In This Issue of Archives of Internal Medicine FREE

In this study, Toh et al used data from the Mini-Sentinel program to assess the risk of angioedema associated with angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and the direct renin inhibitor aliskiren. Compared with the use of β-blockers, the angioedema risk was approximately 3-fold higher for ACEIs and aliskiren and was 16% higher for ARBs.

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In a preliminary investigation, zonisamide, an antiepileptic drug, administered at up to 600 mg/d, led to 6% weight loss (vs 1% for placebo) over 16 weeks in obese adults. This randomized controlled trial examined the weight loss efficacy of 2 doses of zonisamide (200 mg and 400 mg) vs placebo in 225 obese adults over 1 year. Change in body weight was −4.0 kg (95% CI, −5.8 kg to −2.3 kg) for placebo; −4.4 kg (95% CI, −6.1 to −2.6) for zonisamide, 200 mg; and −7.3 kg (95% CI, −9.0 to −5.6) for zonisamide, 400 mg. A weight loss of 10% or greater was achieved in 8% of patients assigned to placebo; 22% of patients assigned to zonisamide, 200 mg; and 32% of patients assigned to zonisamide, 400 mg. Gastrointestinal, nervous system, and psychiatric adverse events occurred at a higher incidence with zonisamide than with placebo. The authors conclude that zonisamide, 400 mg, moderately enhanced weight loss achieved with diet and lifestyle counseling but had a high incidence of adverse events.

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In a meta-analysis of 7 randomized controlled trials, Komócsi et al evaluated the safety and efficacy of new-generation oral anticoagulants compared with placebo in 31 286 patients receiving antiplatelet therapy after an acute coronary syndrome. The use of oral activated factor X antagonists or direct thrombin inhibitors was associated with a 3-fold increase in bleeding events (odds ratio, 3.03; 95% CI, 2.20-4.16; P < .001). Significant but moderate reductions in the risk for stent thrombosis or composite ischemic events were observed, without a significant effect on overall mortality. Regarding net clinical benefit, oral anticoagulant treatment provided no advantage over placebo (odds ratio, 0.98; 95% CI, 0.90-1.06; P = .57).

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Tobias et al evaluated the association between adherence to 3 healthful dietary patterns and risk of progression to type 2 diabetes mellitus (T2DM) among 4413 female participants in the Nurses' Health Study with a history of gestational diabetes mellitus. Food frequency questionnaires measured usual diet, from which authors assessed adherence to the Alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Alternate Healthy Eating Index (aHEI) dietary patterns. After 16 years of follow-up, women with greater adherence to these dietary patterns were significantly less likely to develop T2DM. For a 1–standard deviation increase in score, the aMED, DASH, and aHEI patterns were associated with 23%, 18%, and 30% lower risk of T2DM, respectively.

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Aragon et al examined patterns of Medicare skilled nursing facility (SNF) benefit use in the last 6 months of life among 5163 decedents from the Health and Retirement Study (HRS). They found that 30.5% of HRS decedents used the SNF benefit in the last 6 months of life and 9.2% had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon. These findings suggest that palliative care should be a focus in SNFs alongside the goal of functional improvement.

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