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Annals of Internal Medicine Aug. 20 tip sheet

American College of Physicians

1. Flu vaccination cost-effective for all adults, not just older people

A new study finds that all adults - not just those over 50 or with chronic illnesses - can benefit from a flu shot (Article, p. 225). Analyzing previously published data using a statistical decision model, researchers found that the costs of giving flu vaccine to healthy, working adults, aged 18 to 50, appear worth the benefits in terms of avoiding lost work time and cost of treatment. Researchers also looked at three antiviral medicines for treating the flu and concluded that, if started within 48 hours of developing flu symptoms, all were worth their cost in terms of workdays gained. Head-to-head comparisons of the drugs are needed to determine which drug is most cost-effective.

2. Hormone replacement therapy does not prevent or reduce the rate of developing heart disease, new review says

An analysis of published data on the relationship between hormone replacement therapy (HRT) and cardiovascular disease and coronary artery disease found that HRT does not reduce the rate of developing cardiovascular disease and does not prevent the disease, contrary to what some earlier studies found (Review, p. 273). Researchers for the U.S. Preventive Services Task Force looked at studies that met certain methodological criteria. Authors say this study underscores recently released data from the Women's Health Initiative (WHI), which found women who took HRT had slightly more heart attacks, strokes and blood clots than those who did not use HRT. Both the WHI researchers and the authors of this study conclude that reducing coronary disease is not a valid reason for using HRT.

An editorial says this analysis shows that insufficient statistical adjustment for socioeconomic status explains why many observational studies came to different conclusions from the WHI. Rather than HRT keeping women healthy, as the observational studies assumed, the new analysis shows that healthy women were taking HRT (Editorial, p. 290).

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Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

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