Family Medicine News
Calcium Builds Bones But May Weaken Heart
Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.
Placebo Effects and the Common Cold: A Randomized Controlled Trial
The authors of this article wanted to determine whether the severity and duration of illness caused by the common cold are influenced by randomized assignment to open-label pills, compared with conventional double-blind allocation to active and placebo pills, compared with no pills at all. undertook a randomized controlled trial among a population with new-onset common cold. Study participants were allocated to 4 parallel groups: (1) those receiving no pills, (2) those blinded to placebo, (3) those blinded to echinacea, and (4) those given open-label echinacea. Primary outcomes were illness duration and area-under-the-curve global severity. Secondary outcomes included neutrophil count and interleukin 8 levels from nasal wash at intake and 2 days later.
Overall participants randomized to the no-pill group tended to have longer and more severe illnesses than those who received pills. For the subgroup who believed in echinacea and received pills, illnesses were substantively shorter and less severe, regardless of whether the pills contained echinacea. These findings support the general idea that beliefs and feelings about treatments may be important and perhaps should be taken into consideration when making medical decisions.
An alternative to oral NSAIDs for acute musculoskeletal injuries
A 47-year-old man limps into your office complaining of ankle pain. The patient is well known to you and has a long history of dyspepsia, which is aggravated when he takes any oral nonsteroidal anti-inflammatory drug (NSAID). He injured his ankle while playing basketball. You diagnose acute ankle sprain. Would a topical NSAID be a safe option for pain relief for this patient?
Antihypertensive Efficacy of Hydrochlorothiazide as Evaluated by Ambulatory Blood Pressure Monitoring
The purpose of this study was to evaluate the antihypertensive efficacy of hydrochlorothiazide (HCTZ) by ambulatory blood pressure (BP) monitoring.
A systematic review was made using Medline, Cochrane, and Embase for all the randomized trials that assessed 24-h BP with HCTZ in comparison with other antihypertensive drugs. Fourteen studies of HCTZ dose 12.5 to 25 mg with 1,234 patients and 5 studies of HCTZ dose 50 mg with 229 patients fulfilled the inclusion criteria. The antihypertensive efficacy of HCTZ in its daily dose of 12.5 to 25 mg as measured in head-to-head studies by ambulatory BP measurement is consistently inferior to that of all other drug classes. Because outcome data at this dose are lacking, HCTZ is an inappropriate first-line drug for the treatment of hypertension.
Similar Outcomes With Hemodialysis and Peritoneal Dialysis in Patients With End-Stage Renal Disease
The annual payer costs for patients treated with peritoneal dialysis (PD) are lower than with hemodialysis (HD), but in 2007, only 7% of dialysis patients in the United States were treated with PD. Since 1996, there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved. This article found that there was a progressive attenuation in the higher risk for death seen in patients treated with PD in earlier cohorts; for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through 5 years of follow-up. The median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively. Analyses in 8 subgroups based on age (<65 and 
65 years), diabetic status, and baseline comorbidity (none and 1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods.
Concomitant use of proton pump inhibitors and clopidogrel:
What does the evidence really show?
Regulatory agencies, such as the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA), have notified clinicians and consumers through updated prescribing information about possible drug–drug interactions and drug-related adverse events associated with clopidogrel and proton pump inhibitors (PPIs). Clinicians are tasked with evaluating available evidence from clinical studies to determine the risk/benefit of prescribing medications for their patients. Recent data demonstrating that PPIs, specifically omeprazole, can pharmacologically interact with clopidogrel under certain experimental conditions1,2 have raised concerns as to whether this interaction reduces the clinical effect of clopidogrel, thereby putting patients at risk for a coronary event. However, data from retrospective database analyses and randomized, prospective clinical studies have provided conflicting evidence regarding the impact of PPIs on the clinical significance of this interaction.2 This eNewsletter reviews the existing data and clinical implications of study findings.
Spironolactone for difficult to control hypertension in chronic kidney disease
Spironolactone is effective at treating difficult to control hypertension in the general population, and it is unknown if it is safe or effective for those with chronic kidney disease (CKD) and difficult-to-control hypertension. In a retrospective cohort design, 88 patients with difficult-to-control hypertension study were assessed for blood pressure (BP) response to spironolactone as well as for biochemical changes. In the CKD group (34 patients), the average systolic BP (SBP) fell from 153 ± 18 to 143 ± 20 mm Hg (P = .006) compared with a fall in SBP from 150 ± 17 to 135 ± 17 mm Hg (P < .0001) in the non-CKD group (P < .0001). In 44% of those with CKD and 59% of those without CKD, SBP decreased by >10 mm Hg (defined as responders; P = .22). Potassium rose by 0.5 ± 0.6 mmol/L in the CKD group and 0.3 ± 0.5 mmol/L in the non-CKD group (P = .12). The overall incidence of hyperkalemia was 5.7% in the CKD group and 0% in the non-CKD group (P = .07). Spironolactone is associated with a significant fall in BP among those with CKD and difficult-to-control BP. It is associated with a modest rise in serum potassium, which is more pronounced among those with glomerular filtration rate below 45 mL/minute.
Fish health benefits may outweigh mercury concerns
It may be a red herring to worry over whether people who eat lots of fish may lose whatever heart benefits they might have gained because of an increased exposure to mercury, a new study shows. Rich in omega-3 fatty acids, fish is thought to rank high on the list of heart-healthy foods. But it has a potential dark side: many fish species that wind up on the plate have high levels of mercury, a known neurotoxin.
Drug Lowers Albumin in Diabetic Nephropathy
Patients with diabetic nephropathy had significant reductions in residual albuminuria when the endothelin antagonist atrasentan (Xinlay) was added to ACE inhibitor or angiotensin receptor blocker (ARB) therapy, data from a small placebo-controlled trial showed.
Half of patients treated with 0.75 mg of atrasentan had at least 40% reductions in albuminuria, and the urinary albumin-creatinine ratio declined by 42%. Both values were superior to placebo, according to a report here at the American Society of Nephrology.
Association Between Familial Atrial Fibrillation and Risk of New-Onset Atrial Fibrillation
Although the heritability of atrial fibrillation (AF) is established, the contribution of familial AF to predicting new-onset AF remains unknown. In this cohort, familial AF was associated with an increased risk of AF that was not attenuated by adjustment for AF risk factors including genetic variants. Assessment ofpremature familial AF was associated with a very slight increase in predictive accuracy compared with traditional risk factors.
Mild Asthma Often Over-Treated
Many people with seemingly mild asthma may be over-treated -- at a higher cost without any noticeable clinical benefit, according to a retrospective analysis reported here.
The analysis, based on medical and pharmacy claims for almost 8,500 asthma patients, showed that about two thirds of the patients were prescribed a combination of inhaled corticosteroids and long-acting beta-agonists, adding more than $1,00 to their drugstore bill, said Thomas Manley, BSPharm, of Medco Health Solutions in Franklin Lakes, NJ.
Only 34% of the patients were prescribed less expensive inhaled corticosteroids alone -- the recommended therapy for mild asthma, Manley reported at the annual meeting of the American College of Allergy, Asthma, and Immunology.
Topical Diclofenac a Safe Alternative to NSAIDs for High-Risk Patients With Knee Osteoarthritis
Topical diclofenac solution with the absorption enhancer dimethyl sulfoxide may represent an alternative to oral nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteoarthritis (OA) of the knee, especially in those at higher risk for serious gastrointestinal (GI) and cardiovascular side effects.
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