Abstract:
PURPOSE:To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies. DATA SOURCES:Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease. STUDY SELECTION:Prospective studies and major retrospective epidemiologic studies evaluating the association between homocyst(e)ine levels and cardiovascular disease and the association between blood levels or dietary intake of folate, vitamin B6, and vitamin B12 and cardiovascular disease. DATA EXTRACTION:Relevant data on patient population, plasma homocyst(e)ine levels, duration of follow-up, and main results were extracted from studies that met the inclusion criteria. DATA SYNTHESIS:The designs and results of studies included in this review are summarized. A formal meta-analysis was not performed because the studies were heterogeneous in method and design. CONCLUSIONS:Results of epidemiologic studies suggest that moderately elevated plasma or serum homocyst(e)ine levels are prevalent in the general population and are associated with an increased risk for cardiovascular disease, independent of classic cardiovascular risk factors. Simple, inexpensive, nontoxic therapy with folic acid, vitamin B6, and vitamin B12 reduces plasma homocyst(e)ine levels. Although the association between homocyst(e)ine levels and cardiovascular disease is generally strong and biologically plausible, the data from the prospective studies are less consistent. In addition, epidemiologic observations of an association between hyperhomocyst(e)inemia and cardiovascular risk do not prove the existence of a causal relation. Therefore, the effectiveness of folate, vitamin B6, and vitamin B12 in reducing cardiovascular morbidity and mortality requires rigorous testing in randomized clinical trials. Several such trials are under way; their results may greatly affect cardiovascular morbidity and mortality, given the simplicity and low cost of vitamin therapy.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Eikelboom JW,Lonn E,Genest J Jr,Hankey G,Yusuf Sdoi
10.7326/0003-4819-131-5-199909070-00008subject
Has Abstractpub_date
1999-09-07 00:00:00pages
363-75issue
5eissn
0003-4819issn
1539-3704pii
199909070-00008journal_volume
131pub_type
杂志文章,评审abstract:BACKGROUND:Observations that risk for colorectal cancer is elevated in patients with inflammatory bowel disease and that long-term use of anti-inflammatory drugs may reduce colorectal cancer risk have raised the possibility that inflammation may play a role in the development of colorectal cancer. While a recent prospe...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-142-6-200503150-00008
更新日期:2005-03-15 00:00:00
abstract:BACKGROUND:The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 global treatment target aims to achieve 73% virologic suppression among HIV-infected persons worldwide by 2020. OBJECTIVE:To estimate the clinical and economic value of reaching this ambitious goal in South Africa, by using a microsimulation m...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M16-0799
更新日期:2016-09-06 00:00:00
abstract:OBJECTIVE:To describe how the results of bone densitometry affect women's decisions about measures to prevent fractures and to determine whether labeling women as having below-normal bone density has adverse effects. DESIGN:Mail survey of a random sample of women. SETTING:Four community hospitals in the San Francisco...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-12-990
更新日期:1992-06-15 00:00:00
abstract::Twenty-one juvenile-onset diabetic patients with azotemic nephropathy underwent coronary angiography and left ventriculography before renal transplantation or chronic hemodialysis. Two-year survival of 12 patients with no coronary artery disease (group A) was 88% compared to 22% for nine patients with coronary artery ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-3-346
更新日期:1978-03-01 00:00:00
abstract:BACKGROUND:Because clinical diagnosis is inaccurate, objective testing is usually considered necessary when patients present with suspected deep venous thrombosis (DVT). OBJECTIVE:To determine whether a negative result on a quantitative latex D dimer assay eliminates the need for further investigation in patients with...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-138-10-200305200-00006
更新日期:2003-05-20 00:00:00
abstract::Cost-effectiveness analysis and other forms of decision analysis are becoming more common in the medical literature and are increasingly influential in the development of health policy. Nevertheless, many clinicians find it difficult to apply policies developed from these analyses to individual encounters with patient...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-122-11-199506010-00007
更新日期:1995-06-01 00:00:00
abstract::Previous epidemiologic studies of staphylococcal infections in newborn infants and surgical patients provide clues to the method of infection in toxic shock syndrome. In newborn infants, staphylococci were shown to be transmitted most often by the hands of nursery personnel to the umbilical stump, which afforded a war...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-6-934
更新日期:1982-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the incidence and symptoms of and risk factors for biliary sludge and gallstones during pregnancy and to assess the natural history of these conditions in the first year after delivery. DESIGN:Cohort study. PATIENTS:A total of 272 pregnant women recruited in the first trimester. MEASUREMENTS:Bi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-119-2-199307150-00004
更新日期:1993-07-15 00:00:00
abstract:OBJECTIVE:To determine the effect of treating Helicobacter pylori infection on the recurrence of gastric and duodenal ulcer disease. DESIGN:Follow-up of up to 2 years in patients with healed ulcers who had participated in randomized, controlled trials. SETTING:A Veterans Affairs hospital. PARTICIPANTS:A total of 109...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-116-9-705
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. OBJECTIVE:To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-147-6-200709180-00006
更新日期:2007-09-18 00:00:00
abstract::The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification i...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-4-324
更新日期:1988-08-15 00:00:00
abstract:BACKGROUND:Markers are needed for assessing response to antiretroviral therapy over time. The CD4+ lymphocyte count is one such surrogate, but it is relatively weak. OBJECTIVE:To assess the association of changes in plasma human immunodeficiency virus (HIV) RNA level and CD4+ lymphocyte count with progression to the a...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-126-12-199706150-00002
更新日期:1997-06-15 00:00:00
abstract::Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/AITC201906040
更新日期:2019-06-04 00:00:00
abstract:STUDY OBJECTIVE:To assess the long-term benefit and side effects of danazol therapy, and to delineate factors influencing the responses in patients with autoimmune thrombocytopenia. DESIGN:Before and after trial. SETTING:Referral-based hematology clinics and the University of Miami teaching hospitals. PATIENTS:Data ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-111-9-723
更新日期:1989-11-01 00:00:00
abstract::The classification of acute leukemia has almost invariably been based on the morphologic diagnosis into two broad categories: acute lymphocytic and acute myeloid leukemia. Despite the wide range of morphologic variation in both groups, strict criteria to define the subgroups have only recently been proposed. The conve...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-87-6-740
更新日期:1977-12-01 00:00:00
abstract:OBJECTIVE:To assess the use of L-tryptophan by patients with eosinophilic fasciitis and compare this with its use by patients with progressive systemic sclerosis (scleroderma). DESIGN:Retrospective and prospective analysis. Six patients with eosinophilic fasciitis were identified retrospectively and two prospectively....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-10-758
更新日期:1990-05-15 00:00:00
abstract:BACKGROUND:Dietary trans fat increases risk for coronary heart disease. In 2006, New York City (NYC) passed the first regulation in the United States restricting trans fat use in restaurants. OBJECTIVE:To assess the effect of the NYC regulation on the trans and saturated fat content of fast-food purchases. DESIGN:Cro...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-157-2-201207170-00004
更新日期:2012-07-17 00:00:00
abstract::Tetanus is an expected complication when disasters strike in developing countries, where tetanus immunization coverage is often low or nonexistent. Collapsing structures and swirling debris inflict numerous crush injuries, fractures, and serious wounds. Clostridium tetani infects wounds contaminated with dirt, feces, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-154-5-201103010-00007
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE:To provide a rigor...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-138-11-200306030-00011
更新日期:2003-06-03 00:00:00
abstract:OBJECTIVE:To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomograph...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-8-199510150-00005
更新日期:1995-10-15 00:00:00
abstract:BACKGROUND:Nurse care management programs for patients with chronic illness have been shown to be safe and effective. OBJECTIVE:To determine whether a telephone-mediated nurse care management program for heart failure reduced the rate of rehospitalization for heart failure and for all causes over a 1-year period. DES...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-10-19 00:00:00
abstract:OBJECTIVE:To determine whether concurrent treatment with acetaminophen and zidovudine impairs clearance of zidovudine, thereby increasing the risk for zidovudine-induced hematologic toxicity. DESIGN:Dose escalation, drug interaction study. SETTING:University clinical research center. PATIENTS:Patients with the acqui...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-11-937
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy. OBJECTIVE:To estimate the cost-effectiveness to Medicare of first-dollar coverage ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-143-2-200507190-00007
更新日期:2005-07-19 00:00:00
abstract:BACKGROUND:Exercise stress testing in patients with abdominal aortic aneurysms may cause enlargement or rupture of aneurysms. OBJECTIVE:To evaluate the safety of treadmill exercise stress testing in patients with abdominal aortic aneurysms. DESIGN:Retrospective descriptive study. SETTING:Tertiary care center. PATIE...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-129-8-199810150-00008
更新日期:1998-10-15 00:00:00
abstract::Kidney transplantation is safe, cost-effective, and beneficial for patients with end-stage renal disease. The number of patients who can receive transplants is severely limited by the availability of donor organs. Because most patients do not have a suitable living, related donor, transplant programs now rely on the u...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-4-536
更新日期:1983-04-01 00:00:00
abstract::The approximately 1.2 million inmates in U.S. correctional institutions have a high prevalence of communicable diseases, such as human immunodeficiency virus (HIV) infection, tuberculosis, hepatitis B virus infection, and gonorrhea. Before their incarceration, most inmates had limited access to health care, which, tog...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-118-2-199301150-00010
更新日期:1993-01-15 00:00:00
abstract:BACKGROUND:Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial I...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2006-10-17 00:00:00
abstract:BACKGROUND:The Department of Health and Human Services recently called for public comment on human subjects research protections. OBJECTIVE:To assess variability in reviews across institutional review boards (IRBs) for a multisite, minimal-risk trial of financial incentives for evidence-based hypertension care and to ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-156-10-201205150-00011
更新日期:2012-05-15 00:00:00
abstract::We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing featu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-3-417
更新日期:1984-03-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients. DESIGN:Retrospective incidence cohort study. SETTING:All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center. P...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-76-3-112-6-416
更新日期:1990-03-15 00:00:00