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This week in the medical journals

By Katrina Woznicki
Medpage Today Staff Writer

Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.

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News from the heart

The heart dominated news in medicine this week and much of it came from studies reported at the European Society of Cardiology Congress 2005 meeting in Stockholm. The studies were simultaneously published by leading medical journals.

Heart health findings from Stockholm

Researchers at Brigham and Women's Hospital in Boston said that giving patients Plavix (clopidogrel) before they undergo coronary-artery angioplasty cuts the risk of death, heart attack or stroke by 46 percent. Plavix helps prevent clots by making blood less sticky.

The authors, who reported the results in Stockholm and in an online edition of the Journal of the American Medical Association, said Plavix reduces risk both before and after angioplasty.

ESC: Pretreatment with Plavix reduces MI, stroke, and death before and after stenting

A second study reported in Stockholm found that two drugs -- ACE inhibitors and beta blockers -- should be used to treat heart failure. Standard treatment is to start patients on ACE inhibitors and add beta blockers as needed -- but researchers at Sweden's Lund University report the order of treatment does not matter.

The finding, which was presented in Stockholm and published in Circulation, Journal of the American Heart Association, allows physicians more flexibility in treating heart failure, which affects an estimated 5 million Americans.

ESC: For heart failure initial therapy, beta-blockers match ACE inhibitors

Reports from Lancet

Three studies reported at the Stockholm meeting were published in The Lancet, beginning with an analysis of 20,000 patients with high blood pressure. The analysis found that newer, pricey drugs were more effective that the older, cheaper blood pressure pills.

In the study, patients treated with Norvasc (amlodipine) and Aceon (preindopril) had 16 percent fewer heart attacks, 23 percent fewer strokes and 11 percent lower mortality from all causes than patients given a beta blocker and a diuretic. And, the patients treated with the newer regimen were less likely to develop diabetes.

ESC: ASCOT Results Touted as Triumph of New Drugs Over Old Standbys

In the second study published in The Lancet, researchers at the University of Edinburgh in Scotland reported that patients with a type of heart disease called non-ST-elevation acute coronary syndrome, which causes about 60 percent of heart attacks worldwide, have a better outcome if they are treated aggressively from the start. Early intervention with angioplasty improves survival compared with conservative management that relies on drugs to deal with symptoms, the study found.

ESC: Early intervention prevents MI and mortality in certain high-risk heart patients

Finally, a third study reported that the tiny, drug-coated flexible mesh tubes called drug-eluting stents, which are threaded into the heart to open blocked or narrowed vessels, work very well -- but are so expensive that they should be used only in high-risk patients who have no other options.

ESC: Drug-eluting stents only cost-effective in certain patients

Two drug-eluting stents are on the market. They are Cypher, which is coated with Rapamune (sirolimus), a drug used in kidney transplant patients to prevent organ rejection, and Taxus, which is coated with the chemotherapy drug Taxol (paclitaxel). Using either one adds about $1,000 to the cost of stenting compared with an uncoated stent. A team of researchers from Basel, Switzerland, said that extra expense is not cost-effective.

Awaiting proof

Dutch researchers reported that sticking with a winner is a good approach when trying to control blood clots in heart disease patients. They report in the New England Journal of Medicine that a new class of drugs called direct thrombin inhibitors, which attack the building blocks of clots rather than the clots themselves, have not proven that they work as well as Coumadin (warfarin) or heparin, both old-line blood thinners. The Dutch team says the newer drugs could damage the liver.

Direct thrombin inhibitors: Not ready for prime time?

Antibiotics for cancer patients reduce infection risk

Moving away from the heart, cancer researchers reported in another study published in the New England Journal of Medicine that giving antibiotics along with chemotherapy can reduce treatment-related infections. Doing so, however, might make bacteria drug-resistant.

Two studies from centers in Italy and England suggested that giving Levaquin (levofloxacin) to chemotherapy patients reduced the risk of an infection-related fever.

If, however, the prophylactic antibiotics increase the pool of resistant bacteria, it would pose a threat to chemotherapy patients because their cancer-weakened immune systems may be unable to fight off tougher infections.

Antibiotics prevent chemotherapy-related fever

Folic acid fortification

Switching gears from antibiotics to vitamins, researchers at Thomas Jefferson University in Philadelphia found that adding folic acid to grain products led to a significant drop in babies born with neural tube defects such as spina bifida.. They found the effect was seen across racial and ethnic groups.

Their report, published in this month's issue of Pediatrics, a journal of the American Academy of Pediatrics, indicated that women and their babies have benefited from folate-fortified grains. However, the authors caution that women cannot rely on grains alone to get the 400 micrograms of folic acid they need every day. In addition to consuming fortified grains, women should also take a multivitamin or a folic acid supplement, the researchers said.

Folic acid benefits across racial and ethnic boundaries

Exhausted doctors react like intoxicated ones

The week ended on this sobering note: A study in the Journal of the American Medical Association reported that sleep deprivation in overworked residents impairs their brainpower to the same degree as a blood alcohol concentration of .04 to .05.

Using simulated driving tests, researchers at the University of Michigan found exhausted medical residents had similar reaction times, attention lapses, mistakes and crashes as someone who had been drinking alcohol.

For overworked residents sleep deprivation equals alcohol impairment

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