Mixed Meds: A Dangerous Prescription for Heart Patients

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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. "

_________________

 

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