EFFECTS OF MODERATE ALCOHOL CONSUMPTION ON COGNITIVE FUNCTION IN WOMEN

The adverse effects of excess alcohol intake on cognitive function are well established, but the effect of moderate consumption is uncertain. The authors evaluated cognitive function in 12,480 women age 70-81 in the Nurses’ Health Study between 1995 and 2001. Follow-up assessments were conducted in 11,102 participants 2 years later. They determined the level of alcohol consumption regularly beginning in 1980. They calculated multivariate-adjusted mean cognitive scores and multivariate-adjusted risks of cognitive impairment (defined as the lowest 10% of the scores) and a substantial decline in cognitive function over time (defined as a change that was in the worst 10% of the distribution of the decline). Analyses were stratified according to the apolipoprotein E genotype in a subgroup of women. After multivariate adjustment, it was found that moderate drinkers (those who consumed less than 15.0 g of alcohol per day [about one drink]) had better mean cognitive scores than nondrinkers. Among moderate drinkers, as compared with nondrinkers, the relative risk of impairment was 0.77 on a test of general cognition (95% confidence interval [CI], 0.67-0.88), and 0.81 on the basis of a global cognitive score, combining the results of all tests (95% CI, 0.70-0.93). Investigators found similar results for cognitive decline; for example, on a test of general cognition, the relative risk of a substantial decline in performance over a 2-year period was 0.85 (95% CI, 0.74-0.98) among moderate drinkers, as compared with nondrinkers. There were no significant associations between higher levels of drinking (15.0-30.0 g per day) and the risk of cognitive impairment or decline. No significant differences were found in risks according to the beverage (eg, wine or beer), and no interaction was determined with the apolipoprotein E genotype. The data from this study suggest that in women, up to one drink per day does not impair cognitive function and may actually decrease the risk of cognitive decline.

Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med 2005;352(3):245-253.

AMIODARONE OR AN IMPLANTABLE CARDIO-VERTER -DEFIBRILLATOR FOR CONGESTIVE HEART FAILURE

A leading cause of death among patients with congestive heart failure (CHF) is sudden death from cardiac causes. It has been proposed that treatment with amiodarone or an implantable cardioverter-defibrillator (ICD) can improve the prognosis for patients with CHF. This study involved 2521 patients with New York Heart Association (NYHA) class II or III CHF and a left ventricular ejection fraction (LVEF) of 35% or less. Participants were randomly assigned to conventional therapy for CHF plus placebo (847 patients), conventional therapy plus amiodarone (845 patients), or conventional therapy plus a conservatively programmed, shock-only, single-lead ICD (829 patients). Placebo and amiodarone were administered in a double-blind fashion. The primary endpoint was death from any cause. Results showed that the median LVEF in patients was 25%; 70% were in NYHA class II CHF, and 30% were in class III CHF. The cause of CHF was ischemic in 52% and nonischemic in 48% of study participants. The median follow-up was 45.5 months. There were 244 deaths (29%) in the group taking placebo, 240 deaths (28%) in the group taking amiodarone, and 182 deaths (22%) in the group with ICDs. As compared with placebo, amiodarone was associated with a similar risk of death (hazard ratio, 1.06; 97.5% confidence interval [CI], 0.86-1.30 P = 0.53), and ICD therapy was associated with a decreased risk of death in 23% (0.77; 97.5% CI, 0.62-0.96; P = 0.007) and an absolute decrease in mortality of 7.2 percentage points after 5 years in the overall population. Results did not vary according to either ischemic or nonischemic causes of CHF, but they did vary according to the NYHA class. Study conclusions show that in patients with NYHA class II or III CHF and LVEF of 35% or less, amiodarone has no favorable effect on survival, whereas single-lead, shock-only ICD therapy reduces overall mortality by 23%.

Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352(3):225-237.

BELOW-KNEE ELASTIC COMPRESSION STOCKINGS TO PREVENT THE POST-THROMBOTIC SYNDROME

The limitations of available evidence have hindered widespread use of elastic compression stockings for post-thrombotic syndrome. The authors of this study performed a randomized, controlled clinical trial to evaluate the efficacy of elastic compression stockings for the prevention of post-thrombotic syndrome in patients with proximal DVT. One hundred eighty consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment were evaluated at a university hospital. Before being discharged, patients were randomly assigned to wear or not wear below-knee elastic compression stockings (30-40 mm Hg at the ankle) for 2 years, and were followed up for up to 5 years. Investigators scored the presence and severity of post-thrombotic syndrome by using a standardized scale. It was found that post-thrombotic syndrome developed in 44 of 90 patients who did not wear the stockings (it was severe in 10 of those patients), and in 23 of 90 patients wearing elastic stockings (it was severe in 3 patients). All but one event developed in the first 2 years. The cumulative incidence of post-thrombotic syndrome in the control group versus the elastic stockings group was: 40.0% (95% confidence interval [CI], 29.9-50.1%) versus 21.1% (CI, 12.7-29.5%) after 6 months; 46.7% (CI, 36.4-57.0%) versus 22.2% (CI, 13.8-30.7%) after 1 year; and 49.1% (CI, 38.7-59.4%) versus 24.5% (CI, 15.6-33.4%) after 2 years. After adjusting for baseline characteristics, the hazard ratio for post-thrombotic syndrome in the group wearing elastic stockings compared to controls was 0.49 (CI, 0.29-0.84; P = 0.011). The only limitation of this study was that it lacked a double-blind design. It was concluded that post-thrombotic syndrome develops in almost half of patients with proximal DVT. Below-knee elastic compression stockings reduce this rate by approximately 50%.

Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, Tormene D, Mosena L, Pagnan A, Girolami A. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: A randomized, controlled trial. Ann Intern Med 2004;141 (4):249-256.