Annals of Long Term Care

**sub**What’s New About Old Medications **endsub**
J. Mark Ruscin, PharmD, Assistant Professor, Department of Pharmacy Practice, University of Colorado School of Pharmacy, Denver, CO, noted that the session would focus on seven studies published within the last year, several medications approved prior to 2001, and how these all fit into the practice of geriatric medicine.

Dr. Ruscin first discussed the Warfarin and Aspirin for the Prevention of Recurrent Ischemic Stroke (WARS) study, which compared warfarin and aspirin in secondary prevention. Dr. Ruscin stated that one could conclude from WARS that no differences existed between the two agents regarding risk of death or recurrent ischemic stroke. “Warfarin and aspirin are reasonable therapeutic alternatives, although aspirin is most easily monitored,” he added.

The presenter spoke about the Losartan Intervention for Endpoint (LIFE) study, in which researchers aimed to establish whether selective blocking of angiotensin II improves left ventricular hypertrophy (LVH) beyond reducing a patient’s blood pressure, and, consequently, whether it reduces cardiovascular morbidity and death. This study compared a losartan-based  antihypertensive treatment with atenolol-based treatment. Patients were randomized to losartan 50 mg or atenolol 50 mg. “Atenolol showed significantly more adverse events overall,” Dr. Ruscin noted. “Atenolol also showed more serious drug-related adverse events. It appears that losartan is a little better tolerated than atenolol. The speaker explained that LIFE looked at persons with evidence of LVH and that the information from the study should not be extrapolated to persons without LVH. “Beta blockers and diuretics should be considered for elderly patients with hypertension but without LVH,” he stated.

Dr. Ruscin next discussed data from a study looking at the risks of recurrent stroke and treatment with estrogen. He explained that when the authors of the study looked specifically at the first six months, they found significant differences between those randomized to placebo and estradiol; more total strokes and more fatal strokes occurred in the estradiol group. “Estrogen therapy should not be prescribed for the secondary prevention of cerebrovascular disease,” the speaker said.

Dr. Ruscin presented the Vioxx® Gastrointestinal Outcomes Research (VIGOR) and the Celecoxib Long-term Arthritis Safety Studies (CLASS). He pointed out that there was a higher rate of MIs and cardiovascular events in those who took Vioxx versus naproxen in VIGOR. In CLASS, patients were allowed to take cardiovascular doses of aspirin throughout the study period, unlike participants in VIGOR. Those who did had a 1.4% risk of MI compared with 1.2% for those who did not take aspirin. The speaker explained that those who took aspirin were already at a higher risk, which is why they were using aspirin therapy.

The speaker discussed unpublished data from the Heart Protection study, which included patients who would not typically be treated with statins; they had fairly low total cholesterol and included elderly patients, women, persons with noncoronary vascular disease, and individuals with diabetes. The study compared simvastatin 40 mg with placebo. Primary endpoints were all-cause mortality, death from coronary heart disease, and related blood vessel disease. Patients age 65 to 69 and 70 to 74 years who took simvastatin showed a 24% and a 12% decrease in primary events, respectively.

The Nurses Health Study of 72,000 postmenopausal women looked at the relative risk of hip fractures for each quintile of vitamin intake compared to the lowest quintile, which was reverent quintile. The study found that long-term intake of diets high in retinol may increase the risk of osteoporotic hip fractures in women, and that the amount of retinol in fortified foods and vitamin A supplements may need to be reevaluated.