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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2004;164(21):2303. doi:10.1001/archinte.164.21.2303.
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A U- or J-shaped association exists between alcohol consumption and coronary heart disease. One of the proposed mechanisms is through atherogenesis. In this cross-sectional study, the association between alcohol consumption and coronary calcification was investigated. Participants from the population-based Rotterdam Coronary Calcification Study underwent electron beam computed tomography for the detection of coronary calcium. Data on alcohol consumption were available for 1795 elderly participants without coronary heart disease. A U-shaped association was found between alcohol consumption and coronary calcification. Alcohol consumption of up to 2 drinks per day was inversely associated with extensive coronary calcification. Subjects who consumed 1 to 2 drinks of alcohol per day had a 50% lower risk of extensive coronary calcification compared with nondrinkers.

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In this study, Meijer and colleagues aimed to estimate the risk of abnormal bleeding associated with the use of antidepressants and to calculate the relation between the level of serotonin reuptake inhibition of the individual agents and risk of abnormal bleeding. In a cohort of 64 000 patients taking antidepressants (1992-2000), 196 had a hospitalization for abnormal bleeding. The authors compared these cases with 972 controls. Risk of hospitalization for abnormal bleeding increased with the use of intermediate inhibitors and high inhibitors of serotonin reuptake. Risk of abnormal bleeding was associated with the degree of inhibition of serotonin reuptake.

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Prior studies demonstrate that chronically infected patients have decreased quality of life, but health values (utilities) in those with hepatitis C virus have not been well studied. A total of 124 patients with chronic hepatitis C virus infection representing a cross-section of disease severity were administered a disease-specific version of the Medical Outcomes Study 36-Item Short-Form Health Survey, the Beck Depression Inventory, and 3 direct health value measures including the Rating Scale, Time Trade-off, and Standard Gamble. Time Trade-off and Standard Gamble scores failed to show significant variability in relation to disease activity as determined by serum alanine aminotransferase level, histologic stage, or presence of decompensated liver disease. The Beck Depression Inventory was significantly inversely correlated with Time Trade-off and Standard Gamble.

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A prospective cohort study was conducted to determine the incidence and long-term outcome of thyroid dysfunction in hepatitis C virus (HCV)–infected men treated with interferon and ribavirin combination therapy. Among the 225 patients, the incidence of thyroid dysfunction was 10.7%, including 6.7% with overt thyroid disease and 4.0% with subclinical disease. Most patients with thyroid dysfunction completed HCV therapy, and thyroid disease resolved in 10 of 12 patients with overt hypothyroidism, in 2 of 3 with overt hyperthyroidism, and in all 9 with subclinical thyroid disease. The authors recommend that screening for thyroid disease be performed in all HCV-infected men treated with interferon and ribavirin.

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Whereas the long-term management of chronic pain with opioids may be necessary for many patients with or without malignancies, such management may be complicated by problematic dose increases and drug dependencies. Hermos and colleagues examined the clinical and pharmacological correlates of long-term prescriptions of oxycodone/acetaminophen using databases from the New England Veterans Integrated Service Network. Within a 42-month period of observation, veterans who received oxycodone/acetaminophen for 9 to 42 months, with or without cancer diagnoses, had generally modest and stable doses, reflecting the predominance of “successful” long-term opioid users in that cohort. However, it was also found that in patients without cancer, higher daily oxycodone/acetaminophen doses were associated with concurrent benzodiazepine use and with the diagnoses of “psychogenic chronic pain,” human immunodeficiency virus/AIDS, and alcohol abuse.

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