RSS Feeds
Update in General Internal Medicine
- Darrell W. Harrington, MD; and
- Mark T. Munekata, MD, MPH*
- From Harbor–University of California, Los Angeles, Medical Center, Torrance, California.
2007 Series: Update Sessions from ACP's Internal Medicine 2007
The current Update in General Internal Medicine reviews the past year's most important articles relevant to the practicing internist. The general internist is confronted with a wide variety of clinical scenarios and must maintain a broad database and skill set that often overlap with those of subspecialists. We discuss influential articles from 2006 that have important implications for common therapeutic and diagnostic challenges in internal medicine. The Table(1–9) shows changes to clinical practice that should emerge from these articles.
- In this window
- In a new window
Cardiovascular
Question: Is high-dose atorvastatin safe and effective for the secondary prevention of stroke?
Study Design: Randomized, controlled trial.
Patients: 4731 patients older than 18 years (mean age, 63 years; 60% men) who had ischemic or hemorrhagic stroke or transient ischemic attack 1 to 6 months before randomization; were ambulatory; and had a modified Rankin score less than 3, a low-density lipoprotein cholesterol (LDL) level of 2.6 to 4.9 mmol/L (100 to 190 mg/dL), and no known history of coronary heart disease. Patients with atrial fibrillation, embolism from other cardiac sources, and subarachnoid hemorrhage were excluded.
Setting: 205 medical centers in Australia, Africa, Europe, North America, Central America, and South America from September 1998 to March 2001.
Intervention: Atorvastatin, 80 mg/d (2365 patients), or placebo (2366 patients).
Outcomes: The primary outcome was time to first fatal or nonfatal stroke. Secondary outcomes were all-cause death, stroke or transient ischemic attack, and cardiovascular events (major coronary event [cardiac death, nonfatal myocardial infarction, or resuscitation after cardiac arrest]; major cardiovascular event [stroke plus any major coronary event], acute coronary event [major coronary event or unstable angina], any coronary event [acute coronary event plus coronary revascularization, unstable angina, or angina or ischemia requiring hospitalization], or revascularization procedure [coronary, carotid, or peripheral]; or any cardiovascular event [any …
