HEART DISEASE

A blood pressure drug may

reduce the risk of heart failure.

* THE QUESTION Does ramipril have benefits beyond blood pressure control?

* PAST STUDIES have shown that ramipril (Altace), an ACE inhibitor that is used to lower blood pressure, can reduce the risk of death from heart failure in people who have had heart attacks.

* THIS STUDY examined whether the benefits of ramipril extend to a broader group of people with such risk factors for heart failure as hypertension, diabetes and a previous heart attack. The researchers randomly assigned more than 9,000 participants to receive either 10 milligrams of ramipril or a placebo each day. Over the study period of about five years, those taking ramipril had a 22 percent lower rate of heart failure than those taking placebo.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with risk factors for heart failure.

* CAVEATS King Pharmaceuticals, the manufacturer of ramipril, partially funded the study.

* BOTTOM LINE People at elevated risk of heart failure may wish to consult their physician about using ramipril.

* FIND THIS STUDY Feb. 24 issue of rapid access Circulation; abstract online at http://circ.ahajournals.org/rapidaccess.shtml.

DEPRESSION

Long-term antidepressant use may help prevent relapse.

* THE QUESTION Is there a limit to how long antidepressants should be used?

* PAST STUDIES have shown that antidepressants can reduce symptoms of severe depression, but treatment guidelines direct that these drugs should generally not be used for more than four to nine months.

* THIS STUDY compared the risk of relapse in 4,410 patients from 31 trials who had taken antidepressants for a short period and were randomly assigned to either continue taking the medication for at least one year or switch to placebo. Patients who were switched to placebo had more than twice the risk of relapse during that year as those who continued taking antidepressants (41 percent vs. 18 percent).

* WHO MAY BE AFFECTED BY THESE FINDINGS? People whose depression recurred after they stopped taking medication for the condition.

* CAVEATS These findings are based on the results of different studies with different medications taken for different durations. Also, extended use of drugs carries some risk of side effects.

* BOTTOM LINE People taking antidepressants may wish to consult their physician about long-term treatment to prevent relapse, especially if they have a history of recurrent depression.

* FIND THIS STUDY Feb. 22 issue of The Lancet; abstract online at www.thelancet.com/journal.

THROMBOEMBOLISM

Low doses of a blood thinner can reduce the risk of clotting.

* THE QUESTION Can a low dose of the blood thinner warfarin (Coumadin) reduce blood clots without increasing bleeding?

* PAST STUDIES have shown that warfarin can reduce the likelihood of recurrent blood clots, but the drug can safely be used at full dose for only three to six months because it increases the risk of bleeding. People who stop this treatment, however, have an elevated risk of developing more blood clots.

* THIS STUDY followed 508 patients who had received about six months of full-dose warfarin and were then randomly assigned to take either low-dose warfarin (up to 10 milligrams a day) or a placebo for four years. Those in the warfarin group had a 64 percent lower risk of recurrent blood clots during those four years. Those who were most compliant in taking their medication had up to an 80 percent reduction in risk. Eight people in the placebo group and four in the warfarin group died during the study; major cases of bleeding occurred in two placebo participants and five of those who were taking warfarin.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People who have had blood clots.

* CAVEATS The results may not apply to other blood thinners. In addition, one of the authors has received funding from pharmaceutical companies.

* BOTTOM LINE People at risk of recurrent blood clots may wish to consult their physician about getting continuous low doses of warfarin.

* FIND THIS STUDY April 10 issue of the New England Journal of Medicine or http://content.nejm.org/cgi/reprint/NEJMoa035029v1.pdf.

-- Haleh V. Samiei