News & Analysis
Clinical Trials Update Multivitamins Offer No Protection to Brains or Hearts One-third of individuals in the United States consume multivitamins, but they shouldn’t countonthesupplementstopreventcognitive decline or reduce the risk of cardiovascular events after a heart attack, conclude authors of 2 randomized placebo-controlled trials. The Physicians’ Health Study II trial randomized 5947 male physicians aged 65 years or older to receive a daily multivitamin or placebo for 12 years (Grodstein F et al. Ann Intern Med. 2013;159[12]:806-814). Four assessments over the study period showed no difference in overall cognitive performance between the 2 groups. The study participants may have been too well nourished—or too well educated—to receive a cognitive gain from vitamin supplements, wrote the researchers. They called for additional studies to determine whether supplements may cognitively benefit people with poor nutrition or vitamin deficiencies. In the second trial, 1708 patients with a median age of 65 years who had experienced a myocardial infarction at least 6 weeks before enrollment were randomly assigned to receive a 28-component highdose multivitamin and mineral mixture or to receive placebo for a median of 31 to 35 months (Lamas G et al. Ann Intern Med. 2013; 159[12]:797-805). The multivitamins did not reduce subsequent cardiovascular events, which occurred in 27% of the vitamin group and 30% of the placebo group. The highdose vitamin therapy had no adverse effects, but with 46% of participants in each of the 2 groups discontinuing therapy or placebo, the study’s findings should be interpreted cautiously, advised the researchers.
Resuming Warfarin After GI Bleeding Leads to Better Outcomes Patients with nonvalvular atrial fibrillation (AF) who resumed taking warfarin after major gastrointestinal bleeding (GIB)—a complication that occurs in 5% to 15% of people taking long-term anticoagulation—had a lower risk of thromboembolism and mortality but no greater incidence of recurrent GIB, reported authors of a retrospective cohort study of patients enrolled at one anticoagujama.com
lation clinic (Qureshi W et al. Am J Cardiol. doi:10.1016/j.amjcard.2013.10.044 [published online November 25, 2013]). The study, which included 1329 patients with AF who developed GIB while taking warfarin, found that the majority of the deaths and thromboembolic events occurred in patients who did not restart warfarin within a month of GIB. Restarting warfarin was associated with decreased thromboembolism and reduced mortality. The risk of recurrent GIB was much greater when warfarin was restarted within the first week of major GIB, but resuming the anticoagulant 7 to 30 days after GIB did not increase the risk of future bleeding.
Gastroesophageal Reflux Symptoms Abate When Smoking Stops Quitting smoking improved gastroesophageal reflux symptoms (GERS), but only in individuals of normal weight who used antireflux medications at least weekly, according a prospective study of the population of Nord-Trøndelag County, Norway (NessJensen E et al. Am J Gastroenterol. doi: 10.1038/ajg.2013.414 [published online December 10, 2013]). The investigators used data from 29 610 individuals who reported having GERS during both of 2 health surveys—from 1995 to 1997 and from 2006 to 2008. In the subset of respondents with severe GERS (1553 individuals), they examined GERS status among those who had quit smoking between the 2 survey periods, status among those who had sustained their smoking, and the association of symptoms with the usage of antireflux medications. Individuals with severe GERS who had quit smoking during the 2 survey periods and used various antireflux drugs once a week or more reported that their severe symptoms disappeared or were minor compared with those who smoked daily. Former smokers who used antireflux medication less frequently had no change in severe GERS. Those who were overweight also did not have improvement in their GERS after they quit smoking, most likely because body mass index probably plays a bigger role in the pathophysiology of GERS than does smoking, added the researchers.
Some individuals with gastroesophageal reflux who take antireflux medications may experience an improvement in symptoms after they quit smoking.
Lung Cancers Overdiagnosed With Low-Dose CT Low-dose computed tomography (LDCT) has been promoted as a screening test for lung cancersincetheNationalLungCancerScreening Trial (NLST) demonstrated a 20% relative reduction in lung cancer–specific mortality compared with chest radiography (CXR) screening. In a new analysis of the trial data, in which 53 452 people at high risk were randomly assigned to receive either LDCT or CXR screening, researchers found that more than 18%oflungcancersdetectedbyLDCTwereindolent tumors, which may not have become clinically significant (Patz EF et al. JAMA Intern Med. doi:10.1001/jamainternmed.2013.12738 [published online December 9, 2013]). During the 6.4-year follow-up, 1089 lung cancers were reported in the LDCT group and 969 in the CXR group of the NLST. The researchers attribute the excess number of cancers in the LDCT group to an overdiagnosis of indolent lesions. Overdiagnosis with LDCT increased to 22% for non–small cell lung cancer and 78.9% for bronchioalveolar lung cancer. Theresearcherscautionedthatthepropensity for overdiagnosis with LDCT could create potential harm in a mass screening program. If better biomarkers and imaging become available that could distinguish aggressive disease fromslowlygrowingcancers,masslung-cancer screeningmightbemorevaluableinthefuture, they said. – Anita Slomski JAMA January 22/29, 2014 Volume 311, Number 4
Copyright 2014 American Medical Association. All rights reserved.
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Clinical Trials Update Multivitamins Offer No Protection to Brains or Hearts One-third of individuals in the United States consume multivitamins, but they shouldn’t countonthesupplementstopreventcognitive decline or reduce the risk of cardiovascular events after a heart attack, conclude authors of 2 randomized placebo-controlled trials. The Physicians’ Health Study II trial randomized 5947 male physicians aged 65 years or older to receive a daily multivitamin or placebo for 12 years (Grodstein F et al. Ann Intern Med. 2013;159[12]:806-814). Four assessments over the study period showed no difference in overall cognitive performance between the 2 groups. The study participants may have been too well nourished—or too well educated—to receive a cognitive gain from vitamin supplements, wrote the researchers. They called for additional studies to determine whether supplements may cognitively benefit people with poor nutrition or vitamin deficiencies. In the second trial, 1708 patients with a median age of 65 years who had experienced a myocardial infarction at least 6 weeks before enrollment were randomly assigned to receive a 28-component highdose multivitamin and mineral mixture or to receive placebo for a median of 31 to 35 months (Lamas G et al. Ann Intern Med. 2013; 159[12]:797-805). The multivitamins did not reduce subsequent cardiovascular events, which occurred in 27% of the vitamin group and 30% of the placebo group. The highdose vitamin therapy had no adverse effects, but with 46% of participants in each of the 2 groups discontinuing therapy or placebo, the study’s findings should be interpreted cautiously, advised the researchers.
Resuming Warfarin After GI Bleeding Leads to Better Outcomes Patients with nonvalvular atrial fibrillation (AF) who resumed taking warfarin after major gastrointestinal bleeding (GIB)—a complication that occurs in 5% to 15% of people taking long-term anticoagulation—had a lower risk of thromboembolism and mortality but no greater incidence of recurrent GIB, reported authors of a retrospective cohort study of patients enrolled at one anticoagujama.com
lation clinic (Qureshi W et al. Am J Cardiol. doi:10.1016/j.amjcard.2013.10.044 [published online November 25, 2013]). The study, which included 1329 patients with AF who developed GIB while taking warfarin, found that the majority of the deaths and thromboembolic events occurred in patients who did not restart warfarin within a month of GIB. Restarting warfarin was associated with decreased thromboembolism and reduced mortality. The risk of recurrent GIB was much greater when warfarin was restarted within the first week of major GIB, but resuming the anticoagulant 7 to 30 days after GIB did not increase the risk of future bleeding.
Gastroesophageal Reflux Symptoms Abate When Smoking Stops Quitting smoking improved gastroesophageal reflux symptoms (GERS), but only in individuals of normal weight who used antireflux medications at least weekly, according a prospective study of the population of Nord-Trøndelag County, Norway (NessJensen E et al. Am J Gastroenterol. doi: 10.1038/ajg.2013.414 [published online December 10, 2013]). The investigators used data from 29 610 individuals who reported having GERS during both of 2 health surveys—from 1995 to 1997 and from 2006 to 2008. In the subset of respondents with severe GERS (1553 individuals), they examined GERS status among those who had quit smoking between the 2 survey periods, status among those who had sustained their smoking, and the association of symptoms with the usage of antireflux medications. Individuals with severe GERS who had quit smoking during the 2 survey periods and used various antireflux drugs once a week or more reported that their severe symptoms disappeared or were minor compared with those who smoked daily. Former smokers who used antireflux medication less frequently had no change in severe GERS. Those who were overweight also did not have improvement in their GERS after they quit smoking, most likely because body mass index probably plays a bigger role in the pathophysiology of GERS than does smoking, added the researchers.
Some individuals with gastroesophageal reflux who take antireflux medications may experience an improvement in symptoms after they quit smoking.
Lung Cancers Overdiagnosed With Low-Dose CT Low-dose computed tomography (LDCT) has been promoted as a screening test for lung cancersincetheNationalLungCancerScreening Trial (NLST) demonstrated a 20% relative reduction in lung cancer–specific mortality compared with chest radiography (CXR) screening. In a new analysis of the trial data, in which 53 452 people at high risk were randomly assigned to receive either LDCT or CXR screening, researchers found that more than 18%oflungcancersdetectedbyLDCTwereindolent tumors, which may not have become clinically significant (Patz EF et al. JAMA Intern Med. doi:10.1001/jamainternmed.2013.12738 [published online December 9, 2013]). During the 6.4-year follow-up, 1089 lung cancers were reported in the LDCT group and 969 in the CXR group of the NLST. The researchers attribute the excess number of cancers in the LDCT group to an overdiagnosis of indolent lesions. Overdiagnosis with LDCT increased to 22% for non–small cell lung cancer and 78.9% for bronchioalveolar lung cancer. Theresearcherscautionedthatthepropensity for overdiagnosis with LDCT could create potential harm in a mass screening program. If better biomarkers and imaging become available that could distinguish aggressive disease fromslowlygrowingcancers,masslung-cancer screeningmightbemorevaluableinthefuture, they said. – Anita Slomski JAMA January 22/29, 2014 Volume 311, Number 4
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a SWINBURNE UNIVERSITY OF TECHNOLOGY User on 05/18/2015
349
