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    Wednesday, December 15, 2004

    Dire Warnings: A new study says that taking calcium channel blockers with diuretics may increase your risk of dying:

    The new study indicates calcium channel blockers may indeed double the risk of dying of heart disease, especially when paired with diuretics, which reduce the amount of fluid in the blood. Although the study involved women, the authors believe the findings also apply to men.

    The new study in today's Journal of the American Medical Association involved almost 20,000 women being treated for high blood pressure in the long-term study of postmenopausal women called the Women's Health Initiative.

    It found that women who took diuretics plus calcium blockers had twice the risk of death as women who took diuretics with beta blockers, drugs that reduce the heart's workload. Women took a calcium blocker alone had a 55 percent higher risk of death than women who took a diuretic alone.

    The authors cautioned that the study's design, in which patients are followed for a number of years, doesn't yield the same 'gold-standard' evidence that comes from randomly dividing patients into treatment and control groups.

    And yet, despite that caution, the author's still can't restrain themselves from making comments like this:

    'This raises serious questions about using calcium channel blockers in patients with uncomplicated high blood pressure,' says lead author Sylvia Wassertheil-Smoller of Albert Einstein College of Medicine, New York. 'If I were on that combination, I would want to know, 'Why this one?'

    These are the same authors and the same study that gave us hormone hysteria a few years ago.

    Their abstract only presents their results in terms of hazard ratios, which can be very distorting. But the morning paper had the details, and they aren't nearly as impressive:

    Still, the number of heart-related deaths was relatively small: 31 out of 1,223 women taking the calcium channel blocker combination versus 18 out of 1,380 on the beta blocker combination and 17 out of 1,413 on the ACE inhibitor duo.

    That's 2.5% vs. 1.3% vs. 1.2%. We already know that beta blockers and ACE inhibitors can play important roles in treating heart disease. We would expect that patients on those drugs would do better from a cardiac standpoint. What's more, some people with hypertension are also placed on calcium channel blockers to treat arrhythmias, which could also increase their cardiac mortality. Although the abstract says the authors controlled for "multiple covariates" it doesn't tell us what those covariates were. I'll have to wait until my complementary issue of JAMA arrives in the mail to find out. (Unable to access online.)


    posted by Sydney on 12/15/2004 07:28:00 AM 0 comments


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