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Killing
H. Pylori Helps Prevent Gastrointestinal Bleeding in Patients
Taking Low-Dose Aspirin
Many people take low-dose aspirin on a daily basis to help prevent
heart attacks. Others take larger doses of stronger nonsteroidal antiinflammatory
drugs (NSAIDs), such as naproxen (Anaprox, Aleve, others), to relieve
musculoskeletal pain such as that caused by arthritis. When taken on
a regular basis, however, NSAIDs often cause ulcers and gastrointestinal
(GI) bleeding. Ulcers, which are raw, crater-like breaks in the mucosal
lining of the digestive tract, may also be caused by excess acid production
and a bacterium known as Helicobacter pylori (H. pylori).
In a study published in the New England Journal of Medicine,
researchers enrolled 400 patients with a history of GI bleeding who
were taking aspirin or other NSAIDs to prevent heart disease or to
control musculoskeletal pain. They set out to find whether eradicating H.
pylori infection reduces the risk of recurrent GI bleeding in these
patients. For six months, 250 patients were given an 80 mg "baby" aspirin
once per day, while the remaining 150 patients received 500 mg of naproxen
twice per day. Within each of the two groups, patients were randomly
assigned to take either a daily dose of omeprazole (Prilosec), an acid-suppressing
medication, or a one-week antibiotic treatment to eradicate H. pylori infection,
followed by placebo for the remainder of the trial.
The researchers found that in patients taking aspirin, those who were
treated for H. pylori had a 1.9% risk of GI bleeding while the
risk for those taking omeprazole was 0.9%. In other words, for patients
on low-dose aspirin, the treatments were almost equal.
The results were very different for patients taking naproxen. 19% of
the naproxen patients who had H. pylori treatment suffered from
recurrent bleeding. In contrast, only 4% of the omeprazole group did.
The study suggests that patients with a history of GI bleeding who
take low-dose aspirin to prevent heart attacks should be tested for H.
pylori infection and treated if the infection is found to be present.
Patients taking non-aspirin NSAIDs and who have experienced GI bleeding
are more likely to benefit from acid-suppressing therapy.
April 2001 Update
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Ipriflavone
Not Effective for Osteoporosis
For
years, estrogen replacement therapy was the drug of choice for treatment
of osteoporosis in postmenopausal women. But the potential risks of
HRT sent women searching for alternatives. One option was phytoestrogens — plant-based
compounds that bind to estrogen receptors in the body, presumably mimicking
the beneficial effects of estrogen without its potential risks. Of
the phytoestrogens, the most promising was ipriflavone, a synthetic
version of a naturally occurring isoflavone, a type of phytoestrogen.
But a well-designed study published in the March 21, 2001 Journal
of the American Medical Association refutes the positive results
of previous studies, demonstrating that ipriflavone does not prevent
bone loss or reduce the risk of fracture in postmenopausal women.
It also cautions that ipriflavone lowers levels of lymphocytes, an
effect that could make women more vulnerable to infection.
In the JAMA study, members of the Ipriflavone Multicenter
European Fracture Study Group assigned 474 postmenopausal white women
with low bone mass aged 45 to 75 to either 200 mg. of ipriflavone
taken three times per day or a placebo, for the three-year duration
of the trial.
At the end of the trial, the researchers found no significant difference
between the treatment groups in regard to bone mineral density measured
at the lumbar spine, total hip, and distal radius; in biochemical
markers of bone formation or bone resorption; or in the number of
vertebral fractures suffered by the women.
The major difference was that women treated with ipriflavone experienced
significant drops in their lymphocyte concentration. 13.2% of the
ipriflavone-treated women developed lymphocytopenia, a condition
defined as a total lymphocyte concentration below 500/µL. Of
these women, 52% returned to normal lymphocyte values within one
year of discontinuation of the drug; 81% returned to normal within
two years.
In reviewing their findings, the researchers cautioned against the
use of ipriflavone to treat osteoporosis.
Women throughout
much of the world have used ipriflavone since 1969 to treat osteoporosis.
More recently it has been sold over-the-counter in the United States
as Ostovone.
April 2001 Update
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Early
Cognitive Impairment Following Coronary Bypass May Predict Lasting
Cognitive Impairment
More than 500,000 coronary-artery bypass grafting (CABG) surgical
procedures are performed in the United States each year to bypass blood
around clogged arteries and improve the flow of blood and oxygen to the
heart. Advances in anesthesia, surgical procedure, and other areas have
made CABG a relatively safe procedure for an expanding group of heart
disease patients including older and other high-risk patients. But while
the risk of death after CABG has decreased, the risk of cognitive impairment
has not. Growing evidence suggests that many patients experience short-term
cognitive impairment after CABG.
A recent study in the New England Journal of Medicine confirmed
not only the high incidence but also the persistence of cognitive decline
following the procedure. It also showed that patients who exhibit signs
of cognitive decline immediately following surgery are more likely to
continue to suffer from cognitive decline at up to five years after surgery.
Researchers from Duke University Medical Center tested the cognitive
function of 261 patients before they underwent CABG surgery, and then
again before discharge from the hospital and at six weeks, six months,
and five years after the CABG procedure. 172 patients, whose average
age was 61, completed all of the follow-up.
The researchers found that the incidence of cognitive decline was 53%
at discharge, 36% at six weeks, 24% at six months, and 42% at five years.
The pattern demonstrated improvement of cognitive functioning within
the first six months, and then a decline between six months and five
years after surgery.
Even after controlling for age, education level, and baseline test score,
patients who experienced cognitive decline immediately following surgery
were at a significantly increased risk for long-term cognitive decline
and a reduced level of overall cognitive functioning.
It remains unclear why early, postsurgical cognitive decline is associated
with a greater risk of long-term cognitive decline.
April 2001 Update
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Sertraline
Effectively Treats Depression in Alzheimer's Patients
A large portion of the 4 million Americans with Alzheimer's disease
(AD)
— a progressive degenerative disease of the brain that results
in memory loss, impaired thinking, and personality change — also
suffer from major depression. This can make the already devastating
condition even more difficult, not only for patients, but also for
their caregivers. Until recently, the efficacy of antidepressants in
such patients was uncertain. Now, a study from The American Journal
of Psychiatry shows that sertraline (Zoloft) a type of antidepressant
known as a selective serotonin reuptake inhibitor (SSRI) is more effective
than placebo in reducing depression in patients with AD. This study
is the first to show both the efficacy and safety of an SSRI in treating
depression in patients with AD.
A team of researchers from the Johns Hopkins University School of Medicine
and the Copper Ridge Institute in Maryland selected 22 patients with
Alzheimer's disease who also met the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) criteria for having had a major
depressive episode. Over the course of the 12 week double-blind trial,
the scientists gave the patients, whose average age was 77, either
a placebo or up to 150 milligrams of sertraline per day. All patients
and caregivers received illness education, encouragement, and emotional
support every three weeks over the course of treatment.
The scientists found that AD patients who had been given sertraline
experienced significantly greater improvements in mood than patients
who received a placebo. In addition, the sertraline patients experienced
less decline than placebo patients in the participation of daily activities.
Side effects of the drug included tremor, restlessness, and gastrointestinal
complaints. But all were mild, and there was no significant difference
in side effects between the sertraline group and the placebo group.
April 2001 Update
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Warfarin
and Vaginal Cream Drug Interaction Warning
The Food and Drug Administration (FDA) has issued a warning stating that
women taking the prescription blood thinner warfarin (Coumadin) should
consult their doctor or pharmacist before using over-the-counter vaginal
creams containing the antifungal drug miconazole because of an increased
risk of bleeding or bruising. Miconazole is an active ingredient in many
over-the-counter creams and suppositories used to treat vaginal yeast
infections.
Doctors were already aware of adverse reactions between warfarin and
systemically administered miconazole. This warning urges women to beware
of creams and suppositories as well.
The warning was issued in response to two reports of abnormal blood clotting
tests in women taking the anticoagulant warfarin who used vaginal miconazole.
In addition to the abnormal blood-clotting test, one of the two women
also developed bruises, bleeding gums, and a nosebleed. Two journal articles
also warned of a possible interaction between warfarin and vaginal miconazole.
The FDA warning will appear on miconazole-containing product labels and
consumer brochures.
April 2001 Update
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