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Annals of Internal Medicine tip sheet for June 17, 2014

June 16th, 2014

1. To prevent stroke in women, start young

Stroke risk in women begins in young adulthood, according to a guideline synopsis being published in Annals of Internal Medicine. While stroke typically affects women in old age, sex-specific guidelines from the American Heart Association and American Stroke Association recommend that physicians assess a woman's health history for unique events that increase her risk of stroke later in life, such as being diagnosed with preeclampsia or using of hormonal contraceptives. Each year, more than 3.8 million women and 3 million men will have a stroke in the United States and several risk factors for stroke are more common in women than in men. Women are more likely than men to suffer from hypertension, atrial fibrillation, migraine headache with aura, and depression and psychosocial stress. Internal medicine physicians are uniquely poised to assess a woman's risk for stroke and implement prevention strategies because internists care for patients from early adulthood to end-of-life. Stroke prevention strategies include healthy lifestyle interventions that encourage patients to maintain a healthy weight, eat a healthy diet, abstain from smoking, get regular physical activity and limit alcohol consumption. A healthy lifestyle also includes interventions that help to maintain normal blood pressure and cholesterol and blood glucose levels, as diabetic women have 27 percent higher risk for stroke than diabetic men.

2. Liver cancer screening may not increase survival in chronic hepatitis C

Screening for liver cancer may not lead to greater survival among patients infected with chronic hepatitis C virus, according to an evidence review being published in Annals of Internal Medicine. Current guidelines recommend screening high-risk individuals for liver cancer, but the strength of evidence supporting these guidelines is unclear. Researchers for the Veterans Health Administration conducted a systematic review of published literature to determine the benefits and harms of routine screening for liver cancer in patients with chronic hepatitis C virus (HCV). Twenty-two studies were included in the review. While screening could identify patients with earlier-stage disease who could benefit from treatment, the researchers found very-low-strength evidence about the effects of liver cancer screening on mortality. Studies show that liver cancer has variable rates of progression and some patients may never experience symptoms. Diagnosing and treating patients for liver cancer that would never progress is an example of overtreatment. The researchers found no evidence examining rates of overdiagnosis in liver cancer screening. These findings neither support nor refute current clinical guidelines.

Note: The URL will go live at 5:00 p.m. on Monday, June 16 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To interview the lead author, please contact Elisa Williams at 503-494-4530 or willieli@ohsu.edu. To speak with someone at the Veterans Health Administration, contact Daniel Herrigstad at 503-402-2975 or daniel.herrigstad@va.gov.

Provided by American College of Physicians

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