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17 April 2001 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. Full content of the issue is available on the Internet at

Mild Kidney Disease is Risk Factor for Heart Disease; ACE Inhibitor Helps

A new analysis of data from a large heart study found that mild kidney disease was an independent risk factor for heart disease and that an angiotensin-converting enzyme (ACE) inhibitor, ramipril, safely and effectively reduced heart disease risk in these kidney patients (Article, p. 629). An editorial notes that more research is needed to find out how the ACE inhibitors, originally used to control high blood pressure, appear to protect both the kidney and heart (Editorial, p. 707).

Document Guiding Reporting on Clinical Trials Revised

The 1996 CONSORT statement (Consolidated Standards of Reporting Trials) developed to improve reporting of randomized clinical trials (RCTs) has been revised (Academia and Clinic, p. 657; background paper, p. 663). Although the checklist and flow diagrams in the original CONSORT statement improved reporting, authors still found many reports with systematic errors that biased or exaggerated treatment effects. The revised statement is intended to improve reporting further, which should help readers understand how the trial was conducted and to assess the validity of its results.

AstronautÕs Anemia May Have a Lesson for Earthlings

Astronauts develop anemia (too few red blood cells) soon after they leave the earthÕs gravity. The body apparently compensates for shifts in red blood cells due to loss of gravity by destroying young red blood cells, a process called neocytolysis. To find out if neocytolysis occurs in other situations, researchers studied nine volunteers living at high altitudes (where less oxygen engenders build-up of red blood cells), then moved the volunteers to sea level (Brief Communication, p. 652). In six participants, red cell mass decreased by seven to 10 percent within a few days of descent. Special tests showed that the youngest red blood cells were being destroyed, just as when astronauts go into space. An editorial says that neocytolysis "may have implications that extend beyond space and altitude medicine to renal disease and other situationsÉ" (Editorial, p. 561).

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