News From Annals Of Internal Medicine, October 20, 2009

Main Category: Heart Disease
Also Included In: Cervical Cancer / HPV Vaccine
Article Date: 20 Oct 2009 - 4:00 PDT

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Adding ACE Inhibitors to Standard Care Improves Outcomes for Stable Ischemic Heart Disease Patients; Adding ARBs Does Not Help, Increases Harms

Ischemic heart disease (IHD) is the leading cause of death of both men and women in the United States. IHD is the lack of blood supply to the heart muscle caused by coronary artery disease and heart attacks. Traditionally, IHD is treated with aspirin, beta-blockers, and aggressive modification of risk factors. Angiotension-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are introduced when patients have heart failure or a heart attack with ventricular dysfunction. However, these treatments typically are not used on patients with preserved ventricular function. Researchers reviewed 41 published studies to compare the benefits and harms of using ACE inhibitors, ARBs, or a combination of these treatments in adults with stable IHD and preserved ventricular function. The researchers found that adding ACE inhibitors to standard treatment improves clinical outcomes in these types of patients. A combination of ACE inhibitors and ARBs appeared no better than ACE inhibitor therapy alone and increased harms. The researchers recommend future trials to more clearly define the role for ARBs in this population.

HPV Vaccination Not Cost Effective for Women Older in their 30s and 40s

Most cases of cervical cancer are caused by certain strains of a common sexually transmitted virus called the human papillomavirus, or HPV. Physicians typically screen women for cervical cancer using a Pap smear, sometimes with HPV testing, every one to three years. A vaccine to prevent infection with the strains of HPV that cause cervical cancer is available and is recommended for girls and women between the ages of 11 and 26. The value of the vaccine in older women is questionable because exposure to the virus is likely to have occurred in many women. Researchers modeled a cost-effectiveness analysis to assess the health and economic outcomes of HPV vaccination in older women in the U.S. participating in a screening program. The researchers found that adding HPV vaccination for women aged 35 to 45 years cost from $116,950 to $381,590 per quality-adjusted life-year gained, which is more than the current United States health care system is generally willing to pay for preventive care interventions. The research suggests that current cervical cancer screening interventions are the more economically favorable strategy for reducing cervical cancer deaths among older women.

Source:
Angela Collom
American College of Physicians