Table of Contents

Gregg and colleagues used data from follow-up studies of the 1971 to 2000 National Health and Nutrition Examination Survey cohorts to measure cardiovascular mortality in diabetic and nondiabetic persons. Over 3 decades, mortality rates fell progressively in diabetic and nondiabetic men and in nondiabetic women, but they remained stable in diabetic women. The mortality difference between diabetic and nondiabetic women more than doubled. Diabetic women have not shared in the benefits of improved care for diabetes and cardiovascular disease.

Geriatric conditions, such as incontinence and falls, are common in older people and are associated with disability. However, clinicians are much less likely to provide adequate care for these conditions than for common diseases. Using national survey data, the authors found that almost half of older U.S. adults had geriatric conditions. The frequency of these conditions increases with advancing age. Some conditions are as prevalent as common diseases, such as heart disease. Having a geriatric condition is strongly associated with dependency in activities of daily living.

Because d-dimer levels increase in pregnancy, it was thought that d-dimer testing is less accurate for diagnosing venous thromboembolism in pregnant women than in nonpregnant women. In this observational cohort study of 149 pregnant women, a d-dimer assay identified all 13 women with deep venous thrombosis (DVT) (100% sensitivity). However, the small number of women with DVT means that the d-dimer sensitivity is subject to considerable statistical uncertainty, and the true value could be as low as 70%. Therefore, in pregnant women with a high pretest probability of DVT, a negative d-dimer test result may not rule out DVT.

This Update in Cardiology features 11 articles published in 2006. Topics include ischemic heart disease, atrial fibrillation and arrhythmias, and cardiovascular drugs.

The authors review the latest American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. The algorithms for basic life support and advanced cardiovascular life support have changed substantially since 2000. For unwitnessed cardiac arrest, the guidelines no longer recommend immediate defibrillation; cardiac arrest victims should no longer receive stacked shocks; and the recommended compression–ventilation ratio has changed. Outcomes of in-hospital and out-of-hospital cardiac arrest have improved with use of automated external defibrillators, and defibrillators that use a biphasic waveform have improved first-shock efficacy over defibrillators that use a monophasic waveform. Amiodarone is effective in shock- refractory ventricular tachycardia and ventricular fibrillation.

The 1996 U.S. Preventive Services Task Force recommendation addressed primary care interventions to increase the use of motor vehicle occupant restraints. The current recommendation focuses on the independent role of primary care interventions to increase the proper use of child safety seats, booster seats, and lap-and-shoulder belts to prevent motor vehicle occupant injuries. The recommendations also address the effectiveness of primary care counseling to prevent alcohol-related motor vehicle accidents.

This evidence update supports the U.S. Preventive Services Task Force recommendations on the proper use of motor vehicle occupant restraints and alcohol use to prevent injury.

We lack an evidence-based comprehensive strategy for improving cardiovascular outcomes in diabetic women. Until we have one, a prudent clinical approach involves 2 steps. First, we must recognize that diabetic women are at excess risk for coronary heart disease (CHD). In addition, we must take an aggressive, guideline-based approach to CHD risk factor management.

For me, it all began one autumn day in 1950, during my third year of medical school. We had studied obstetrics for a full semester, after which the University of Wisconsin sent us to spend a month at a place called “The Chicago Maternity Center.” Our mission was to deliver babies in the homes of the inhabitants of the south side of Chicago.

This issue provides a clinical overview of osteoarthritis, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits.