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Gervasio A. Lamas, MD; Robin Boineau, MD, MA; Christine Goertz, DC, PhD; Daniel B. Mark, MD, MPH; Yves Rosenberg, MD; Mario Stylianou, PhD; Theodore Rozema, MD; Richard L. Nahin, PhD, MPH; Lauren Lindblad, MS; Eldrin F. Lewis, MD; Jeanne Drisko, MD; Kerry L. Lee, PhD, for the TACT (Trial to Assess Chelation Therapy) Investigators

Whether high-dose vitamins and minerals reduce cardiovascular events after myocardial infarction (MI) is not known. This randomized trial found that time to recurrent MI, stroke, coronary revascularization, hospitalization for angina, or death did not differ among participants after MI who received daily high-dose multivitamins and minerals or placebo, suggesting that high-dose multivitamins and minerals do not seem to be useful for secondary prevention of cardiovascular events after MI.

Topics: myocardial infarction, minerals, vitamins, multivitamins
Francine Grodstein, ScD; Jacqueline O’Brien, ScD; Jae Hee Kang, ScD; Rimma Dushkes, PhD; Nancy R. Cook, ScD; Olivia Okereke, MD; JoAnn E. Manson, MD, DrPH; Robert J. Glynn, PhD; Julie E. Buring, ScD; J. Michael Gaziano, MD, MPH; and Howard D. Sesso, ScD, MPH

Multivitamins are commonly used to prevent various chronic conditions, but whether they prevent age-related cognitive decline is unclear. In a substudy of a large randomized trial of male physicians aged 65 years or older, daily multivitamin use compared with placebo did not improve cognitive performance. This study does not support use of multivitamins to improve cognitive function.

Topics: multivitamins, cognitive ability
C. Arnoud Meijer, MD; Theo Stijnen, PhD; Martin N.J.M. Wasser, MD, PhD; Jaap F. Hamming, MD, PhD; J. Hajo van Bockel, MD, PhD; Jan H.N. Lindeman, MD, PhD, for the Pharmaceutical Aneurysm Stabilisation Trial Study Group

Doxycycline has been shown to slow the increase in size of abdominal aortic aneurysms (AAAs) in animal studies, but whether and how this observation translates to humans is unclear. In this randomized trial of Dutch patients, doxycycline did not slow the increase in size for smaller AAAs during 18 months of follow-up, nor did it influence the need for AAA repair or the time to surgical repair.

Topics: abdominal aortic aneurysm, doxycycline, aneurysm, diameter
Stephen P. Fortmann, MD; Brittany U. Burda, MPH; Caitlyn A. Senger, MPH; Jennifer S. Lin, MD, MCR; and Evelyn P. Whitlock, MD, MPH

This systematic review for the U.S. Preventive Services Task Force updates evidence on the benefits and harms of vitamin and mineral supplements for primary prevention of cardiovascular disease and cancer. It found insufficient evidence of an effect of nutritional doses on cardiovascular disease, cancer, or death in healthy individuals for most supplements. There was sufficient evidence, however, of no effect for vitamin E and confirmation that β-carotene was associated with increased risk for lung cancer in smokers.

Topics: cardiovascular diseases, cancer, vitamins, mineral supplements, multivitamins, primary prevention of cardiovascular disease ...
Amir Qaseem, MD, PhD, MHA; Robert H. Hopkins Jr., MD; Donna E. Sweet, MD; Melissa Starkey, PhD; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians

Early-stage chronic kidney disease is common, and many patients are not aware that they have it. This American College of Physicians guideline makes evidence-based recommendations on screening for, monitoring, and treating stage 1 to 3 chronic kidney disease.

Topics: kidney failure, chronic, angiotensin-converting enzyme inhibitors

Palliative care has a limited presence in medical education. This commentary discusses palliative care and argues that it teaches good medical practice and the art of medicine and should be an essential and longitudinal component of medical education and training.

Topics: education, medical, palliative care
Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, PhD

In this issue, 3 articles address vitamin and mineral supplements for prevention of chronic diseases. The editorialists discuss the articles' findings and their implications for public health and research. They conclude that most mineral and vitamin supplements have no clear benefit, might even be harmful in well-nourished adults, and should not be used for chronic disease prevention.

Topics: cachexia, vitamins, mineral supplements, money, multivitamins

In this issue, Meijer and colleagues' trial of doxycycline in patients with smaller AAAs found that the drug significantly increased AAA enlargement. The editorialist discusses the trial's findings and asks where this leaves us, concluding that no drug can currently be recommended for reducing AAA enlargement.

Topics: abdominal aortic aneurysm, hypertrophy
Jane T. Broxterman, MD
Includes: Audio/Video

It was 2 weeks before Christmas, and I was rounding on our inpatient palliative care service for the weekend. I was surprised to see the name of one of my long-time clinic patients on our consult list.

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Virginia A. Moyer, MD, MPH; Michael L. LeFevre, MD, MSPH; and Albert L. Siu, MD, MSPH
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Marcus M. Reidenberg, MD
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José Luis Andreu, MD, PhD; and Domingo Ly-Pen, MD, PhD
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Isam Atroshi, MD, PhD; and Jonas Ranstam, PhD
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Dimitrios Farmakiotis, MD
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Adam Gilden Tsai, MD, MSCE; and Thomas A. Wadden, PhD
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Barbara Quick
Includes: Audio/Video
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Topics: percutaneous coronary intervention, st-segment elevation mi, cardiac event, coronary heart disease
Topics: cytology, human papillomavirus, vaccination
Topics: deep vein thrombosis, fibrinolytic agents, knee replacement arthroplasty, wound complication
Topics: warfarin, hemorrhage, ischemic stroke, heart valve prosthesis, artificial, dabigatran etexilate
Topics: aerobic exercise, exercise, isometric, osteoarthritis, lower limb pain
Topics: knee region, knee joint, osteoarthritis, hip, pain management, glucosamine, sulfate
Topics: ldl cholesterol lipoproteins, cardiovascular diseases
Topics: parkinson disease
Topics: ischemic stroke, oral contraceptives, venous thromboembolism
Topics: venous thrombosis, combined oral contraceptives
Topics: cardiopulmonary resuscitation, cardiac arrest
Geno J. Merli, MD; and Howard H. Weitz, MD

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: hyperglycemia, consultation
Topics: myocardial infarction, minerals, multivitamins
Topics: multivitamins, cognitive ability
Topics: kidney failure, chronic
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