1999.07.26 Pearls
 

In this meta-analysis, giving ACE inhibitors during the acute phase of a heart attack (within 36 hours of the onset of symptoms) was associated with an improved 30 day survival. Ace Inhibitor Myocardial Infarction Collaborative Group. Circulation 1998;97:2202.

If you have coronary heart disease, consider undergoing a cardiac rehabilitation program. In this study of 268 elderly patients with CAD, those who underwent cardiac rehab were less likely to become depressed. Milani RV, Lavie CJ. Am J Cardiol 1998;81:1233.

In this study of over 9,000 women over 65 years old, more exercise was associated with fewer hip fractures, but a similar rate of wrist or vertebral fractures. Active exercise was described as moderate or intense activity, for at least two hours a week. Gregg EW et al. Ann Intern Med 1998;129:81.

Five days of antibiotics are just as effective as ten days in the treatment of ear infections (otitis media) according to this meta-analysis. An associated editorial, however, pointed out that the research into this is still preliminary. Kozyrskyj AL et al. JAMA 1998;279:1736.

This editorial, by a University of Washington Clinical Professor, adds to the growing demand by physicians that the government stop dictating medical care, and allow the medical use of marijuana. Washington State recently passed a state-wide law allowing such use, but the federal government still insists that the medical use of marijuana is a federal crime. Newkirk G. Modern Medicine 1999;67(6):9.

This study of 1063 women found that a low bone mineral density (BMD) was associated with an increased mortality. The BMD of the women was determined just after menopause, and the women were followed for 11 years. For every standard deviation decrease in BMD, there was a 43% increase in total mortality! The researchers hypothesize that an increase in bone loss leads to calcification of the blood vessels, causing an increase in cardiovascular mortality. von der Recke P et al. Am J Med 1999;106:273.

Women found to have higher levels of vitamin C in their blood were half as likely to suffer from gallstones than those with average levels. Low levels, interestingly enough, were also associated with about a third less risk. The hypothesis is that high levels encourage the breakdown of gallstones, while low levels of vitamin C decrease production. Simon JA et al. Am J Public Health 1998;88:1208.

This study looked at the use of opiods for pain control in rheumatoid arthritis. In the 290 patients studied, opiods were found to be safe, well tolerated, and not abused in those with both acute and chronic pain. Ytterberg SR et al. Arthritis Rheum 1998;41:1603.

In this meta-analysis of the use of aspirin to prevent ischemic strokes, the use of aspirin was associated with a 15% decrease in the annual, all-cause mortality. The average length of the studies analyzed was three years. He J et al. JAMA 1998;280(22):1930.

Vitamin D deficiency was found to be very common in this study of 290 patients admitted to the hospital (for other reasons). Among this group, 57% were found by blood testing to be vitamin D deficient. N Engl J Med 1998;338:777.