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Articles 
George Davey Smith, Yiscah Bracha, Kenneth H. Svendsen, James D. Neaton, Steven M. Haffner, Lewis H. Kuller for the Multiple Risk Factor Intervention Trial Research Group* In previous trials of strategies to prevent type 2 diabetes, the participants had impaired glucose tolerance. This secondary analysis of the Multiple Risk Factor Intervention Trial (MRFIT) studied people with normal glucose tolerance. In nonsmokers, interventions to change diet and increase exercise reduced the risk for diabetes.
William H. Herman, Thomas J. Hoerger, Michael Brandle, Katherine Hicks, Stephen Sorensen, Ping Zhang, Richard F. Hamman, Ronald T. Ackermann, Michael M. Engelgau, Robert E. Ratner for the Diabetes Prevention Program Research Group* This cost-effectiveness analysis estimates that the Diabetes Prevention Program's lifestyle intervention would cost society about $8800 per quality-adjusted life-year saved. The corresponding result for metformin was $29 900. The lifestyle intervention was cost-effective at any adult age; metformin was not cost-effective after age 65 years.
Brian J. McMahon, Dana L. Bruden, Kenneth M. Petersen, Lisa R. Bulkow, Alan J. Parkinson, Omana Nainan, Marina Khristova, Carolyn Zanis, Helen Peters, and Harold S. Margolis The duration of protection afforded by hepatitis B vaccination is unknown. In this cohort of Alaska Natives who received vaccination against hepatitis, antibody levels decreased over a 15-year period, but breakthrough hepatitis B virus infection was very infrequent in all age groups.
Mark J. Sarnak, Tom Greene, Xuelei Wang, Gerald Beck, John W. Kusek, Allan J. Collins, and Andrew S. Levey The optimal blood pressure to slow progression of chronic kidney disease is not known. In this report of long-term follow-up of patients with a moderately to severely decreased glomerular filtration rate in the Modification of Diet in Renal Disease Study, random assignment to a low target blood pressure slowed the progression of nondiabetic kidney disease.
Improving Patient Care
Tejal K. Gandhi This article, part of the Quality Grand Rounds series, examines the case of a patient whose diagnosis of tuberculosis was substantially delayed because of systems problems, including poor continuity of care, failure to communicate test results and other clinical information, and several mismanaged handoffs. The article discusses strategies to ensure adequate communication of critical information and follow-up of test results.
Reviews
Fotini B. Karassa, Miltiadis I. Matsagas, Wolfgang A. Schmidt, and John P.A. Ioannidis This meta-analysis shows a sensitivity and specificity of 86% when the halo sign or occlusion or stenosis is present. The post-test probability is low if none of these findings are present and the pretest probability is low. Ultrasonography can be useful for giant-cell arteritis if interpreted in light of the patient's clinical presentation.
Simon Sanderson, Jon Emery, Trevor Baglin, and Ann-Louise Kinmonth Aspirin is an important drug for the secondary prevention of cardiovascular disease, but recurrent vascular events are common even when patients take aspirin. This paper reviews the concept of aspirin resistance, its measurement, and its clinical consequences for patients prescribed aspirin to prevent recurrences of cardiovascular disease.
Editorials
Jaakko Tuomilehto Many large public health problems and epidemics have been overcome by acting on much less evidence than we have for preventing type 2 diabetes. Therefore, we should act as if vigorous measures could control the emerging epidemic of diabetes, even though we may not eradicate this disease in those with a strong genetic background.
Ding-Shinn Chen McMahon and colleagues' study in this issue reveals that serum levels of antibodies to hepatitis B surface antigen declined faster in persons who were immunized at 0.5 to 4 years of age. However, unless continued surveillance shows clinically significant rates of infection in adolescents or adults who were vaccinated as children, booster vaccinations will be wasteful.
Letters Care Management for Heart Failure
Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Chronic Heart Failure
Mark B. McClellan, Jerod M. Loeb, Carolyn M. Clancy, Gary S. Francis, Alice K. Jacobs, Kenneth W. Kizer, Margaret E. O'Kane, and Michael J. Wolk Demarcated Truncal Jaundice: A Sign of Retroperitoneal Bile Leakage
The International Campaign to Revitalise Academic Medicine
Correction: Angiotensin-Receptor Blockers in Chronic Heart Failure and High-Risk Acute Myocardial Infarction
Pierce Gardner
Mark D. Hannis
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