Ann Intern Med 7 Aug 2007 Vol 147

For some weeks this paper has been on the journal’s website, bringing the unwelcome news that outcomes for women with diabetes have not improved between the NHANES cohort of 1971-1986 and the cohort of 1986-2000. For everyone else, cardiovascular morbidity and mortality have fallen, so that diabetic women are now in much the same position as diabetic men, who used to be at much higher risk. And having diabetes makes a woman twice as likely to die or have a cardiovascular event as her non-diabetic contemporaries. All a bit puzzling: and perhaps the next NHANES will show an improvement due to much more attention to blood pressure control and statin prescribing.

D-dimer testing as a means of helping the diagnosis of deep vein thrombosis provides many useful lessons about how to use diagnostic tests. One important one is that not all groups are the same – pregnant women are a special group, for example, and even after this study, there are too few data to be absolutely certain that during pregnancy, a normal D-dimer definitely excludes DVT. But it does in most cases.