January 2010

Medical-Intelligence

A Periodic Review of Selected Medical Research
by Marc D. Schwartz, MD
MarcDSchwartzMD@GMail.com

Table of Contents
More Questions about the Value of Daily Aspirin
A Promising New Weight Loss Medication
Antibiotics to Avoid During Pregnancy
Yet Another Benefit of Taking Statins
Best Treatment of a Pain in the Neck
Zetia and Vytorin May Be Less Than Helpful
Pleeeze Take Your Hypertension Medication
High Dose Vitamin D Prevents Falls in Seniors
Folic Acid May Be Dangerous to Your Health

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More Questions about the Value of Daily Aspirin
We previously reported that a very large scale study that compiled all the major aspirin studies through 2008 found that the problems caused by the regimen slightly outweighed the advantages. In particular, the increase in brain hemorrhages in people taking daily aspirin was slightly greater than the decrease in brain clots.

Now a study of diabetics found that aspirin was no better than a placebo in reducing the risk for major cardiovascular events (heart attack, stroke, or death) in women though it was somewhat beneficial to men. (http://dx.doi.org/10.1136/bmj.bj4596)

A Promising New Weight Loss Medication
A new weight loss medication brought about an average weight loss of 5% in five months in over 500 obese people. This was twice the loss found with a placebo and was significantly greater that achieved with Orlistat. A closely related drug, Exenetide (brand name Byetta), is available in the US. It may be a useful adjunct to diet and exercise for overweight people. - Lancet Nov 2009

Antibiotics to Avoid During Pregnancy
With your permission, I will spare you the study details. The following medications appear to be safe during pregnancy: penicillin, erythromycin, and cephalosporin. Sulfonamides and nitrofurantoins appear to be associated with birth defects and should be avoided if possible. Quinolones are not recommended for use during pregnancy. Arch Pediatr Adolescent Med Nov 2009

Yet Another Benefit of Taking Statins
Statins were recently shown to reduce the incidence of gall stones. (They may also strengthen bones, reduce the risk of dementia and stroke, delay the onset of diabetes plus, of course, they do reduce the risk of heart attack.) - JAMA Nov 2009

A Pain in the Neck
A six week study compared the effects of three treatments on neck pain radiating into the arm: 1) a semi-hard neck collar and neck rest for 3 weeks, 2) physical therapy two or three times a week, and 3) daily activities without specific treatment. The neck collar and rest resulted in significantly less disability at six weeks than the other two approaches. At six months, there were no significant differences in pain scores over the three groups. -Brit Med J Oct 2009

Zetia and Vytorin May Be Less Than Helpful
While Zetia (ezetimibe) is used by itself or as an ingredient of Vytorin to lower LDL cholesterol. Research has failed to demonstrate that this translates into any patient benefit. (Do we need health care reform or what!) A recent study showed that, on the contrary, it caused an unhealthy thickening of the walls or the carotid artery, which serves the brain. The Journal Watch editors suggest that is should be used as "a drug of last resort if at all."

Pleeeze Take Your Hypertension Medication
It may be a bore to take anti-hypertensive medication day after day. However, in a study of 19,000 hypertensive patients, those who were highly treatment adherent to prescribed treatment had only a little more than half the number of cardiovascular events (heart attack, stroke, etc) as those who were poorly adherent. - Circulation Oct 2009

High Dose Vitamin D Prevents Falls in Seniors
Eight studies have found that high daily doses of Vitamin D2 or D3 (700 - 1000 IU, available in drug stores) lowered the risk of falling in those over 70 years of age by 20%, probably by increasing muscle strength and balance. The risk was lowered only among patients whose serum Vitamin D3 level was over nmol/liter with treatment. Doses lower than 700 mg had no effect. - Brit Med J Oct 2009

Folic Acid May Be Dangerous to Your Health
Not all supplemental vitamins are healthy for you. Half of 7,000 middle aged patients were randomized to get folic acid or not each day for six and a half years. The risk of dying among those taking folic acid was 18% higher than those who did not take it. This study supports the concern about daily folic acid supplements generated by previous studies that found it increased the risk of prostate cancer. - JAMA Nov 2009

"See, I told you Mabel. Four drinks a day make my brain really sharp."
A recent study suggests that people over 60 who consume moderate amounts of alcohol have a reduced risk for Alzheimer's disease and other dementias. In an article published in the July 2009 issue of the American Journal of Geriatric Psychiatry, researchers reviewed 15 studies that together followed more than 28,000 subjects for at least two years. The studies defined light to moderate drinking as one to 28 drinks per week (sic) . That's up to four a day! (hic)

Compared with abstainers, male drinkers reduced their risk for dementia by 45 percent, and women by 27 percent. If true, this is pretty exciting news, but two years seems to me to be a pretty short period of time to study the progression of dementia, and calling people who average four drinks a day moderate drinkers seems a bit loose, some might say enabling.

The real downside of this news is that it might turn drinking into a virtue, thereby subverting some of its pleasure.