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19 December 2000 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 on December 19, 2000.

Hormone Replacement Protects Older Women From Heart Disease But May Increase Risk for Stroke

New data from the ongoing Nurses' Health Study found that postmenopausal women without previous heart disease, taking either a standard dose of estrogen (0.625 milligrams) or a lower dose (0.3), had about a 40 percent less chance of having a heart attack than those who didn’t take hormones (Article, p. 933). However, taking 0.625 milligrams of estrogen or greater and taking estrogen in combination with progestin increased risk for stroke by about 30 percent.

An editorial cites data from other trials, including a randomized trial in progress finding that hormone replacement is linked to increased risk for heart disease (Editorial, p. 999). "The idea that the findings of large, well-conducted observational studies (like the Nurses' Health Study) may produce wrong conclusions is disturbing," the writers say. However, they advise, "clinicians should not use hormone therapy for prevention of coronary disease until this practice is supported by evidence from randomized trials."

Pap Tests for Older Women Indicated Only Every Two Years

A study of Papanicolaou (Pap) tests for cervical cancer done a year after a normal test found most abnormal tests in postmenopausal women were false positives (Article, p. 942). The authors conclude that the tests should not be performed within two years of a normal test but further research is needed to determine the optimal schedule for testing older women. The study also found that women taking hormone replacement therapy did not have more abnormal Pap tests than those who did not take hormones.

Osteoporosis in Older Men May Be Related to Estrogen Levels

Low levels of the hormone testosterone are related to bone loss in younger men. A study of 405 older men, ages 68 to 96, found low levels of estrogen, not testosterone, correlated with low bone density levels (Article, p. 951). An editorial says that the bioavailability of free testosterone is the key factor in bone health, perhaps because some testosterone is converted in the body to estrogen. (Editorial, p. 1002).

Club Drug Increases Heart Rate, Blood Pressure and Oxygen Consumption

The cardiovascular effects of 3,4-Methylenedioxymethamphetamine (MDMA), an illicit, not well-understood compound also known as "ecstasy," was compared with a well-studied heart stimulant (Brief Communication, p. 969). MDMA increased heart rate, blood pressure, and oxygen consumption in the study’s eight participants. Subjective effects of MDMA reached their peak between one and one-half and three hours. The authors suggest that emergency treatment of MDMA-induced heart problems include a combination of a beta-blocker with a vasodilator such as nitroglycerine.

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