IMMEDIATE STATIN TREATMENT AFTER MI
Reductions in one-year mortality shown.
Studies have shown that initiating treatment with a statin drug-which reduces cholesterol-three to six months after a heart attack reduces the risk of subsequent coronary events and mortality. Now a group of Swedish researchers has found that starting a statin drug before or at hospital discharge after acute myocardial infarction (AMI) significantly reduces the risk of death occuring within one year.
More than 19,000 survivors of a first AMI were enrolled at 58 coronary care units between 1995 and 1998 and followed after discharge. At one year, the mortality rate was 9.3% in the group that didn't receive a statin drug before or at discharge, compared with 4% in the group that did. In the subgroup of 60-to-69-year-olds, the risk of one-year mortality was cut in half among those who started the statin drug at discharge. This reduction in mortality subsisted even after adjustments for sex, presence of diabetes mellitus, presence of congestive heart failure, and concomitant medications.
The authors recommend initiating statin treatment before or at the time of hospital discharge in all survivors of a first MI whose cholesterol levels fall within the guidelines for initiating statin treatment as secondary prevention.
Stenestrand U, et al. JAMA 2001;285(4):430-6.
GLYBURIDE IN GESTATIONAL DIABETES
As safe and effective as insulin.
The administration of insulin during pregnancy can be inconvenient and expensive. Sulfonylureas, however, have long been contraindicated in pregnancy, since earlier generations of sulfonylureas were found to cause severe neonatal hypoglycemia. Glyburide, in contrast to older sulfonylureas, doesn't cross the placenta in appreciable quantities but its safety and efficacy have never been studied in pregnant women. But a recent study has shown that glyburide may safely be used instead of insulin in pregnant women who develop gestational diabetes.
Four hundred women with gestational diabetes were randomly assigned to receive either oral glyburide or subcutaneous insulin. Researchers found a comparable degree of glycemic control among the two groups, including comparable glycosylated hemoglobin values, over the course of treatment. Only eight women assigned to take glyburide switched to insulin because of inadequate control.
Perinatal outcomes were also comparable in the two groups. There were no significant differences between the two groups in the incidence of cesarean delivery, macrosomia, or neonatal hypoglycemia. Glyburide was not detected in the cord serum of any infant.
Langer O, et al. N Engl J Med 2000;343(16):1134-8.
ANTIDEPRESSANTS AND ANTICONVULSANTS
Equally effective for neuropathic pain.
Both antidepressants and anticonvulsants have been used for several decades for managing neuropathic pain, but which drug class should be administered as first-line therapy has never been determined. In a recent study, researchers in the United Kingdom who set out to answer this question found that they are nearly equally safe and effective.
They systematically reviewed all randomized, double-blind, placebo-controlled studies involving the use of antidepressants or anticonvulsants to treat diabetic neuropathy or postherpetic neuralgia. There was no evidence that either drug class was more effective than the other. Both tricyclic antidepressants and anticonvulsants (phenytoin, gabapentin, and carbamazepine) had an analgesic efficacy statistically superior to placebo. (The few trials involving selective serotonin reuptake inhibitors, however, showed no significant benefit compared with placebo.)
There was little difference in the incidence of adverse effects in either of the two medication classes, compared with placebo. However, because of adverse effects patients were more likely to discontinue taking antidepressants than anticonvulsants.
Collins SL, et al. J Pain Symptom Manage 2000;20(6):449-58.
BRIEFLY
An angiotensin-converting enzyme inhibitor may be effective in the prevention of migraine, according to a randomized trial published in the January 6 issue of the British Medical Journal. Lisinopril, an antihypertensive medication, was shown in a 12-week trial to reduce the number of hours with headache, number of days with headache, number of days with migraine, and headache severity, while improving quality of life, in patients suffering migraine attacks two to six times a month.
Ginkgo biloba, reputed to be beneficial for symptoms of cerebral insufficiency including memory disturbances and tinnitus, was shown to confer no beneficial effect on the latter condition. The results of the randomized, placebo-controlled trial, which enrolled more than 1,000 people, were published in the January 13 issue of British Medical Journal.