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This Week in JAMA |

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JAMA. 2005;293(13):1549. doi:10.1001/jama.293.13.1549.
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To assess whether treatment with angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers (CCBs) is superior to a thiazide-type diuretic to reduce the incidence of cardiovascular disease (CVD) in blacks vs nonblacks with hypertension, Wright and colleaguesArticle analyzed data from the ALLHAT study, in which participants were randomly assigned to a CCB (amlodipine), an ACE inhibitor (lisinopril), or a thiazide-type diuretic (chlorthalidone) and followed up for a mean of 4.9 years. In both black and nonblack participants, the authors found no significant differences by treatment for the primary outcome of combined fatal coronary heart disease and nonfatal myocardial infarction or for any other major CVD or renal outcome. In an editorial,Article Neaton and Kuller discuss previous hypertension treatment trials and possible explanations for race-specific outcomes in ALLHAT.


Natriuretic peptide levels predict outcome for patients with established heart disease, but no studies have assessed their prognostic value in healthy individuals or in comparison with other biomarkers of cardiac risk. Kistorp and colleaguesArticle assessed the risk of mortality and first major cardiovascular event by baseline levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and urinary albumin/creatinine ratio in a cohort of older adults with no history of cardiovascular disease. They found significant associations between increased baseline levels of NT-proBNP and mortality and first cardiovascular event. These associations were stronger than those for CRP and mortality or first cardiovascular event and were independent of traditional risk factors. In an editorial,Article Schillinger discusses the mechanisms of disease associated with NT-proBNP, CRP, and urinary albumin/creatinine ratio, and their clinical utility.


Oral naltrexone is an effective treatment for alcohol dependence, but adherence to daily therapy can be poor. Garbutt and colleagues assessed the efficacy and tolerability of a long-acting intramuscular formulation of naltrexone, at a dose of 380 mg or 190 mg administered monthly, compared with a placebo injection and combined with a low-intensity psychosocial intervention in adult alcohol-dependent patients. They found that patients receiving 380 mg of naltrexone had significantly fewer heavy drinking days compared with patients receiving placebo. Naltrexone injections appeared to be well tolerated and adverse events were comparable across the 3 treatment groups.

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Psychosocial factors are associated with an increased risk of ischemic heart disease (IHD), but whether modifying these factors will reduce cardiovascular risk is not clear. In a randomized trial, Blumenthal and colleagues studied the effect of adding either exercise training or stress management training to routine medical care vs routine medical care alone on psychosocial functioning and cardiovascular risk in a cohort of patients with stable IHD. They found that patients in both active treatment groups had greater improvements from baseline in psychosocial functioning and intermediate markers of cardiovascular risk compared with patients receiving only routine medical care.

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An advisory panel to the US Food and Drug Administration recently recommended that the agency allow continued marketing of cyclooxygenase 2 inhibitors but urged physicians to use greater caution when prescribing all nonsteroidal anti-inflammatory drugs.

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In a randomized trial, youth asked about suicidal ideation or behavior did not have more distress or increased suicidal ideation after screening compared with youth not asked these questions.

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In a meta-analysis of 129 surgical studies, which included data on patients’ workers’ compensation status, patients who received compensation had worse surgical outcomes.

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Clinical Review
A review of clinical symptoms associated with the presence of cell-free hemoglobin suggests that hemolysis and hemoglobinemia should be considered a novel mechanism of disease.

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For your patients: Information about alcohol abuse and alcoholism.

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