0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Week in JAMA |

This Week in JAMA FREE

JAMA. 2004;292(21):2547. doi:10.1001/jama.292.21.2547.
Text Size: A A A
Published online

RHABDOMYOLYSIS AND LIPID-LOWERING DRUGS

Lipid-lowering agents such as fibrates and statins can have adverse effects on muscle, including rhabdomyolysis; however, reliable risk estimates for rhabdomyolysis are lacking. Graham and colleagues reviewed 1998-2001 pharmacy and hospital claims data and medical records for patients prescribed statins and fibrates, alone or in combination, to estimate the incidence of hospitalization for rhabdomyolysis. They found that rhabdomyolysis risk was low for monotherapy with atorvastatin, pravastatin, or simvastatin, but the risk increased for patients prescribed combined statin-fibrate therapy, particularly older patients with diabetes mellitus. Patients taking cerivastatin plus a fibrate had a 10% annual risk of rhabdomyolysis.

See Article

THYROID STATUS IN OLD AGE

The relationship of subclinical thyroid dysfunction to morbidity and mortality in older individuals is unclear. To assess the long-term impact of subclinical thyroid dysfunction on performance and survival, Gussekloo and colleaguesArticle conducted a prospective, population-based study of persons aged 85 through 89 years in Leiden, the Netherlands. Comparing participants with subclinical or overt hypothyroidism at baseline with those having normal thyroid function, the authors found no differences in activity, depressive symptoms, or cognitive function. However, persons with increased thyrotropin levels had a lower risk of mortality over 3 years of follow-up. In an editorial,Article Cooper discusses the implications of these findings for the care of elderly patients.

THYROID DISEASE AND IODINE 131 EXPOSURE

Between 1944 and 1957, large amounts of sodium iodide 131 (131I) were released into the atmosphere near the Hanford Nuclear Site in Washington state, and there has been concern that exposed individuals may have an increased risk of thyroid disease. Davis and colleagues report results of a retrospective cohort study involving individuals born from 1940 through 1946, with presumed exposure to the Hanford 131I releases. In this cohort of individuals with low-dose and protracted environmental 131I exposure during infancy and childhood, the authors found no association of exposure with thyroid neoplasia, benign thyroid nodules, autoimmune thyroiditis, or hypothyroidism.

See Article

PHARMACEUTICAL POSTMARKETING SURVEILLANCE

Recent reports of serious harms associated with approved medications have raised concerns about the drug approval and postmarketing surveillance systems and about potential conflicts of interest in the evaluation of adverse drug reactions. Several articles in this issue of JAMA explore these issues. Psaty and colleaguesArticle report results of a literature review and related internal Bayer Corporation documents, which documented a clear and known association of cerivastatin with an increased risk of rhabdomyolysis. An article by StromArticle discusses the role of voluntary adverse event reporting in monitoring drug safety and the limits of pharmacoepidemiologic analyses for triggering investigation of potentially serious events. Piorkowski, in an invited response,Article describes Bayer Corporation’s premarketing and postmarketing knowledge of and response to reports of rhabdomyolysis related to cerivastatin use and critiques the assertions of Psaty and colleagues,Article who provide a response to those critiques. In an editorial,Article Fontanarosa, Rennie, and DeAngelis describe the circumstances surrounding this collection of articles and endorse measures to improve postmarketing drug surveillance and patient safety.

MEDICAL NEWS & PERSPECTIVES

A new initiative by the Centers for Disease Control and Prevention is designed to promote research into how to develop HIV/AIDS prevention strategies that are tailored to minority communities as well as to mentor young investigators with ties to these underserved communities.

See Article

PRURITIC ERUPTION IN HIV INFECTION

An altered and exaggerated immune response to arthropod bites may be the cause of a pruritic papular eruption common in persons with human immunodeficiency virus (HIV) infection in sub-Saharan Africa.

See Article

CLINICIAN'S CORNER

Clinical Crossroads
Mandel reviews the evaluation of a 64-year-old woman with a history of multinodular goiter and partial thyroidectomy who has a new thyroid nodule.

See Article

JAMA PATIENT PAGE

For your patients: Information about thyroid nodules.

See Article

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...