This is Journal Watch, a medical-literature
survey produced by the Massachusetts Medical
Society.
  Twice a week, our physician-editors summarize
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  Contents copyright 1994, Mass. Medical Society.

Journal Watch Summaries for November 15, 1994

MORE ON ZIDOVUDINE AND MOTHER-INFANT HIV TRANSMISSION.
  N Engl J Med 1994 Nov 3; 331:1173-80.

CHOLESTEROL IS NOT A RISK FACTOR FOR CHD IN THE
ELDERLY.
  JAMA 1994 Nov 2; 272:1335-40.

FISH-EATING MAY LIMIT DAMAGE FROM SMOKING.
  Am J Respir Crit Care Med 1994 Oct; 150:983-7.

ABBREVIATED HEPARIN REDUCES COMPLICATIONS AND COSTS
AFTER PTCA.
  J Am Coll Cardiol 1994 Nov 1; 24:1214-9.

LOW-DOSE ASPIRIN AFTER INTERNAL MAMMARY BYPASS
GRAFTING.
  J Am Coll Cardiol 1994 Nov 1; 24:1181-8.

MECHANICAL CHEST COMPRESSION FOR CYSTIC FIBROSIS.
  Am J Respir Crit Care Med 1994 Oct; 150:1154-7.

IRON-RICH FORMULA MAY PREVENT ANEMIA AND PSYCHOMOTOR
DECLINE.
  J Pediatr 1994 Oct; 125:527-34.

MORE ON ZIDOVUDINE AND MOTHER-INFANT HIV TRANSMISSION.
   Earlier this year, we reported preliminary trial
results showing that zidovudine reduced mother-to-infant
transmission of HIV (see MMWR 1994; 43:285-7). Now, the
complete findings have been published.
   The trial randomized over 400 HIV-infected pregnant women
with CD4 counts over 200 cells per cubic millimeter to
receive zidovudine or placebo, starting at 14 to 34 weeks'
gestation. Infants of zidovudine-treated mothers also
received the drug for six weeks. Fewer than 5 percent of the
women had used zidovudine previously.
   At 18 months, the estimated prevalence of HIV infection
was only 8 percent for children in the zidovudine group,
versus 26 percent for controls. Only three women in each
group stopped treatment because of side effects. None of the
fetal or neonatal deaths (5 in the zidovudine group and 3 in
the control group) were deemed drug-related. Zidovudine did
not cause premature birth, growth retardation, or con{*filter*}
anomalies. The only side effect in infants in the zidovudine
group was a mildly reduced hemoglobin concentration.
   Comment: This appears to be one of the few unequivocal
success stories for antiretroviral therapy. The success of
zidovudine will magnify if long-term ill effects do not
surface, and if results are equally good in other subgroups
of pregnant women with HIV. --AS Brett.
   Citation: Connor EM; et al. Reduction of maternal-infant
transmission of human immunodeficiency virus type 1 with
zidovudine treatment. N Engl J Med 1994 Nov 3; 331:1173-80.

CHOLESTEROL IS NOT A RISK FACTOR FOR CHD IN THE
ELDERLY.
   Widespread public education programs to encourage
cholesterol screening do not generally issue different
recommendations for different age groups. However, this
prospective cohort study found that cholesterol levels do
not predict morbidity or mortality in the elderly.
   Researchers studied 997 people who had their cholesterol
levels measured as part of a longitudinal epidemiologic
program in New Haven, Conn., in 1988. The mean age was 79
years, and 15 percent of subjects had a history of
myocardial infarction. During the next four years, 24
percent of the subjects died, including 4 percent who died
from coronary heart disease. No association was found
between elevated total serum cholesterol and any outcome,
including myocardial infarction and unstable angina. In
fact, subjects with the lowest serum cholesterol tended to
have the *highest* rates of myocardial infarction or
unstable angina.
   Comment: These data strongly suggest that the importance
of cholesterol screening and treatment of high cholesterol
levels in the elderly has been overemphasized. The study
reminds us that cholesterol interventions in the elderly
remain of unproven benefit. --TH Lee.
   Citation: Krumholz HM; et al. Lack of association between
cholesterol and coronary heart disease mortality and morbidity
and all-cause mortality in persons older than 70 years. JAMA 1994
Nov 2; 272:1335-40.