Pharmacy & Therapeutics - February 2008 - (Page 88)

NEW DRUGS betic and nondiabetic patients with nonischemic findings had lower rates of major events each year, compared with the overall population of diabetic and nondiabetic patients with positive exercise ECG results. Over a median of 26 months of followup, 34 diabetic patients and 124 nondiabetic patients died or had MIs or late revascularizations. Independent predictors were age, diabetes, and ischemia at stress echocardiography. At five years, 24% of patients with ischemia and 4% of those without ischemia experienced MI or died; 46% of those with ischemia and 7% of those without experienced major events. Antianginal therapy at the time of testing was associated with an increased risk of major events in all patients. In particular, the annual rate of major events was more than three times higher in diabetic patients and more than twice as high in nondiabetic patients with a non-ischemic test result during therapy, compared with patients not receiving therapy. For both groups of patients, a nonischemic test result predicted an uneventful six-month period and a 2% rate for a major event at one year. As expected, diabetes was a strong multi variable predictor; thus, non-ischemic stress test results had less prognostic value in those patients. Angiography seemed to be appropriate for diabetic and nondiabetic patients with ischemia at stress echocardiography. Conversely, a conservative strategy based on adequate treatment of risk factors and periodic assessment with stress testing was considered appropriate in patients without ischemia who were not taking antianginal therapy. More frequent noninvasive evaluation is advised for diabetic patients after the first year of follow-up. (Source: Am J Cardiol 2007;100:1744– 1749.) DRUG NEWS calcium-channel blockers for those with metabolic syndrome. The results also support the use of diuretics for initial blood pressure-lowering therapy in African-Americans with the syndrome. ALLHAT compared a diuretic (chlorthalidone) with three newer classes of medications to treat high blood pressure: a calcium-channel blocker (amlodipine besylate [Nor vasc, Pfizer]), an alphablocker (doxazosin mesylate [Cardura, Roerig/Pfizer]), and an ACE-inhibitor (lisinopril [Zestril, AstraZeneca]). Even among patients with metabolic syndrome, and for both black and non-black participants, the less costly diuretics control blood pressure consistently and were equally beneficial in preventing heart attack and coronary heart disease death. They are also more beneficial than newer drugs in preventing cardiovascular disease, including heart failure and stroke. In 2002, the study had reported that diuretics were the most beneficial of the drug classes for hypertension and for protecting against adverse cardiovascular outcomes. (Sources: Arch Intern Med, January 28, 2008; Diabetes Care, February 2008; www.nhlbi.nih.gov.) Does C-peptide Prevent Diabetes Complications? A compound formed during insulin production—and once dismissed as irrelevant in diabetes—might be a key factor in preventing the complications that make type-1 diabetes such a serious disease. Scientists previously believed that the compound, called C-peptide, had little biological activity and was a useless byproduct of insulin production. More recently, however, they have observed beneficial effects of C-peptide in patients with type-1 diabetes, including improved kidney function, ner ve function, and blood flow. New laboratory research suggests that C-peptide might enhance the ability of red blood cells to use glucose. According to the American Chemical Society, type-1 diabetes afflicts about 800,000 people in the U.S. alone and sharply raises the risk of heart attacks, vision loss, and kidney failure. (Source: Chem Eng News, January 14, 2008, http://pubs.acs.org/cen/science/ 86/8602sci1.html.) Diuretics Still Best For Hypertension In Metabolic Syndrome In a new study of patients with high blood pressure as part of the metabolic syndrome, diuretics offer greater protection against cardiovascular disease, including heart failure, and are at least as effective for lowering blood pressure as newer, more expensive medications. People with metabolic syndrome have three or more risk factors for heart disease, including elevated blood pressure, low HDL levels, and diabetes or pre-diabetes. These findings, from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), run counter to current practices that favor angiotensin-converting enzyme (ACE)–inhibitors, alpha-blockers, and Breast Cancer Risk: Lower Than Thought? The risk of breast cancer varies widely in women with BRCA1 and BRCA2 genetic mutations, according to a study sponsored by the National Cancer Institute. Women with certain gene mutations might be at a lower risk than previously believed. Researchers from Memorial SloanKettering Cancer Center suggested that there is no single risk associated with BRCA1 or BRCA2 carrier status. Previous studies had reported on the overall increased risk of breast cancer among women with BRCA1 and BRCA2 gene mutations, but they had not focused on 88 P&T® • February 2008 • Vol. 33 No. 2 http://pubs.acs.org/cen/science/86/8602sci1.html http://pubs.acs.org/cen/science/86/8602sci1.html http://www.nhlbi.nih.gov

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - February 2008

Pharmacy & Therapeutics - February 2008 Contents Editorial Medication Errors Prescription: Washington The Language of (Forgive Us) Change, As P&T Enters the Digital Age New Drugs/Drug News/New Medical Devices Drug Forecast Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience American Society of Hematology, 49th Annual Meeting Pharmaceutical Approval Update

Pharmacy & Therapeutics - February 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.