SCHIZOPHRENIA

Clozapine may reduce suicidal behavior more than olanzapine.

* THE QUESTION Is the drug clozapine more effective in helping to prevent suicide than olanzapine, which is also used for this purpose?

* PAST STUDIES have shown that people with schizophrenia or related disorders who take the clozapine (Clozaril), an atypical anti-psychotic drug, may have lower rates of attempted suicide than people who receive drugs classified as typical anti-psychotics. About half of all schizophrenics try to commit suicide at least once, and about 10 percent die as a result of these attempts.

* THIS STUDY randomly assigned 980 schizophrenia patients who were considered to be at particularly high risk for suicide to take either clozapine or another atypical drug, olanzapine (Zyprexa or Zydis), for two years. Those in the clozapine group had a 24 percent lower risk of suicidal behavior than those taking olanzapine. These behaviors included suicide attempts, hospitalization to prevent suicide and worsening of suicidal thoughts. Few patients in either group (five who were taking clozapine and three who were using olanzapine) committed suicide during the study period.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with schizophrenia.

* CAVEATS Novartis Pharmaceuticals, the manufacturer of Clozaril, partially funded the study.

* BOTTOM LINE People with schizophrenia or their caregivers may wish the consult the patient's physician about using clozapine. They should be aware, however, that this medication can have serious side effects such as blood disorders or swelling of the heart muscle. In addition, both clozapine and olanzapine may cause seizures.

* FIND THIS STUDY January issue of the Archives of General Psychiatry; abstract online at http://archpsyc.ama-assn.org/.

DIABETES

Blood pressure drugs may aid diabetics with clogged arteries.

* THE QUESTION Does intensive blood pressure treatment have any effect on the risk of serious heart problems and stroke in diabetics with clogged leg arteries ?

* PAST STUDIES have shown that peripheral artery disease (PAD), where fatty deposits clog leg and foot arteries, signals heart disease and may lead to heart complications or stroke. People with diabetes have an elevated risk of PAD.

* THIS STUDY compared the risk of heart complications, such as heart failure and heart attack, in people with type 2 diabetes and normal blood pressure who were randomly assigned to receive either a placebo or aggressive blood pressure treatment for five years. Thirty-one participants in the placebo group had PAD, as did 22 in the treatment group. About 14 percent of the PAD patients who received blood pressure treatment had heart complications, compared with about 39 percent of those who took the placebo. This risk reduction was evident even in cases where the treatments did not restore normal blood flow to the patients' legs.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Diabetics with clogged leg arteries, even if they have normal blood pressure.

* CAVEATS Bayer Pharmaceutical Co., a manufacturer of blood pressure drugs, partially funded the study. In addition, the results need to be verified in a larger group of people.

* BOTTOM LINE Diabetics with PAD may wish to consult their physician about aggressive blood pressure treatment.

* FIND THIS STUDY Jan. 20 issue of the rapid access edition of Circulation; abstract online at http://circ.ahajournals.org/rapidaccess.shtml.

-- Haleh V. Samiei