Beta blockers seem safe, even in the initial weeks of treatment.
* THE QUESTION Do beta blocker drugs endanger patients' lives before producing beneficial effects?
* PAST STUDIES have shown that patients taking beta blockers to treat chronic heart failure may initially experience a dangerous drop in blood pressure and salt retention that could worsen their condition in the short term. Most of these findings, however, come from uncontrolled studies.
* THIS STUDY examined the effects of the beta blocker drug carvedilol (Coreg) for about 10 months in patients with severe heart failure. The researchers randomly assigned 2,289 patients with symptoms of severe heart failure to two groups, which received either carvedilol or a placebo. Those who took carvedilol developed no more heart complications than those who took the placebo, and fewer of them died or needed hospitalization; even in the first eight weeks of treatment, participants in the drug group experienced no more adverse effects than those in the placebo group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with severe heart failure.
* CAVEATS Roche Pharmaceutical and GlaxoSmithKline, manufacturers of beta blockers, supported the study. In addition, the results may vary with other beta blockers or for patients with less severe heart failure.
* BOTTOM LINE People with severe heart failure may wish to consult their physician about starting beta blocker treatment at a low dose and gradually increasing to optimum safe levels.
* FIND THIS STUDY Feb. 12 issue of the Journal of the American Medical Association; abstract online at http://jama.ama-assn.org/.
For the elderly, ACE inhibitors may be preferable to diuretics.
* THE QUESTION How do ACE inhibitors and diuretics compare in reducing blood pressure and other heart problems in the elderly?
* PAST STUDIES have shown that controlling high blood pressure with diuretics, beta blockers or both may also reduce further heart problems. It is not clear, however, whether newer blood pressure medications called angiotensin-converting-enzyme (ACE) inhibitors have similar effects.
* THIS STUDY compared heart problems that developed over four years in 6,083 older people with high blood pressure but otherwise good health who were randomly assigned to receive either ACE inhibitors or diuretic agents. Both groups experienced similar reductions in blood pressure. Participants taking ACE inhibitors, however, had an 11 percent lower risk of heart problems or death than those taking diuretics. This risk reduction was especially evident in men.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with hypertension who are older than 65.
* CAVEATS The results may not apply to younger people or those with additional illnesses. In addition, the results may vary with different ACE inhibitors. Finally, patients often need a combination of drugs to lower blood pressure.
* BOTTOM LINE An accompanying editorial notes that another major study recently pointed to diuretics as a better treatment for hypertension than ACE inhibitors. Given the differences between these studies and the varying ways individuals react to drugs, people with hypertension may wish to consult their physician about all options.
* FIND THIS STUDY Feb. 13 issue of the New England Journal of Medicine; abstract online at www.nejm.org.
A "Western" diet may increase
a person's risk of colon cancer.
* THE QUESTION Is there an association between diet and colon cancer?
* PAST STUDIES have had inconsistent results on an association between colon cancer and specific nutrients or such foods as fruit, vegetables and fiber. Some researchers believe that studying overall dietary patterns may be more effective in identifying any such associations.
* THIS STUDY examined the risk of colon cancer over 12 years in 445 women who followed a so-called Western diet -- rich in red meat and refined grains -- and 445 women who followed a "prudent" diet -- rich in fruit and vegetables, fish, poultry and whole grains. The two groups' risks for colon cancer were not compared, but both groups were divided into five subsets of increasing adherence to the specific diet. Those who followed the Western diet most closely had 46 percent greater risk of colon cancer than those who followed it least closely. Those who followed the prudent diet most closely had a lower risk of colon cancer than those who followed it least closely, although this difference was not statistically significant.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women inclined toward a diet rich in processed and red meats, sweets and desserts, fries and refined grains.
* CAVEATS The results may not apply to men. In addition, the women self-reported their diets. Finally, the results are not based on a randomized trial.
* BOTTOM LINE Women may lower their risk of colon cancer by limiting their consumption of such foods as red meat and refined grains.
* FIND THIS STUDY Feb. 10 issue of the Archives of Internal Medicine; abstract online at http://archinte.ama-assn.org/.
-- Haleh V. Samiei