JAMA 24 Jan 2007

We’ve known for some time that about a quarter of patients in hospital with coronary artery disease are depressed, and that this worsens their prognosis – hence those questions we are supposed to ask patients when they come to our CHD clinics.Despite several studies with dreadful acronyms – ENRICHD, SADHEART, and now CREATE – we don’t yet know if treating depression improves cardiac outcomes, but we do know that serotonin reuptake inhibitors are safe and effective in the short term. This latest study was very short-term indeed – 12 weeks – and in that time it found no added benefit from combining the SSRI with interpersonal psychotherapy. So perhaps just use a pill for this ill – citalopram or sertraline. The Australian town of Dubbo lies approximately 400km northwest of Sydney (I tell you this because I was accused of geographical inaccuracy in a previous review) and it is a sort of Framingham-with-kangaroos. It has a stable population of about 32,000 people, 98.6% white, and this study follows up what happened to those with low-trauma fractures. More women than men got these, as expected, but thereafter the two sexes had an equally increased risk of refracture to start with, but this risk normalised after ten years. When might you treat an abdominal aortic aneurysm with steroids and methotrexate? According to this case-based review, when it’s inflammatory. These greatly thickened AAAs tend to occur in younger men and are associated with a raised ESR and/or CRP. They are less likely to rupture than ordinary atherosclerotic aneurysms but the internal size criteria for surgery are the same. We don’t really know why they happen, though they are commonest in smokers with bad lipid profiles. “Practice-based research may be the best setting for studying the process of care and the manner in which diseases are diagnosed, treatments initiated, and chronic conditions managed.