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1 October 2002 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

Kidney Disease Linked to Lower Heart Attack Survival

A study of Medicare and other government records of 130,099 elderly heart attack patients found that those with kidney disease were at much higher risk for death than other elderly heart attack patients during the month following hospitalization (Article, p. 555). One-year death rates for those with moderate kidney disease were 66 percent and for those with mild kidney disease was 46 percent, compared to 24 percent for those with no kidney disease. People with moderate kidney disease received some proven heart attack treatments much less often than those with no kidney disease. Another study of 3,106 people with kidney disease who were hospitalized for heart attack found that they received less-aggressive cardiac treatment and were at increased risk for death from heart attack (Article, p. 563). Even mild kidney disease was linked to poor outcomes after heart attack. An editorial says that these studies reinforce the fact that patients with reduced kidney function are at higher risk for death after a heart attack (Editorial, p. 615). Physicians should use all available treatments to prevent heart disease in kidney patients, and, when a kidney patient has a heart attack, should treat it aggressively, the writer says.

Some Statin-Induced Muscle Problems May Not Be Detected by Blood Tests

Four cases of muscle aches apparently caused by widely prescribed cholesterol-lowing drugs called statins are reported in the October 1 issue of Annals of Internal Medicine (Brief Communication, p. 581). These case reports were released on September 20 at a medical writers conference sponsored by the American Medical Association. The four patients had normal creatine kinase, (elevated levels indicate muscle damage), but researchers verified muscle damage with muscle biopsies. An editorial says statins, taken by millions of people in the United States, have a remarkably safe profile (Editorial, p. 617). Their proven efficacy for preventing heart disease "outweighs the unlikely possibility of permanent muscle damage," the writer says.

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