Mixed Meds: A Dangerous Prescription for Heart Patients]

[Guest guest]

>

>

> Mixed Meds: A Dangerous Prescription for Heart Patients

> Tue Jul 1,11:48 PM ET

> By Amanda Gardner

>

> HealthDay Reporter

> (HealthDay is the new name for HealthScoutNews.)

>

> TUESDAY, July 1 (HealthDayNews) -- Patients with diabetes and heart

> failure seem to be routinely receiving medications that may

> aggravate one conditioneven if they help the other.

>

>

> Specifically, metformin (brand name Glucophage) and a class of

> medications called thiazolidinediones --

> both of which help (?) control glucose levels in diabetics (news -

> web sites) --

>

> may cause serious complications in patients with heart failure.

>

>

> The findings are detailed in a study in the July 2 issue of the

> Journal of the American Medical Association (news - web sites).

>

>

> " The number of patients with diabetes has increased dramatically in

> the country over the last 10 years and increasingly these

> medications are being used as part of their therapy, " says Dr. Sid

> Smith, director of the Center for Cardiovascular Science and

> Medicine at the University of North Carolina.

>

>

> " Because of the observations of fluid retention and weight gain [in

> the case of thiazolidinediones], it's very important that they not

> be used in patients with known heart failure or, if necessary, that

> possible problems be monitored very carefully, " adds Smith, who is a

> past president of the American Heart Association (news - web sites).

>

> Part of the problem is that so many patients, especially patients

> with diabetes, have other health conditions as well.

>

> " The typical heart failure patients are patients who have many

> concurrent illnesses and complications and can end up on a lot of

> different medications, "

> says study author Dr. Harlan M. Krumholz, a professor of medicine

> and epidemiology and public health at Yale University School of

> Medicine.

>

> " As people end up going to a specialist, there's often not a lot of

> cross-talk.

> We need to pay a lot more attention to the integration of our

> approaches and taking into account a variety of conditions, "

> Krumholz says.

>

> But there's also the issue of whether physicians are paying

> attention to U.S.Food and Drug Administration (news - web sites)

> (FDA) " black box " warnings on medications.

>

> Such warnings are the most serious category of health side effects.

> " There's a discordance between what the FDA is saying and what's

> going on in practice, " Krumholz says. " We're potentially undermining

> the entire system. "

>

> The black-box warning for metformin indicates the drug could lead to

> lactic acidosis -- or acid in the blood,

> a potentially life-threatening problem for people with *heart

> failure*.

> (moderator's Note: All diabetic drugs list coronary thrombosis

> (arterial blockages) as a likely 'side effect' in the little paper

> which you receive with your meds!)

>

> And thiazolidinediones may cause fluid retention, again a serious

> condition for heart failure patients.

>

> " Good care of a chronic condition of heart failure entails getting

> people into the right balance.

> And if they're on medications that cause them to retain

> fluid, it may turn them in the wrong direction and tip them over and

> cause them to be hospitalized, " Krumholz says.

>

> For this study, Krumholz and his colleagues pored through the

> medical recordsof Medicare beneficiaries who had been hospitalized

> with heart failure and diabetes from April 1998 to March 1999 and

> July 2000 to June 2001.

>

> The earlier sample consisted of 12,505 patients, 7.1 percent of whom

> were discharged with a prescription for metformin, 7.2 percent with

> a prescription

> for a thiazolidinedione, and 13.5 percent with a prescription for

> one or the other.

>

> In the second sample, which consisted of 13,158 patients, 11.2

> percent got

> metformin, 16.1 percent got a thiazolidinedione, and 24.4 percent

> one or the other.

>

> The study authors did not look at how many people had adverse

> reactions, simply how many patients were prescribed the drugs.

> It's not entirely clear why this disconnect is happening, the

> researchers say.

> Physicians may simply not be aware of the dangers or they may think

> the benefits (??) outweigh the risks. Or they may have decided that

> the risks aren't as high as advertised.

>

> " We have a problem when the FDA is saying one thing with respect to

> the safetyof a medication and clinicians are so frequently doing

> something else, " Krumholz says.

>

> " We need to determine the best way to treat patients, " he says. " It

> is a problem when the FDA's black-box warning is not being heeded.

> Either the FDA

> has overreacted or clinicians are exposing their patients to

> unnecessary risk,and we [have] to know which it is. "

>

> And it's not just an issue for heart failure patients with diabetes,

> although this is a group that warrants more attention.

> " It raises the issue about the way that we deliver health care in

> this

> country, " says Dr. Kenneth Hupart, chief of endocrinology, diabetes

> and metabolism at Nassau University Medical Center in East Meadow,

> N.Y.

>

>

>

> " Are we either having doctors who are generalists taking care of

> these complicated illnesses too much, or are we balkanizing it too

> much and having super-specialists taking care of [patients] and

> sometimes lacking the broad picture?

>

> We have to reexamine the way we provide health care to people in

> this country. We can hypothesize but we can't really know from a

> study like this. It invites further studies. "

> _________________

>

> JoAnn Guest

> mrsjoguest

> DietaryTipsForHBP

> www.geocities.com/mrsjoguest/Genes

>

>