Group Health and UW experts highlight the year’s top 10 medical findings

Seattle—What recently published medical research is most important for your doctor? That’s the question answered in an article by Eric B. Larson, MD, MPH, director of Group Health Center for Health Studies, and John V.L. Sheffield, MD, University of Washington professor of medicine.

In the August 2, 2005 issue of the Annals of Internal Medicine, Larson and Sheffield cite studies in 10 areas that commonly concern patients, including weight loss, anti-inflammatory drugs, hormone therapy, and prostate cancer prevention. In addition to the print report, the information is shared online with more than 119,000 physicians who are members of the American College of Physicians, the nation’s largest medical specialty organization.

"With tens of thousands of scientific papers published each year, no one physician could possibly keep up with all the new findings that are important to his or her clinical practice," said Larson. Reviews like this in Annals highlight the year’s most important findings as determined by a systematic review by experts.

The studies cited in Larson and Sheffield’s article were selected by authorities in internal medicine—a broad-ranging specialty that focuses on prevention and treatment of adult diseases. The authors surveyed general internal medicine physicians and sub-specialists from the University of Washington Medical School, along with editors of the American College of Physicians’ Journal Club.

"Our article is designed to tell internists and primary care physicians, "Pay close attention to these findings in particular because they will make a difference in the way you treat your patients’ most common problems," said Larson, who has teamed up with Sheffield to co-author the Annals annual update five times in the past nine years.

"This is the first year that we found something definitive for physicians to say about weight loss programs," said Larson, referring to studies that demonstrated the health benefits of adherence to regulated diets.

Larson also pointed to important evidence emerging in the area of prostate cancer, where a recent study showed that a rapid increase in PSA levels in the year before diagnosis may indicate that a man is at a higher risk for dying of prostate cancer despite undergoing surgery. "Prostate cancer is an area where doctors and patients are continuously dealing with uncertainty," said Larson. "But the evidence base is growing and that’s helpful."

Findings related to the hazards of the COX-2 inhibitors such as Vioxx show the growing importance of "post marketing studies to monitor long-term drug safety," the authors wrote. They also touted the past year’s "victories for such common-sense approaches as exercise, self-monitoring, and smoking cessation."

Top 10 findings cited in Annals’ 2005 "Update in General Internal Medicine"

1) Cardiovascular disease and statin use: Two studies—one in patients with type 2 diabetes, and one in patients with coronary artery disease—both showed that statin drugs were more effective than previously thought in preventing cardiovascular problems.

2) Management of coronary artery disease: Percutaneous coronary intervention (PCI) procedures such as angioplasty and the insertion of stents to open narrowed coronary arteries may not be that valuable in certain people. In fact, one study showed that aerobic exercise was more effective than PCI for certain patients. Another study found that having PCI prior to heart surgery did not did not substantially alter the long-term outcome for some patients.

3) Hypertension: In elderly patients with hypertension, home measurement of blood pressure predicted cardiovascular problems more accurately than blood pressure measured in medical centers. This suggests the value of self-monitoring over time in the management of high blood pressure.

4) Weight loss programs: Studies comparing various diets found that adherence to any regulated diet—not a particular diet itself—was the most important predictor of the weight loss achieved and of improvements in other health outcomes.

5) Cyclooxygenase-2 (COX-2) inhibitors: Earlier studies showing a link between selective COX-2 inhibitors such as Vioxx and increased risk of heart attacks and strokes caused some of these drugs to be withdrawn from the market in 2004. Physicians should prescribe COX-2 inhibitors with caution, especially for patients with moderate to high cardiovascular risk.

6) Hormone replacement therapy (HRT): Previous studies showed that HRT increases the risk for heart disease and invasive breast cancer in postmenopausal women with a uterus. One new study shows the same risks in postmenopausal women with previous hysterectomy. Another shows that HRT does not prevent dementia. These studies provide further evidence that postmenopausal women should not take HRT for the general prevention of chronic disease.

7) Dementia: The anticholinesterase inhibitor donepezil, a commonly prescribed generic drug for Alzheimer’s disease, may produce modest improvements in symptoms, but probably does not alter the course of the disease. Physicians should individualize the decision to prescribe this drug and should pay careful attention to clinical response and adverse effects.

8) Pulmonary medicine: Patients with chronic obstructive pulmonary disease (COPD) had improved health outcomes when they used a newer once-daily bronchodilator called tiotropium rather than an older drug called ipratropium. Although tiotropium is more expensive, the increased cost is justified because it reduced exacerbation and improved lung function and quality of life.

9) Prostate cancer: A single prostate-specific antigen (PSA) blood test does not accurately measure a man’s risk of dying of prostate cancer because the tests often give false negative or false positive results. Recent studies indicate that measuring velocity—i.e., how quickly PSA levels rise over time—is probably a better way to predict which men might benefit from prostate cancer treatment in addition to surgery. Men whose PSA levels increase more than 2.0 ng/mL in the year before diagnosis may have a higher risk for dying of prostate cancer despite undergoing radical prostatectomy.

10) Preventive medicine: The authors noted three findings in this area: 1) A new vaccine against Human Papilloma Virus (HPV) prevented cervical infection and abnormalities that indicate a precancerous condition. "The vaccine may be licensed soon and offers real promise for reducing cervical cancer incidence," the authors wrote. 2) Vitamin D supplementation in older people with stable health was associated with a 20 percent reduction in the risk for falls, possibly because of improved muscle function. 3) Early and intensive cigarette use was linked to highest mortality among smokers. The earlier the age of smoking cessation, the more years of life expectancy gained.

Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc. serve nearly 550,000 members in Washington and Idaho. Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Group Health Center for Health Studies is funded primarily through government and private research grants.

August 10, 2005

Group Health and UW experts highlight the year’s top 10 medical findings