COLORECTAL CANCER

Aspirin may reduce the likelihood of recurrent polyps.

* THE QUESTION Does aspirin affect the risk of recurrent polyps?

* PAST STUDIES have shown that people who take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may have a lower risk of developing colorectal polyps, which sometimes become cancerous. These observations, however, have not been verified in randomized trials.

* THIS STUDY involved 635 survivors of colon cancer who were randomly assigned to take either 325 milligrams of aspirin or a placebo each day for 21/2 years. Seventeen percent of the participants taking aspirin developed one or more polyps during that time, compared with 27 percent of those taking the placebo. Because this difference was so substantial, the research was halted early. A related study in the same issue of the journal showed that a lower dose of aspirin (81 milligrams) reduced the likelihood of recurrence in people whose prior polyps had not been cancerous.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People previously treated for colon cancer.

* CAVEATS The researchers have worked for pharmaceutical companies that manufacture aspirin or other NSAIDs. In addition, an accompanying editorial asserts that benefits of aspirin shown in the study are outweighed by the bleeding complications that aspirin sometimes causes. Finally, more studies are needed to compare aspirin to other NSAIDs.

* BOTTOM LINE People at risk for colon cancer, particularly those who have had it in the past, may wish to discuss with their physician aspirin use vs. regular screening for and prompt removal of new polyps.

* FIND THIS STUDY March 6 issue of the New England Journal of Medicine; abstract online at www.nejm.org.

OSTEOPOROSIS

Vitamin D supplements seem to reduce fractures in the elderly.

* THE QUESTION Does large-dose, infrequent vitamin D supplementation reduce fractures?

* PAST STUDIES have shown that daily consumption of supplements containing vitamin D and calcium can reduce fractures in the elderly. It is not clear whether these benefits are caused by one of those ingredients or the other, or by the combination. Also, some people find it difficult to adhere to a daily regimen of taking supplements.

* THIS STUDY involved 2,686 people aged 65 and older who were randomly assigned to take either a capsule containing 100,000 International Units (IU) of vitamin D3 (cholecalciferol) or a placebo once every four months. This dosage equates to about double the recommended dietary allowance for vitamin D for this age group (400 IU a day). Those who took the supplements had a 22 percent lower risk of having any first-time fracture during the five years of the study than those who took the placebo. For the bones often affected by osteoporosis, such as hip and wrist bones, those taking the vitamin had an even lower incidence of fractures (33 percent lower than placebo). The vitamin D supplementation did not seem to affect death rates from heart disease or cancer.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People 65 or older.

* CAVEATS The incidence of fractures was determined through questionnaires. In addition, most participants were physicians. Finally, the results need to be verified in more people.

* BOTTOM LINE People 65 or older may wish to consult their physician to make sure they are getting adequate vitamin D through sunlight, diet or supplementation.

* FIND THIS STUDY March 1 issue of the British Medical Journal or www.bmj.com/current.shtml.

HEART DISEASE

Drugs and surgery seem to be equally beneficial for angina.

* THE QUESTION Do older people with chronic angina pectoris benefit more from invasive treatments than from medication?

* PAST STUDIES have shown that younger patients with chronic angina benefit more from angioplasty or bypass surgery than from drugs that just control their symptoms. It is not clear, however, if these findings also apply to the elderly.

* THIS STUDY involved 282 angina patients aged 75 and older who were randomly assigned either to undergo angioplasty or coronary-artery bypass surgery or to receive standard medications for their condition. After a year, there was no difference in quality of life, nonfatal heart attacks or death between the two groups. In addition, almost half those who had been placed in the medication group switched to the surgical approach within that year.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People 75 and older who have chronic angina.

* CAVEATS The results need to be verified in more people and for a longer time. In addition, the study does not distinguish between the various invasive procedures that some of the patients underwent.

* BOTTOM LINE Elderly people may wish to consult their physician about treating their angina with invasive procedures vs. medications.

* FIND THIS STUDY March 5 issue of the Journal of the American Medical Association; abstract online at http://jama.ama-assn.org/.

-- Haleh V. Samiei