Statins may help diabetics without high cholesterol.
* THE QUESTION Statins frequently are given to people with high cholesterol to lower their levels and prevent heart problems. Would statins help diabetics whose cholesterol levels are not elevated but who still face a high risk of cardiovascular disease because of their diabetes?
* THIS STUDY randomly assigned 2,838 people with Type 2 diabetes and low levels of LDL ("bad") cholesterol to take either atorvastatin (Lipitor) or a placebo daily. After about four years, people who took atorvastatin had had 37 percent fewer serious cardiovascular problems than the placebo group. Strokes alone were down 48 percent, and 27 percent fewer people in the statin group had died.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with Type 2 diabetes, who face a two- to fourfold increased risk for heart disease and stroke.
* CAVEATS How a higher dose of atorvastatin or the addition of other cholesterol-lowering drugs might affect the results was not addressed. The study ended two years early because hoped-for benefits had been achieved; whether a longer study would have shown an even larger improvement in the risk of death could not be determined. The research was funded in part by Pfizer, which makes Lipitor.
* BOTTOM LINE Type 2 diabetics may want to ask their doctor about statins.
* FIND THIS STUDY Aug. 21 issue of The Lancet; abstract available online at www.thelancet.com.
* LEARN MORE ABOUT the effect of statins at www.mayoclinic.com and at www.americanheart.org.
Teenagers seem to gain from talk therapy with medication.
* THE QUESTION Most teenagers are sad or moody occasionally. But for some, these feelings are strong and persistent. What is the best treatment for these adolescents?
* THIS STUDY evaluated the effectiveness of antidepressant drugs and psychotherapy for 439 teens diagnosed with moderate to severe depression. The youths were randomly assigned to one of four treatment groups: fluoxetine (Prozac); cognitive behavior therapy (intended to reinforce positive thoughts and behavior); Prozac and therapy; or placebo pills. After 12 weeks, 71 percent of the youths who received the combination treatment had improved, compared with 61 percent of those who took Prozac alone, 43 percent of the therapy-only recipients and 35 percent of the placebo group. Suicidal thoughts were reported by 27 percent of all participants at the start of the study, dropping to 9 percent at the end; those who received Prozac and therapy had the largest decline.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Adolescents, an estimated 4 percent of whom become seriously depressed each year.
* CAVEATS Whether drugs similar to Prozac would yield the same results was not shown. Variations in therapy methods also could produce differing results. Eight to 12 percent of Prozac users reported incidents of self-inflicted harm or aggressive thoughts and actions, about twice the rate of participants who did not take the drug. Gastrointestinal problems and insomnia also were more frequent in the Prozac group.
* BOTTOM LINE Parents of depressed teens may want to ask their doctor about a combination treatment. Prozac is the only antidepressant approved for adolescents.
* FIND THIS STUDY Aug. 18 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.
* LEARN MORE ABOUT teenage depression at www.kidshealth.org/teen and www.nimh.nih.gov (search for: "Let's Talk About Depression").
A new drug may relieve pain and reduce the risk of ulcers.
* THE QUESTION People taking NSAIDs (nonsteroidal anti-inflammatory drugs) to kill the pain of osteoarthritis sometimes get ulcers. Might so-called COX-2 inhibitors offer an alternative free of stomach complications and without additional risk to the cardiovascular system?
* THIS STUDY randomly assigned 18,325 adults with osteoarthritis to take either the COX-2 inhibitor lumiracoxib or one of two NSAIDs: naproxen or ibuprofen. After a year, the percentage of people who had had a heart attack or stroke was about the same in all groups. About 1 percent of the NSAID users had ulcer problems, four times the rate of those in the lumiracoxib group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with osteoarthritis, the degenerative joint disorder that strikes mostly people over age 45.
* CAVEATS Lumiracoxib, sold as Prexige in the United Kingdom, is being evaluated by the Food and Drug Administration; the drug could be available in the United States next year. Whether other COX-2 inhibitors produce similar results is unknown. People with heart disease were excluded from the study. The study was funded by Novartis, which produces lumiracoxib; the company also managed and analyzed the data.
* BOTTOM LINE People with osteoarthritis may want to ask their doctor about COX-2 inhibitors.
* FIND THIS STUDY Aug. 21 issue of The Lancet; abstracts of two articles on the study are available online at www.thelancet.com.
* LEARN MORE ABOUT osteoarthritis at www.arthritis.org and www.niams.nih.gov.
-- Linda Searing