Abstract:
PURPOSE:To review prospective epidemiologic studies and randomized trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular disease, with emphasis on differences in results obtained by these two types of studies. DATA SOURCES:Computerized and manual searches of the literature on antioxidant vitamins and cardiovascular disease. STUDY SELECTION:Prospective epidemiologic studies and randomized trials that included 100 or more participants and provided quantified estimates of antioxidant vitamin intake. DATA SYNTHESIS:Comparisons of relative risk reductions (RRR) across observational studies and randomized trials, including assessment of dose-response relations. RESULTS:All three large epidemiologic cohort studies of vitamin E noted that high-level vitamin E intake or supplementation was associated with a significant reduction in cardiovascular disease (RRR range, 31% to 65%), as measured by various fatal and nonfatal cardiovascular end points. To obtain these reductions, vitamin E supplementation must last at least 2 years. Less consistent reductions were seen in studies of beta-carotene (RRR range, -2% to 46%) and vitamin C (RRR range, -25% to 51%). Considerable biases in observational studies, such as different health behaviors of persons using antioxidants, may account for the observed benefit. By contrast, none of the completed randomized trials showed any clear reduction in cardiovascular disease with vitamin E, vitamin C, or beta-carotene supplementation. The trials were not specifically designed to assess cardiovascular disease, did not provide data on nonfatal cardiovascular end points, may have had insufficient treatment durations, and used suboptimal vitamin E doses. The completed trials were of adequate size to indicate that the true therapeutic benefit of vitamin E and other antioxidants in reducing fatal cardiovascular disease (a survival benefit as long as 5 years) is probably more modest than the epidemiologic data suggest. CONCLUSION:The epidemiologic data suggest that antioxidant vitamins reduce cardiovascular disease, with the clearest effect for vitamin E; however, completed randomized trials do not support this finding. Much of this controversy should be resolved by the ongoing large-scale and long-term randomized trials designed specifically to evaluate effects on cardiovascular disease.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Jha P,Flather M,Lonn E,Farkouh M,Yusuf Sdoi
10.7326/0003-4819-123-11-199512010-00009subject
Has Abstractpub_date
1995-12-01 00:00:00pages
860-72issue
11eissn
0003-4819issn
1539-3704journal_volume
123pub_type
杂志文章,评审abstract::The U.S. Preventive Services Task Force (USPSTF) seeks to provide reliable and accurate evidence-based recommendations to primary care clinicians. However, clinicians indicate frustration with the lack of guidance provided by the USPSTF when the evidence is insufficient to make a recommendation. This article describes...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-3-200902030-00010
更新日期:2009-02-03 00:00:00
abstract::Increased adrenocorticotropic hormone (ACTH) levels after bilateral adrenalectomy could be secondary to a pituitary tumor, under replacement with cortisol, or an abnormality in the hypothalamic-pituitary-adrenal feedback loop. To distinguish between these possibilities, ACTH levels were measured before and after corti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-3-277
更新日期:1982-03-01 00:00:00
abstract:BACKGROUND:Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated. OBJECTIVE:To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings. DESIGN:Prospective cohort study. SETTING:Close con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-2671
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:To determine in female tennis and squash players the effect of biological age (that is, the starting age of playing relative to the age at menarche) at which tennis or squash playing was started on the difference in bone mineral content between the playing and non-playing arms. DESIGN:Cross-sectional study. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-1-199507010-00003
更新日期:1995-07-01 00:00:00
abstract::Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-1-24
更新日期:1980-01-01 00:00:00
abstract::Platelets may have a role in the development of animal tumor metastases. Ultrastructural studies in vivo have shown arrested tumor emboli surrounded by platelets. Several tumor cell lines induce thrombocytopenia in vivo. Certain tumor cells aggregate platelets in vitro. Correlations exist between the ability of some t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-95-5-636
更新日期:1981-11-01 00:00:00
abstract::Twenty-nine men with stage III or unresectable stage II malignant germ cell tumors and no previous chemotherapy received treatments with the VAB-6 protocol. The VAB-6 regimen is a 1-year program beginning with three successive inductions at 3-to-4-week intervals: day 1--cyclophosphamide, 600 mg/m of body surface area ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-95-1-59
更新日期:1981-07-01 00:00:00
abstract::Considerable evidence links elevated blood cholesterol levels to the development of atherosclerosis. The National Cholesterol Education Program (NCEP) has recently published revised guidelines for detecting and treating hypercholesterolemia in adults. Included in these guidelines is the recommendation that all adults ...
journal_title:Annals of internal medicine
pub_type: 评论,杂志文章,评审
doi:10.7326/0003-4819-124-5-199603010-00008
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of these fractures remains uncertain. OBJECTIVE:To determine the association of new vertebral fractures with back pain and back-related functional l...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-10-199805150-00001
更新日期:1998-05-15 00:00:00
abstract::To increase the utility of administrative databases, it has been recommended that they include disease-specific, patient-centered outcome measures. This paper reviews practical and theoretical considerations and the critical evidence to support this recommendation. The strengths and weaknesses of the recommended appro...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-127-8_part_2-199710151-00060
更新日期:1997-10-15 00:00:00
abstract::Electrophysiologic studies were done in 32 patients with aortic stenosis. In 24 patients with intact A-V conduction, A-H intervals ranged from 55 to 145 msec and were prolonged in two. Two had split His bundle potentials. The H-V intervals ranged from 25 to 94 msec and were prolonged in 12. The mean H-V interval was 6...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-3-275
更新日期:1977-09-01 00:00:00
abstract:BACKGROUND:When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis. OBJECTIVE:To determine whether the combination of a low clinical suspicion and a normal D -dimer result rules out deep venous thrombosis. DESIGN:Prospective cohort study. SETTING:Three tertiary care...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-2-200107170-00011
更新日期:2001-07-17 00:00:00
abstract::Levels of circulating platelet aggregates and plasma beta-thromboglobulin reflect the degree of platelet activation in vascular injury and repair. Both values were evaluated in 38 patients with scleroderma and 18 control subjects matched for age, sex, and race. Circulating platelet aggregates (expressed as percentage ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-5-610
更新日期:1982-05-01 00:00:00
abstract::During the National Cooperative Gallstone Study, therapy with chenodiol, 750 or 375 mg/d, for 2 years resulted in confirmed, complete gallstone dissolution in 14% and 5% of patients, respectively, and partial dissolution (greater than 50%) in 27% and 18%. The present study was done to determine the frequency with whic...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-100-3-382
更新日期:1984-03-01 00:00:00
abstract:BACKGROUND:The optimal strategy for diagnosis of deep venous thrombosis (DVT) is less well established for the upper extremities than for the lower extremities. Duplex color ultrasonography can be difficult to perform in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreove...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-136-12-200206180-00007
更新日期:2002-06-18 00:00:00
abstract:BACKGROUND:No effective oral therapy exists for early coronavirus disease 2019 (COVID-19). OBJECTIVE:To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients. DESIGN:Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/M20-4207
更新日期:2020-10-20 00:00:00
abstract::The usefulness of HbA, as a monitor of metabolic control was studied in 15 diabetic outpatients during periods of stable, deteriorating, and improving control. Mean fasting concentrations of HbA, and plasma glucose during a 3-month period of stable control were 12.6% +/- 0.8% and 120 +/- 8 mg/dL, respectively. One wee...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-3-357
更新日期:1980-03-01 00:00:00
abstract::Between September 1972 and January 1976 an outbreak of dialysis dementia affected 20 patients maintained by long-term hemodialysis. The clinical picture was characterized by an insidious onset of altered behaviour, dementia, speech disturbance, myoclonus, and convulsions. Nineteen patients died, but one patient has su...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-4-502
更新日期:1978-04-01 00:00:00
abstract::Restrictive cardiomyopathy produced by primary cardiac amyloidosis may have a clinical syndrome identical to noncalcific constrictive pericarditis. We report two patients with amyloidosis and restrictive physiology who had enlarged papillary muscles shown on left ventricular angiocardiogram. Rapid volume expansion wit...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-2-177
更新日期:1983-02-01 00:00:00
abstract:DESCRIPTION:Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for bladder cancer. METHODS:The USPSTF performed a targeted literature search for new evidence on the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefit...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-155-4-201108160-00008
更新日期:2011-08-16 00:00:00
abstract::Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliabi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-108-2-170
更新日期:1988-02-01 00:00:00
abstract::Thirty-two studies (2889 subjects) that investigated the prevalence of the causes of dementia were critically reviewed. Particular attention was paid to potential and actual reversibility. Although dementia manifests itself primarily in old age (particularly age 75 and older), the mean age of patients for the studies ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-109-6-476
更新日期:1988-09-15 00:00:00
abstract::Research participants require ongoing protection of the kind already established in law and regulation. However, "special scrutiny" for certain types of research is also needed. Three criteria for special scrutiny are 1) research that involves initial experiences of translating new scientific advances into humans, esp...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-140-3-200402030-00013
更新日期:2004-02-03 00:00:00
abstract:BACKGROUND:Apolipoprotein E (apoE) genotypes play critical roles in lipid metabolism and are believed to influence risk for coronary heart disease (CHD). Despite many population studies, however, the impact of apoE polymorphism on risk for CHD remains uncertain. PURPOSE:To qualitatively and quantitatively assess the e...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-141-2-200407200-00013
更新日期:2004-07-20 00:00:00
abstract:BACKGROUND:Recent postmarketing trials produced conflicting results about the risk for hospitalized heart failure (hHF) associated with dipeptidyl peptidase-4 (DPP-4) inhibitors, creating uncertainty about the safety of these antihyperglycemic agents. OBJECTIVE:To examine the associations of hHF with saxagliptin and s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M15-2568
更新日期:2016-06-07 00:00:00
abstract:BACKGROUND:Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. OBJECTIVE:To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-148-6-200803180-00004
更新日期:2008-03-18 00:00:00
abstract::Ensuring patient safety is essential for better health care, but preoccupation with niches of medicine, such as patient safety, can inadvertently compromise outcomes if it distracts from other problems that pose a greater threat to health. The greatest benefit for the population comes from a comprehensive view of popu...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-140-1-200401060-00009
更新日期:2004-01-06 00:00:00
abstract:BACKGROUND:Tumor necrosis factor-alpha is present in arteries in giant cell arteritis. OBJECTIVE:To evaluate the efficacy of infliximab, an anti-tumor necrosis factor-alpha agent, in giant cell arteritis. DESIGN:Randomized, controlled trial. SETTING:22 sites in the United States, the United Kingdom, Belgium, Italy, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-146-9-200705010-00004
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the influence of a human immunodeficiency virus (HIV) vaccine given to uninfected volunteers on the interpretation of serodiagnostic HIV test results. DESIGN:Retrospective cohort study. SETTING:5 AIDS Vaccine Evaluation Units funded by the National Institute of Allergy and Infectious Diseases. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-121-8-199410150-00005
更新日期:1994-10-15 00:00:00
abstract::Wilson's disease is an inherited disorder of copper accumulation that is fatal if untreated. Because penicillamine, the established treatment, is toxic in a substantial number of patients, we studied the efficacy of zinc treatment. We induced a negative or neutral copper balance in five out of five patients with Wilso...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-3-314
更新日期:1983-09-01 00:00:00