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18 March 2003 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.

High Meat Protein Diet May Speed Kidney Decline in Mild Kidney Disease

Data from 1,624 women in the prospective Nurses Health Study show that high total protein intake, particularly animal protein, may accelerate loss of kidney function in women who had mild chronic kidney disease at the beginning of the study period (Article, p. 460). Neither high protein intake nor the type of protein was associated with kidney decline in women with normal kidney function. At the beginning of the 11-year study, 1,135 women had normal kidney function, 489 had mild kidney insufficiency. Ninety-eight percent of the women were white, an important concern since kidney disease is particularly harmful in people of African-American descent.

Implantable Defibrillators Cut Deaths in Many Patients with Heart Disease

A meta-analysis of eight randomized, controlled trials (RCTs) that compared implantable cardioverter defibrillators (ICDs) with other types of therapy (mainly drugs to control abnormal heart rhythms) found that the ICDs significantly reduced sudden cardiac death and death from all causes in many patients (Article, p. 445). ICDs were equally effective for patients who had survived a cardiac arrest and for patients who had never had a cardiac arrest. Because ICD therapy is very expensive, researchers would like to find ways to identify patients who will gain the most from it. An editorial notes that some of the RCTs used in this meta-analysis did not identify patients by the type of underlying heart disease, which makes it more difficult to decide which patients will gain the most from ICDs (Editorial, p. 512). The writer says that research into prevention of death in a "huge reservoir of lower-risk patients is where the real challenge lies."

Ephedra Riskier Than Other Herbals and Should Be Banned

(This Brief Communication was first published online at on Feb. 4, 2003.)

Evaluation of Risks of Smallpox Vaccination and Policy

(This Review article was first published online at on Jan. 21, 2002.)

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