reduction in estimated radiation dose received by patients undergoing cardiac CT angiography without impairment of diagnostic image quality.

The optimal treatment of patients with acute myeloid leukemia (AML) in first complete remission is uncertain. In a systematic review and meta-analysis of data from 24 trials involving adult patients with AML in first complete remission, Koreth and colleagues examined the relapse-free survival and overall survival benefit of allogeneic stem cell transplantation compared with nonallogeneic stem cell transplantation therapies (consolidation chemotherapy, autologous stem cell transplantation, or both). The authors report that compared with nonallogeneic stem cell transplantation, allogeneic was associated with significant relapse-free survival and overall survival among patients with AML in first complete remission, specifically, among patients with cytogenetic intermediate-risk and poor-risk AML.

Corticosteroid therapy has been used for decades to treat patients with severe sepsis and septic shock. In a meta-analysis of data from 17 randomized and 3 quasi-randomized trials that compared the benefits and risks of corticosteroids with placebo or supportive treatment, Annane and colleagues Article found no overall reduction in 28-day mortality risk among patients receiving corticosteroids. However, in a subgroup analysis of data from 12 contemporary trials that investigated the effects of prolonged low-dose corticosteroid therapy, a significant reduction in 28-day mortality was found. In an editorial, Jaeschke and Angus Article discuss the implications of these findings for patient care.

“I had once thought the biggest issue facing our patients was access to health care, but now their concerns are much more basic.” From “Clinic of Tears.”

The US Food and Drug Administration is requiring tougher warning labels for over-the-counter analgesics and seeking to educate patients who use methadone for pain control or opioid addiction about the drug's risks.

Influenza A(H1N1): pandemic preparedness and international law
Article

Guidelines for the management of HIV-related infections
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Universal voluntary testing and treatment for prevention of HIV
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Using information to optimize medical outcomes
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Join Peter Hwang, MD, June 17, 2009, from 2 to 3 PM eastern time to discuss the diagnosis and treatment of rhinosinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 70-year-old woman with shingles? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is June 24.

For your patients: Information about acute myeloid leukemia