December 22, 2009 — Postmenopausal women taking either a tricyclic antidepressant (TCA) or a selective serotonin-reuptake inhibitor (SSRI) appear to be at increased risk for all-cause mortality, and SSRI users seem to be at increased risk for hemorrhagic and fatal stroke, although the absolute event risks are low, according to an analysis from the Women's Health Initiative (WHI) study.
In an article published in the December issue of the Archives of Internal Medicine, Jordan Smoller, MD, from Massachusetts General Hospital, Boston, and colleagues report that new use of either a TCA or an SSRI during a mean follow-up of 5.9 years was not significantly associated with an increased risk for coronary heart disease (CHD) in this large prospective cohort of postmenopausal women.
In contrast, compared with women who did not use antidepressants, "those using SSRIs had a 45% increased relative risk of incidence stroke and a 32% increased risk of death in models stratified on propensity and adjusted for multiple covariates," the investigators report. TCA use in turn was associated with a 67% higher relative risk for all-cause death (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.33 - 2.09). The TCAs also increase stroke risk, but not significantly so.
Sunday, December 5, 2010
Friday, December 3, 2010
Glycated Hemoglobin Better Than Fasting Glucose for Predicting Cardiovascular Risk
Glycated hemoglobin levels, especially above 6.0%, are better than fasting glucose for predicting long-term cardiovascular risk, the New England Journal of Medicine reports.
Researchers measured glycated hemoglobin and fasting glucose in some 11,000 adults without diabetes or cardiovascular disease and followed them for a median of 14 years. Compared with hemoglobin levels of 5.0% to 5.5%, higher values — especially above 6% — were associated with significantly increased risks for diabetes, coronary heart disease, and stroke. Associations between hemoglobin and all-cause mortality were also significant, but formed a J-shaped curve, with the lowest and highest levels being predictive of death.
These findings held true even after adjustment for fasting glucose.
The authors say their findings "may add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes."
Researchers measured glycated hemoglobin and fasting glucose in some 11,000 adults without diabetes or cardiovascular disease and followed them for a median of 14 years. Compared with hemoglobin levels of 5.0% to 5.5%, higher values — especially above 6% — were associated with significantly increased risks for diabetes, coronary heart disease, and stroke. Associations between hemoglobin and all-cause mortality were also significant, but formed a J-shaped curve, with the lowest and highest levels being predictive of death.
These findings held true even after adjustment for fasting glucose.
The authors say their findings "may add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes."
Association Found Between Vitamin E Supplements and Hemorrhagic Stroke
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."
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."
Friday, November 19, 2010
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."
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.
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.
Thursday, November 18, 2010
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."
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."
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