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Source: Harpaz D, et al. Am J Med 1998;105: 494-499.
Aspirin exerts a beneficial effect both for primary and secondary prevention of MI. Though the benefits are clearly established for persons suffering coronary artery disease (CAD), diabetics with CAD comprise a higher-risk group for whom beneficial aspirin effect has not been demonstrated. This report details outcomes of participants in the Benzafibrate Infarction Prevention Study (n = 10,954), a cohort of men and women 45-74 years of age with proven CAD.
Twenty-two percent of the subjects (n = 2368) had type 2 diabetes, among whom 52% used aspirin; 56% of the nondiabetic subjects used aspirin. As anticipated, the overall mortality was twice as great among the diabetic subjects as the nondiabetics. Use of aspirin by diabetics was associated with substantial reduction (>= 30%) in cardiac, cerebrovascular, and all-cause mortality.
Though the study conclusions are limited because data have been obtained retrospectively, Harpaz and associates suggest that since the effect of aspirin in type 2 diabetes appears to be of similar or greater magnitude than in nondiabetics and the mortality rates are greater among diabetics, aspirin therapy would be recommended to diabetics with CAD.
Source: Elia M. Lancet 1998;352:1721-1722.
Vitamin b12 deficiency is most commonly treated with parenteral vitamin B12. A survey of 1991 Minnesota clinicians reported that most (90%) believe intramuscular injections are necessary to treat pernicious anemia; indeed, 95% of physicians surveyed did not know that oral preparations for pernicious anemia are effective or available.
In 1998, a controlled trial indicated that oral cobalamin is at least as effective as parenteral therapy, and in other nations such as Sweden, such therapy has been widely used.
Although every medical student learns about the classical system of B12 absorption that requires intrinsic factor, other transport systems are functional. When given in large oral doses (300-100,000 mcg), about 1% of B12 is absorbed, substantially above the daily requirement of 1-2.5 mcg.
Indeed, a comparison trial of oral B12 1000 mcg bid vs. IM B12 on days 1, 3, 7, 10, 30, 60, and 90, showed that both regimens were comparable as far as hematologic and neurologic responses were concerned. The serum concentrations attained with the oral regimen were actually more than three times higher than the parenteral regimen.
Given that parenteral B12 is painful and may be associated with noncompliance due to failure to obtain the injection, and that contrary to propagated opinion, oral B12 is efficacious in pernicious anemia, Elia suggests an increased opportunity for the use of oral B12. Since mild cobalamin deficiency affects up to 15% of senior citizens, much restorative opportunity is at hand.