vitamin e ups/downs hemorrhagic/ischemic strokes for a wash

Vitamin E supplements have no effect on overall stroke incidence, but when stroke type is examined, the supplements significantly increase risk for hemorrhagic stroke, according to a BMJ meta-analysis.


Researchers examined data from nine trials encompassing some 120,000 subjects who'd been randomized to receive vitamin E or placebo and were followed for more than 1 year. Rates of stroke overall did not differ between groups. However, when the type of stroke was examined, ischemic strokes were significantly fewer among the vitamin recipients, while hemorrhagic strokes were significantly increased — by some 20%.


The authors say that the contrasting effects have tended to obscure vitamin E's hemorrhagic risks. They write that the mechanism behind the effect is unknown and that it may stem from vitamin E's interference with a vitamin-K-dependent clotting factor. They conclude that "indiscriminate widespread use of vitamin E should be cautioned against."

Cymbalta Approved for Chronic Musculoskeletal Pain

The FDA has approved the use of duloxetine (Cymbalta), a non-narcotic, to treat chronic musculoskeletal pain, including low back pain and osteoarthritis, the agency announced on Thursday.


The drug was previously approved as maintenance therapy in major depression and to treat generalized anxiety disorder, diabetic peripheral neuropathy, and fibromyalgia. The manufacturer says it is uncertain how duloxetine relieves pain, but it is believed to increase activity of serotonin and norepinephrine in the central nervous system.


Duloxetine's label includes a warning about the risk for increased suicidality among children, adolescents, and young adults.

Featured in Journal Watch: Nothing to Cough About — A Treatment for Involuntary Laughing and Crying

Dextromethorphan with quinidine appears safe and effective for a syndrome seen in neurological disorders.

Anacetrapib predecessor is torcetrapib

Anacetrapib, a cholesteryl ester transfer protein inhibitor, had "robust effects" on LDL and HDL cholesterol levels in an industry-funded, phase III study presented Wednesday at the American Heart Association meeting and published in the New England Journal of Medicine.


Some 1600 adults who were already taking statins were randomized to receive 100 mg of anacetrapib or placebo daily for 18 months. At 6 months, the mean LDL level had dropped from 81 to 45 mg/dL with anacetrapib, compared with a drop from 82 to 77 mg/dL with placebo. Similarly, mean HDL increased significantly more with the drug (from 41 to 101 mg/dL) than with placebo (40 to 46 mg/dL).


Throughout treatment, the groups did not differ in cardiovascular events or in blood pressure, electrolyte, or aldosterone levels (such side effects kept anacetrapib's predecessor, torcetrapib, from reaching the market).


The authors call for a larger clinical trial, noting that this study "is too small to provide definitive results regarding the overall safety or efficacy of anacetrapib."