Bmj Usa: Editor's Choice

This month in BMJ USA

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E138

From BMJ USA 2002;September:478

Vitamin E does not help macular degeneration

A randomized trial in 1000 healthy volunteers by Taylor and colleagues (BMJ USA p 491) shows that daily supplementation with vitamin E for four years does not alter the incidence or progression of macular degeneration. A positive family history and cigarette smoking are the known risk factors, but oxidative stress has been suspected. The authors suggest that vitamin E to protect against macular degeneration may be effective only in selected subgroups of patients.

Exercise can prevent falls in older people

A weekly exercise program focusing on balance can prevent falls among older people living at home. Day and colleagues (BMJ USA p 499) assessed three interventions among people aged 70–84 years and found exercise to be the most effective single intervention. Home hazard management and treating poor vision had no significant effect when used alone but added value when combined with the exercise program. Further trials should examine the effectiveness of interventions among people who are aged over 85 or in poorer health.

Detecting renal impairment early improves outcome

Doctors should optimize the care of patients with chronic kidney disease before the onset of end stage renal disease, says Malvinder Parmar (BMJ USA p 507). He warns that appreciable renal dysfunction may be present even when serum creatinine is normal and reports that the prevalence of common cardiovascular risk factors is high in chronic renal disease; early identification and effective control of these risk factors have been shown to improve patient outcomes.

Pregnancy and cardiovascular risk

Complications in pregnancy may predispose mothers to later vascular and metabolic disease. Sattar and Greer (BMJ USA p 514) say that these women should be screened and given relevant health education. The complications include gestational diabetes, preeclampsia, low birth weight, and preterm labor. The potential for modifying risk factors before a subsequent pregnancy or in early pregnancy also requires further investigation.

Major trial of pain killer did not present all the data

A widely publicized trial, showing that celecoxib causes less gastrointestinal complications than conventional non steroidal anti-inflammatory drugs, did not report all the data, argue Peter Jüni and colleagues (BMJ USA p 520). The trial authors reported only the first six months of data to JAMA, and Jüni et al assert that a fuller analysis of the data reveals no evidence of benefit from celecoxib. The drug maker responds (BMJ USA p 522) and Jüni et al offer a rebuttal (BMJ USA p 523).

Articles cited in This month in BMJ USA are listed below, beginning with their BMJ USA page number:

BMJ USA p 491 Vitamin E supplementation (Taylor),

BMJ USA p 499 Randomised factorial trials of falls prevention (Day)

BMJ USA p 507 Chronic renal disease (Parmar)

BMJ USA p 514 Pregnancy complications and maternal cardiovascular risk (Sattar)

BMJ USA p 520 Are selective COX 2 inhibitors superior (Juni),

BMJ USA p 522 CLASS clarification (Geis),

BMJ USA p 523 The authors respond (Juni),

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