Multivitamins and Cancer/ Statins and Mortality/Antidepressants Ranked

Friday, October 29, 2010 // Uncategorized

2/15/2009 7:23:42 PM

Multivitamin Use Not Associated with Lower Risk for Cancer or CVD in Women

Multivitamins do not reduce the risk for cancer, cardiovascular disease, or overall mortality in postmenopausal women, according to study from the Women’s Health Initiative published in Archives of Internal Medicine.
Researchers assessed multivitamin use in 160,000 postmenopausal women and subsequent diagnoses of cancer (invasive breast, colorectal, endometrial, stomach, ovarian, renal, lung, and bladder); cardiovascular disease (MI, stroke, and venous thromboembolism); and overall mortality.
After 8 years’ follow-up, multivitamin use was not associated with risk for developing cancer or cardiovascular disease, or with total mortality. Stress multivitamins (e.g., high doses of B vitamins, vitamin C, selenium, zinc) did have a protective effect against MI (hazard ratio, 0.75), although the authors acknowledge this could be due to chance.
They conclude: “Nutritional efforts should remain a principal focus of chronic disease prevention, but without definitive results from a randomized controlled trial, multivitamin supplements will not likely play a major role in such prevention efforts.”

Bottom Line:  Health doesn’t come in a vitamin pill.

Statins Linked to Reduced Mortality in Patients With and Without CHD
Consistent use of statins is associated with a lower risk for all-cause mortality among patients with and without coronary heart disease, according to a retrospective cohort study in Archives of Internal Medicine.
The cohort included nearly 230,000 members of an Israeli HMO who filled at least one prescription for a statin between 1998 and 2006. About 40% had CHD at baseline.
During a mean 4 to 5 years’ follow-up, mortality decreased as the proportion of days on statins increased (statin use was calculated using pharmacy data). After adjustment for LDL level and other confounders, statin use on 90% of days or more cut mortality risk by about half among patients with and without CHD, relative to use on less than 10% of days.
The authors say their results highlight “the importance of promoting statin therapy and increasing its continuation over time for both primary and secondary prevention.”

Bottom Line:  Taking a pill may reduce deaths due to cardiovascular disease.

Sertraline, escitalopram rank best out of 12 newer antidepressants

Escitalopram (Lexapro) and sertraline (Zoloft) are the most effective and well-accepted of the newer generation of antidepressants, a new study found.

Researchers reviewed 117 randomized controlled trials from 1991-2007 that studied the effects of antidepressants in 25,928 patients with major depression. Sixty-four percent of patients were women; the mean duration of studies was 8.1 weeks. The 12 drugs tested were bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram, fluoxetine (Prozac), fluvoxamine (Luvox), milnacipran (Ixel), mirtazapine (Remeron), paroxetine (Paxil), reboxetine (Edronax), sertraline, and venlafaxine (Effexor). The main outcomes were the proportion of patients who responded to (effectiveness) or dropped out (acceptability) of the treatment. The study was published in the Jan. 29 online issue of The Lancet.

Escitalopram and sertraline were the most accepted by patients, resulting in fewer treatment discontinuations than duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine. Sertraline was also 30% more effective than duloxetine, 27% more effective than fluvoxamine, 25% more effective than fluoxetine, 22% more effective than paroxetine, and 85% more effective than reboxetine. Escilatopram was 33% more effective than duloxetine, 32% more than fluoxetine, 35% more than fluvoxamine, 30% more than paroxetine, and 95% more than reboxetine. Mirtazapine and venlafaxine scored high on effectiveness, but were less acceptable to patients than escitalopram and sertraline.

Escitalopram and sertraline may be the best options for treating moderate to severe depression because they balance efficacy and acceptability, the study’s authors concluded. While sertraline may be preferable because it often costs less, that assertion hasn’t been tested by a full economic model, they said. The study, which received no funding from drug manufacturers, is limited in that its findings apply only to treatment for eight weeks and it did not specifically compare side effects of the various drugs.

Bottom line:  Not all antidepressants are created equal.  If someone is well controlled on another medication, there is no reason to change.  This information may be useful in people who are starting a medication.  Zoloft (sertraline is available in generic), Lexapro (excitalopram) is not available as a generic and is more costly.


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