STUDY:

JOURNAL: Arch Intern Med. 2003;163:59-64

AUTHORS: Susanne Oksbjerg Dalton

ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of gastrointestinal (GI) bleeding, especially when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), according to the results of a population-based cohort study published in the Jan. 13 issue of the Archives of Internal Medicine.

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COMMENTARY: "Serotonin is thought to play an important role in hemostasis, mainly through an enhancing effect on adenosine diphosphate and thrombin," write Susanne Oksbjerg Dalton, MD, from the Institute of Cancer Epidemiology at the Danish Cancer Society in Copenhagen, and colleagues.

"The SSRIs in therapeutic doses consistently deplete serotonin after several weeks of treatment."

Using the Pharmaco-Epidemiologic Prescription Database of North Jutland, Denmark, the investigators identified 26,005 users of antidepressants in that county from January 1, 1991, to December 31, 1995. Data from the Hospital Discharge Register allowed comparisons of hospitalizations for upper GI bleeding among users of antidepressant medications and among those who did not receive prescriptions for antidepressants.

During periods of SSRI use without use of other drugs increasing risk of upper GI bleeding, there were 55 episodes of upper GI bleeding. The risk was 3.6 times that of nonusers of antidepressants (95% confidence interval [CI], 2.7 - 4.7), corresponding to a rate difference of 3.1 per 1,000 treatment years. With concurrent use of SSRIs and NSAIDs, the risk ratio was 12.2 (95% CI, 7.1 - 19.5), and with SSRIs and low-dose aspirin, it was 5.2 (95% CI, 3.2 - 8.0).

With use of non-SSRIs, the risk ratio for upper GI bleeding was 2.3 (95% CI, 1.5 - 3.4).

Antidepressants not known to affect the serotonin receptor had no significant effect on the risk of upper GI bleeding. After discontinuation of SSRIs, the risk of upper GI bleeding returned to normal. However, users of non-SSRIs had increased risks of GI bleeding even after discontinuing the drug.



"SSRIs increase the risk of upper GI bleeding, and this effect is potentiated by concurrent use of NSAIDs or low-dose aspirin, whereas an increased risk of upper GI bleeding could not be attributed to other types of antidepressants," the authors write.

"We interpret the increase in risk of upper GI bleeding in users of non-SSRIs cautiously because of the similarity of the risk estimates between periods of current and former use in these persons. However, more studies of the association between antidepressant drugs and upper GI bleeding are clearly warranted owing to the high prevalence of use of these drugs, resulting in an appreciable absolute risk and, thus, considerable public health implications."

STUDY:

JOURNAL: JAMA 2003;289:323-330.

AUTHORS: Dr. Anne McTiernan

ABSTRACT: In a recent study, postmenopausal women who began an exercise program of brisk walking or cycling lowered levels of abdominal fat by about 6% and lost weight, regardless of body weight or age. Not surprisingly, the most active women lost the most body fat and the most weight.

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COMMENTARY: In contrast, women who performed only daily stretching exercises actually experienced a slight increase in intra-abdominal fat and weight after 1 year, researchers report in the January 15th issue of the Journal of the American Medical Association.

The study has implications for the soaring rates of obesity in the US. Nearly two thirds of the adult population are now considered overweight or obese.

In the current study, Dr. Anne McTiernan from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues assessed the outcomes of 168 sedentary women, between 50 and 70 years of age, who were randomized to perform moderate-intensity exercises or stretching. All of the women had a body mass index over 25.

The exercisers walked on a treadmill or cycled on a stationery bicycle for at least 45 minutes, 5 days a week, for 1 year. Weight training was recommended but not required. Women in the control group performed a series of stretching exercises 1 day a week for the year.

The most active women, or those who exercised more than 3 hours and 15 minutes a week, lost about 7% of intra-abdominal fat, compared with a loss of 6% among intermediate exercisers, as measured by CT scan.

Those who exercised less than 2 hours and 15 minutes a week lost 3.4% of their intra-abdominal fat, while women in the control group gained 0.1% intra-abdominal fat, the study found.

Body weight decreased by an average of 1.3 kg in the exercise group, while body weight rose slightly in the control group.

STUDY: Vit A and Weak Bones

JOURNAL: N Engl J Med 2003;348:287-294,347-349.

AUTHORS: Dr. Karl Michaelsson

ABSTRACT: High serum retinol levels are associated with an increased risk of fracture in men.

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COMMENTARY: The findings suggest that vitamin A levels in fortified foods and vitamin supplements may need to be reassessed since they are a major contributor to serum retinol levels, the study authors note.

Dr. Karl Michaelsson of University Hospital in Uppsala, Sweden and colleagues, studied 2322 men, between 49 and 51 years of age, who were followed for 30 years.

The researchers found that men with the highest serum retinol levels were 1.64 and 2.47 times more likely to sustain any fracture and a hip fracture, respectively, than their peers with lower levels.

In contrast, levels of beta-carotene, a precursor to vitamin A, were not associated with fracture risk.

These findings are in agreement with those from animal and epidemiologic studies, which first suggested that that vitamin A may inhibit new bone formation and increase the risk of fractures.

In the study, men with the highest fracture risk had more than 75.62 micrograms/dL of retinol in their blood samples at the start of the study. During the study period, 266 men sustained fractures.

In an accompanying editorial, Dr. Paul Lips, from Vrije Universiteit Medical Center in Amsterdam, the Netherlands, comments that "vitamin A supplementation and fortification of food with vitamin A may be harmful in Western countries, where the life expectancy is high and the prevalence for osteoporosis is increasing."

I always use beta carotene with my patients as this is the safe alternative to Vit A. The study showed not correlation between beta carotene and fracture.

Just don't use high doses of pure vitamin A.

STUDY: One electric toothbrush tops study

JOURNAL: Cochrane Collaboration’s Oral Health report

AUTHORS: William Shaw

ABSTRACT: Only one type of electric toothbrush clearly does a better job of cleaning teeth than the old-fashioned manual kind, according to the first comprehensive attempt to evaluate the devices used by an estimated 55 million Americans.

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COMMENTARY: ELECTRIC BRUSHES with bristles that spin in both directions are the sole kind offering sufficient proof of any advantage over regular toothbrushes, according to the report from the Cochrane Collaboration, an independent nonprofit group based in Oxford, England, that evaluates medical practices.

“The others were not worse, but they were just not any better” than manual brushes, said William Shaw, a professor of orthodontics at the University of Manchester in England, who helped coordinate the report of the Cochrane Collaboration’s Oral Health report.

To evaluate electric toothbrushes, six reviewers combed through every published study on the devices and asked manufacturers for any unpublished results they had. The team then combined 29 studies it considered to be well designed, yielding data involving 2,547 people in North America, Europe and Israel.

BRAUN ORAL-B TOPS STUDY

Of five types of brushes examined, only the “rotational oscillation” design of the Braun Oral-B device was clearly more effective than manual toothbrushes, the researchers concluded. Compared to manual brushes, that design removed about 11 percent more of the build-up on teeth known as plaque, and reduced by about 17 percent the development of gum disease, or gingivitis. None of the other brushes evaluated — the Philips Sonicare, the Interplak, the Teledyne Aqua Tech, the Ultrasonex, the Rowenta Dentiphant and the Rowenta Plaque Dentacontrol Plus — performed better than manual brushes, Shaw said. Michele Szynal, a spokeswoman for Gillette Co., which makes the Braun Oral-B, said the company is “thrilled” by the findings. “This basically confirms four decades of our own research,” she said.

The Braun product is the choice of 41 percent of Americans who use electric toothbrushes, according to Gillette.

STUDY: Survey finds a majority continuing hormone therapy

JOURNAL: Express Scripts

AUTHORS:

ABSTRACT: More than half of women taking hormone replacement therapy stuck with it last year despite reports that show it can raise the risk of heart disease, cancer and stroke, a new survey found.

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COMMENTARY: Studies released over the summer indicated significant health risks associated with HRT, 36 percent of women stopped their treatments, the survey by pharmacy benefit manager Express Scripts found.

But 57 percent continued using HRT, the St. Louis-based company found. And even though the studies found no extra risk for women taking estrogen alone, 22.6 percent of those surveyed stopped taking an estrogen product, Express Scripts said.

For its report, Express Scripts surveyed a sample of 372,777 women who used HRT or osteoporosis drugs. The company compared use patterns last year before and after the announcement, and during similar periods in 2001.

The Food and Drug Administration strengthened warning labels on all women’s hormone replacement therapy products to take account of last year’s findings.

An estimated 10 million women were taking HRT at the time last year’s reports were released.

The risk to an individual woman is small, but accumulates when many women take the drugs over time. The FDA says the overall risks to women outweigh the benefits of the drugs, but recommends that each woman consult with her doctor about what to do.

The studies used only Wyeth’s PremPro and related products, but the FDA said there was no reason to believe that other HRT products would not have similar effects.

HRT was, until last year, widely prescribed to treat not only the immediate symptoms of menopause such as hot flashes, but also to prevent heart disease and osteoporosis.