In This Issue of Archives of Internal Medicine FREE

Statins are one of the most widely prescribed classes of medications; however, owing to concerns regarding an associated risk of hepatitis and myopathy, most physicians routinely screen transaminase and creatine kinase (CK) values. The yield of this routine screening in a primary care setting is unclear. This study of 1194 patients receiving statin medications demonstrated that routine monitoring of these laboratory tests resulted in no significantly abnormal transaminase or CK values attributable to statin use. In addition, there were no moderate elevations in transaminase values and only 2 moderate elevations in CK potentially attributable to statins. This study questions the usefulness of routine measurement of transaminase and CK in all patients taking statin medications.

This study provides the first national estimates of alcohol use disorders among inpatient admissions to short-stay, general hospitals in the United States, using a structured diagnostic instrument to identify DSM-IV alcohol use disorders. The study investigates overall prevalence and prevalence according to person and environmental characteristics. Prevalence of alcohol abuse or dependence in current-drinking admissions was 24%, suggesting that hospitalization offers a unique opportunity to identify alcohol use disorders. The authors recommend that all hospitalized drinkers be screened, with further evaluation and appropriate referral or intervention for those screening positive, and that concerted attention be directed toward understanding and addressing the racial disparity in prevalence observed.

Individuals with Down syndrome (DS) are known to have a high risk of leukemia and possibly other cancers, as well as an excess risk of mortality from a number of conditions, but specific information quantifying these risks is sparse. A cohort of 4872 individuals with a hospital discharge diagnosis of DS in Sweden and Denmark from 1965 to 1993 were followed by linkage to national cancer and vital statistics registries. In addition to a 25-fold increased risk of incident acute leukemia, risks of incident testicular and liver cancer were also elevated. Individuals with DS also experienced elevated mortality attributed to stomach cancer, as well as 3- to 16-fold increases in mortality attributed to diabetes, ischemic heart disease, other heart disease, cerebrovascular disease, and infectious diseases. Mortality due to epilepsy, dementia and Alzheimer disease, respiratory diseases, and congenital anomalies was more than 25 times greater than expected. The incident cancer risks and mortality experience of those with DS have implications for their clinical care and for the early detection of associated diseases. The results also shed light on chromosome 21 gene involvement and potential modifiers of risk.

Stroke is the third leading cause of mortality after coronary heart disease and cancer and the leading cause of disability. Although lowering blood cholesterol level decreases the risk of coronary heart disease, whether it decreases the risk of stroke remains unclear. Previous overviews suggested that hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), but not other lipid-lowering therapy (LLT), may reduce stroke incidence in coronary patients. To investigate the amplitude and sources of heterogeneity of LLT effects on stroke prevention, Corvol et al searched the literature from 1966 to 2001 and then conducted a meta-analysis including randomized trials of primary and secondary coronary heart disease prevention, testing statins, nonstatin drugs, diet, or other interventions and providing data on stroke incidence. The meta-analysis (38 trials, 83 161 patients, mean follow-up of 4.7 years) showed a significant relative risk reduction of strokes by LLT of 17% (P<.001), without significant heterogeneity between trials and between subgroups according to either the type of prevention #1primary or secondary) or the type of LLT. The most substantial effects were obtained, however, with statins (relative risk reduction, 26%). Corvol et al conclude that LLT appears to reduce stroke incidence in coronary patients and that such benefit appears to be related to blood cholesterol lowering, explaining why statin drugs provide the most consistent benefit among trials.