Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.
Statins lower LDL cholesterol and C-reactive protein levels, both markers for cardiovascular disease risk. A 2008 study of 17,802 people showed that the statin rosuvastatin reduced cardiovascular problems in persons with no previous cardiovascular disease and normal LDL cholesterol levels but elevated C-reactive protein levels. In this secondary analysis of the data, researchers found that nearly half of the 393 first cardiovascular events observed among the trial participants occurred in the 5,695 patients who were 70 years or older. They found that the older patients who took rosuvastatin had fewer heart problems and strokes than those who did not. The benefit was greater for older patients than younger patients. However, overall mortality did not differ in older patients who received rosuvastatin compared with those who received placebo.
Some health care providers and advocacy organizations market the use of low-dose computed tomography (CT) or chest x-ray for lung cancer screening directly to consumers. However, the cumulative false-positive rates for lung cancer screening using these modalities have not been clearly defined. Researchers for the ongoing National Lung Screening Trial conducted a randomized, controlled trial of low-dose CT versus chest radiography in 3,190 current or former smokers aged 55 to 74 with no history of lung cancer to quantify the cumulative risk for a false-positive result, as well as rates of unnecessary diagnostic procedures. Participants had a baseline screen followed by repeat screening one and two years later. The CT group had a 33 percent cumulative incidence of false-positive results after two examinations while the chest x-ray group had a 15 percent incidence. Of the patients with a false-positive CT scan, 7 percent had an unnecessary invasive procedure and 2 percent had unnecessary major surgery. Given the high false-positive rates and the fact that false positives can lead to unnecessary invasive procedures, physicians should talk with their patients about the potential benefits and harms of using low-dose CT or chest x-ray to screen for lung cancer.
For the past 20 years, U.S. News & World Report has published annual rankings of the top 50 American hospitals in several specialties. Hospitals are rated based on reputation, structure, process, and outcomes. Structure and outcomes are assessed by objective measures, including nurse staffing, patient volume, patient safety adverse events, and adjusted mortality of hospitalized patients. This analysis sought to quantify the role of reputation versus objective measures in determining the relative standings of the hospitals on the 2009 list. Researchers conducted a cross-sectional study of the rankings based on the U.S. News score, subjective reputation score, and then on objective quality measures. On average, rankings based on reputation score alone agreed with the U.S. News overall rankings 100 percent of the time for top hospitals in each specialty, 97 percent for the top 5, 91 percent for the top 10, and 89 percent for the top 20. However, hospital reputation did not seem to depend on objective measures of hospital quality. The researchers conclude that the U.S. News 2009 rankings “fall short of being an evidence-based system that data-conscious consumers, value-based purchasers, and reform-minded policymakers can rely on for health care decisions.”