EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 22, 2004
To contact Serge Hercberg, M.D., Ph.D., e-mail: hercberg{at}cnam.fr.

ANTIOXIDANT SUPPLEMENTATION MAY REDUCE INCIDENCE OF CANCER IN MEN

CHICAGO—Low-dose antioxidant supplementation may reduce the risk of cancer among men, but not in women, according to an article in the November 22 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, antioxidants including beta carotene, ascorbic acid, vitamin E, selenium, and zinc may prevent some of the harmful effects caused by free radicals - reactive molecules produced by metabolism in the body. It has also been suggested that a low dietary intake of antioxidants increases the incidence of cancer and cardiovascular disease.

Serge Hercberg, M.D., Ph.D., of the Institut National de la Sante et de la Recherche Medicale (INSERM) and Unite de Surveillance et d'Epidemiologie Nutritionnelle, Paris, and colleagues tested the efficacy of dietary supplementation with a combination of antioxidant vitamins and minerals in reducing the incidence of cancer and cardiovascular disease among 13,017 French adults. There were 7,876 women aged 35 to 60 years old, and 5,141 men ages 45 to 60 years old included in the study. Participants were randomly assigned to take either a daily capsule containing 120 milligrams of ascorbic acid, 30 milligrams of vitamin E, six milligrams of beta carotene, 100 micrograms of selenium, and 20 milligrams of zinc; or a placebo capsule. Participants were followed-up for a median of 7.5 years.

The researchers found no differences between the antioxidant and placebo group in terms of cancer incidence (4.1 percent of the antioxidant group vs. 4.5 percent of the placebo group), or in cardiovascular disease incidence (2.1 percent for the antioxidant group vs. 2.1 percent for the placebo group) or all-cause death (1.2 percent for the antioxidant group vs. 1.5 percent for the placebo group).

However, when the researchers looked at cancer incidence according to sex, they found a significant protective effect of the antioxidants in men, who were 31 percent less likely to develop cancer than women. A similar trend was seen in men for death rates.

"After 7.5 years, low-dose antioxidant supplementation lowered total cancer incidence and all-cause mortality in men but not in women. Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene," the researchers write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 22, 2004
To contact corresponding author Eibert R. Heerdink, Ph.D., e-mail: e.r.heerdink{at}pharm.uu.nl

ANTIDEPRESSANTS MAY INCREASE RISK OF ABNORMAL BLEEDING

CHICAGO—New users of selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant) have an increased risk of being admitted to the hospital for abnormal bleeding, according to an article in the November 22 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, case reports and observational studies have shown a relationship between SSRI use and abnormal bleeding. It is believed that serotonin plays a role in blood clotting, and because SSRIs affect serotonin levels, they may be associated with an increased risk of bleeding, the article states.

Welmoed E. E. Meijer, Ph.D., of Utrecht Institute for Pharmaceutical Sciences, the Netherlands, and colleagues estimated the risk of abnormal bleeding associated with antidepressant use among 64,000 new antidepressant users. The data analyzed were collected from 1992 through 2000. Individuals were classified according to the degree (high, intermediate, or low) of serotonin reuptake inhibition of the antidepressants they were taking.

Among study participants, there were 196 cases of abnormal bleeding (including abnormal uterus bleeding and gastrointestinal bleeding). The risk of hospitalization increased with the use of drugs providing intermediate (twice as likely) and high (2.6 times as likely) degrees of serotonin reuptake inhibition.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 22, 2004
To contact John A. Hermos, M.D., call Jodi Petrie at 617/638-5432.

STUDY IDENTIFIES FACTORS ASSOCIATED WITH LONG-TERM OPIOID TREATMENT OF VETERAN PATIENTS

CHICAGO—Veteran patients who receive long-term opioid prescriptions generally are treated with modest and stable medication dosages, according to an article in the November 22 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

"The long-term use of opioids for the treatment of chronic pain of nonmalignant [noncancerous] origin has been generally supported by specialists in pain management as a less than ideal but often necessary and humane course of treatment," according to background information in the article. Long-term opioid use can by complicated by problematic dose increases, drug dependency, and toxic effects.

John A. Hermos, M.D., from Boston University School of Public Health, and colleagues analyzed pharmacy and clinical databases in order to determine characteristics of prescribing patterns and to identify potential high-risk opioid prescribing. Data on durations, doses, and dose changes of oxycodone/acetaminophen and concurrent use of long-acting opioids, benzodiazepines, tricyclic antidepressants, and anticonvulsants were obtained from the Veterans Integrated Service Network for the New England region (VISN 1) from January 1998 through June 2001.

The researchers found that during the study period, 47,302 patients received 177,840 prescriptions (initial and renewed prescriptions) for short-acting opioid medications, and 6,936 received 53,083 prescriptions for long-acting opioids. Two thousand one hundred ninety-five patients (31 percent with cancer) received oxycodone/acetaminophen for more than nine months at an average prescribed dose of 3.9 tablets per day, without significant changes in daily prescribed average dose over time. Patients with cancer were more likely to receive other long-acting opioids simultaneously. In those without cancer, high daily average doses were associated with duration, older age, HIV and/or AIDS, and with prescription of benzodiazepines and long-acting opioids.