Clinical Briefs
Clinical Briefs
By Louis Kuritzky, MD
The Association between Low Bone Mass at Menopause and Cardiovascular Mortality
The relationship between osteoporotic fractures and cardiovascular disease is ill-defined. All-cause mortality is higher in elderly women with low bone mineral density (BMD), especially secondary to stroke. Additionally, the degree of aortic arterial calcification is related to BMD in an inverse fashion. Hormone replacement therapy has been suggested as being beneficial for both cardiovascular disease and osteoporosis. However, the only major randomized trial of hormone replacement as secondary prevention for coronary heart disease showed no benefit.
This study (n = 1063) evaluated postmenopausal women enrolled from 1977 to 1988 in Denmark. Its purpose was to measure bone mass soon after onset of menopause to determine whether there is a relationship between BMD and subsequent mortality.
Von der Recke and associates found that for each one standard deviation decrease in BMD, there was a 43% increase in total mortality; specifically focusing on cardiovascular mortality, a similar decrease in BMD was associated with a 2.3-fold increased relative risk of cardiovascular death. In a multivariate analysis of these data (age, systolic and diastolic blood pressure [BP], body mass index, cholesterol, smoking), only systolic BP and BMD were related to cardiovascular death; BMD and smoking were related to all-cause mortality. Von der Recke et al conclude that low BMD in women at menopause is associated with an increased risk of death from cardiovascular disease.
von der Recke P, et al. Am J Med 1999;106:273-278.
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A Comparison of Three Months of Anticoagulation with Extended Anticoagulation for a First Episode of Idiopathic Venous Thromboembolism
Conventional treatment for a first acute venous thromboembolism (VT) usually incorporates a week of heparin followed by three months of oral anticoagulants. Post-anticoagulation recurrences appear more frequently in patients whose VT was not associated with a known risk factor, such as surgery (i.e., idiopathic VT). This study was instituted to see if a longer course of anticoagulant therapy would be beneficial to the perceived higher risk group of idiopathic VT sufferers.
The original intention of the study was treatment but, after an average of 10 months, the relative risk of VT among placebo recipients was almost 20-fold higher than those with continued warfarin therapy.
Perhaps surprisingly, the presence of procoagulation factors (Leiden and others) did not predict the subgroup having a substantially higher risk of recurrent VT. This does, however, simplify our decision process, in that Kearon and colleagues conclude that all patients with idiopathic VT should be considered for longer term anticoagulation than the three months traditionally practiced. The optimum duration of anticoagulation remains unknown.
Kearon C, et al. N Engl J Med 1999; 340:901-907.
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Accuracy of Data in Abstracts of Published Research Articles
The abstract presented at the outset of a research article should reliably present the data as found in the body of the article. Based upon a pilot experience in which 25% of abstracts in a medical journal were found not to adequately reflect the contents of the article, Pitkin and associates undertook an analysis of articles appearing in Annals of Internal Medicine, BMJ, Journal of the American Medical Association, Lancet, New England Journal of Medicine, and Canadian Medical Association Journal for one year or longer, beginning in 1996.
If material in the abstract was not corroborated by the data in the body of the article, or if information in the abstract was not found in the body of the article, the abstract was assessed to be deficient. Altogether, 88 journal articles were evaluated.
The percentage of deficient abstracts ranged from a low of 18% to a high of 68% for individual journals. Most deficiencies resulted from a discrepancy between what was stated in the abstract and what was contained in the body of the article, rather than abstract data missing from the body.
Although some of the discrepancies detected were of inconsequential nature, some were not. The journals selected are notably some of the most prestigious, and—it is presumed—scientifically scrutinized in the world. Pitkin et al advocate the necessity of ensuring consistency between abstracts and their accompanying articles.
Pitkin RM, et al. JAMA 1999;281: 1110-1111.
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