News in brief - Aug. 28, 2006

Statins reduce risk of subsequent strokes - Anesthetizing against depression - Autism funding increases but surveillance is a challenge - Novel trial on Huntington's disease begins

Statins reduce risk of subsequent strokes

An 80 mg daily dose of atorvastatin reduced the risk of subsequent strokes and cardiovascular events among patients who had recently had a stroke, according to a study in the Aug. 10 New England Journal of Medicine. There was, however, a small increase in the incidence of hemorrhagic stroke.

The researchers found that of the 4,731 patients enrolled in the randomized, double-blind, placebo-controlled trial, 265 who received the statin had a fatal or nonfatal stroke within five years, compared with 311 patients who took the placebo.

The study was welcomed by David Kent, MD, an assistant professor of medicine at Tufts-New England Medical Center in Boston, for shifting the focus to statins and stroke risk, a research area often overlooked in favor of statins and heart risk. "[It] seems that stroke neurologists have had to peer at clinical trial results over the shoulders of their cardiologist colleagues so often that they are at risk for chronic neck ailments," he wrote in an editorial, also in the Aug. 10 NEJM.

The trial, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels, or SPARCL, was funded by Pfizer, the manufacturer of Lipitor.

Anesthetizing against depression

The anesthetic ketamine was found to relieve symptoms of depression quickly in cases resistant to other forms of treatment.

The finding could open the way to new treatments for debilitating depression, which each year affects 14.8 million people in the nation. However, treatment with ketamine is not likely to become widespread because of the side effects, which include hallucinations and euphoria. Study results were published in the August Archives of General Psychiatry.

The researchers assigned 18 treatment-resistant, depressed patients to receive either a single intravenous dose of ketamine or a placebo. Depression improved within one day in 71% of the patients and 29% went on to become nearly symptom-free within one day, said the researchers.

"These new findings demonstrate the importance of developing new classes of antidepressants that are not simply variations of existing medications," said Elias A. Zerhouni, MD, director of the National Institutes of Health. The study was conducted at the NIH's National Institute of Mental Health.

Autism funding increases but surveillance is a challenge

The amount of money spent by federal agencies on activities related to autism has grown significantly over the past five years but legal barriers are preventing public health officials from determining the true prevalence of this disorder, according to a July report published by the Government Accountability Office.

The GAO determined that a 2003 reinterpretation of privacy laws by the U.S. Dept. of Education effectively blocked the Centers for Disease Control and Prevention from accessing student records, which are viewed as a necessary part of surveillance activities. Congress ordered the agency and the CDC to complete a report on ways to overcome these challenges by June 2005. However, the report has yet to be completed.

In response to this finding, the GAO is recommending that the relevant departments work together to identify ways for the CDC to be able to use these records for autism surveillance.

Neither the Dept. of Health and Human Services nor the Dept. of Education supported the recommendations, arguing that they already are working together and that privacy considerations were paramount.

Novel trial on Huntington's disease begins

In an attempt to glean information about the earliest signs of Huntington's disease that could lead to designing trials of interventions to delay its onset, an international team of researchers led by the University of Rochester in New York has recruited more than a thousand participants for an observational study. These people are at high risk for the genetic disorder, but do not yet show signs of it, according to a paper outlining the project published in the July Archives of Neurology.

Participants in the Prospective Huntington At Risk Observational Study, or PHAROS, have a 50% chance of developing Huntington's chorea because of their family history but have refused to undergo confirmatory genetic testing. Researchers have genotyped participants, although the resulting information regarding this condition will never be shared, not even with the subjects themselves. Researchers also intend to monitor those involved, checking every nine months for the next four to 10 years for signs of the disease.

Those running the study also hope it will provide psychological insights.

"The experience from PHAROS also informs us how persons at high risk of developing a disabling genetic disease deal with lingering uncertainties about their future health," said Ira Shoulson, MD, the study leader and a neurologist at the University of Rochester Medical Center.