ShortCuts-This Week in the Journals

June 16, 2008

lake.jpgCommentary by Joshua Remick MD, NYU Senior Chief Resident

We’ll start this week off with some good news—we’re living longer and dying less! At least we were back in 2006. You remember 2006 don’t you? That was the year that Dick Cheney shot his buddy, Pluto was demoted, Brokeback Mountain created the stir but Crash won the Oscar, Roger Clemens unretired for the 3rd time (more on this in a bit) and Taylor Hicks was your American Idol. This week the CDC released its preliminary review of national mortality data from 2006 and found that the age-adjusted death rate dropped about 3% from 2005 to an all-time low of 776 deaths per 100,000 individuals while the average life-expectancy increased to a record high of 78.1 years.

In other news, two interesting articles were published in The Archives of Internal Medicine this week. The first article, entitled “25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men,” used a cohort of 454 men in the Health Professionals Follow-Up Study (which had close to 18,000 men) who had fatal and non-fatal coronary events. They then examined 25 (OH) D levels in those men and compared them to 900 matched controls. The findings showed that lower levels of 25 (OH) D conferred an almost 2 fold relative risk of coronary events after adjusting for age, diabetes, hypertension, LDL-levels and several other factors which could have been confounders. In fact, there seemed to be an almost linear relationship between the lower the 25 (OH) D levels and the higher risk of events. While intriguing, one must remember that this is an observational study and therefore must be viewed with some skepticism, especially since two prior randomized controlled trials of this subject have shown no benefit of vitamin D supplementation, though the authors of the present study argue that the amount of vitamin D used in those trials was not sufficient (based on their calculations of how much people need to take in order to decrease their risk of MI) to show a benefit. Regardless, it’s probably not a bad idea to get outside (after you’ve finished reading this entry) and go enjoy the sun!

Another interesting article from The Archives focused on whether Topiramate can improve drinking outcomes in alcoholics. After randomizing 370 adults with alcohol dependence to Topiramate, which was titrated to a max dose of 300 mg/d, or to placebo, the authors found significant reductions in alcohol consumption in the Topiramate group (as measured by questionnaires and GGT levels). Furthermore, other markers of overall health (BMI, Blood Pressure, Quality of Life questionnaires, Liver Function Tests and Cholesterol Panels) were all significantly reduced in the intervention group. Hypothesizing that the treatment effects were through Topiramate’s effects on the GABA receptor and antagonism of glutamate activity, this study raises intriguing possibilities for the treatment of alcohol dependence. However, one must also recognize that the patients enrolled in this trial were highly motivated subject, who wanted to “kick their habit.” Therefore, the applicability to our own patients remains in doubt.

This week in JAMA, another blow was dealt to the popular herbal medication St. John’s Wort. Often used in children and adolescents with ADHD, St. John’s Wort is an herbal medication that works as a norepinephrine re-uptake inhibitor. However, in a randomized, placebo-controlled trial, children treated with St. John’s Wort three times daily for 8 weeks showed no improvement in any clinical end-point compared to placebo. While the results may not surprise most readers, It think the importance of this study lies in the fact that this herbal treatment was subjected to the type of scientific examination that is required of any type of medical treatment. Still though, there are thousands of other herbals taken by millions of people around the globe that have not been “put through the rigors” of scientific examination and are not given the same government oversight as “traditional” medications. But at least this article is a good start.

Leaving the realm of complementary medicine, we come now to the physician’s office, where The Journal of the National Cancer Institute has published very useful, easy to read charts showing the 10-year risk of dying from various causes, including heart disease, stroke, six kinds of cancer, stroke, pneumonia, influenza, chronic obstructive pulmonary disease, accidents, AIDS, accidents and all causes based on age, sex and smoking status. The authors encourage the distribution of these charts to patients so that they can see the effects of some of their lifestyle choices. For instance, these charts indicate that the effect of smoking is like adding 10 years to your age.

And lastly, from the realm of the truly bizarre, as mentioned at the beginning of Shortcuts, Roger Clemens was in the news again, accused now of using more than just steroids. Sources say Clemens used to keep a stash of Viagra in his locker. While Viagra has become popular amongst athletes who dope for its ability to increase endurance, one wonders how Roger really got his nickname…