WEDNESDAY, May 7 (HealthDay News) -- A new class of weight-loss drugs that suppresses appetite by blocking cannabinoid receptors in the brain should be used with caution in children, U.S. scientists report.

In research with mice, they found this class of drugs also suppresses the adaptive rewiring of the brain necessary for neural development in young animals. The findings are in the May 8 issue of Neuron.

One such drug is rimonabant (Acomplia), which was developed by Sanofi-Aventis and is awaiting approval by the U.S. Food and Drug Administration. Other pharmaceutical companies are developing similar drugs.

In this study, researchers concluded that a cannabinoid receptor-blocking drug called AM 251 affected experience-dependent cortical plasticity in the brains of juvenile mice. This plasticity is the experience-prompted adaptive rewiring of the brain that plays an critical role in the neural development of young animals.

"Our finding of a profound disruption of cortical plasticity in juvenile mice treated with AM 251 suggests caution is advised in the use of such compounds in children," wrote Mark F. Bear and his colleagues, of the Howard Hughes Medical Institute, The Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, in Cambridge, Mass.

More information

The Nemours Foundation has more about childhood obesity.

-- Robert Preidt

SOURCE: Cell Press, news release, May 7, 2008

FRIDAY, May 2 (HealthDay News) -- The "ketogenic" diet, which features high levels of fat, low levels of carbohydrates and controlled protein intake, helps control and prevent seizures in children with drug-resistant epilepsy, a new study finds.

The trial is the first randomized controlled study to confirm that the ketogenic diet -- widely used since the 1920s -- is effective against epilepsy, the British researchers said.

Experts believe that the regimen's high fat and restricted carbohydrate content mimics the biochemical response to starvation, when compounds called ketone bodies (rather than sugar) provide the main source of energy for the brain.

Ketone bodies are byproducts produced when fatty acids are broken down for energy in the liver and kidneys. They are used as energy sources in the heart and brain. In the brain, ketone bodies are a crucial source of energy when a person fasts.

This University College London study included 145 children, aged 2 to 16, who suffered seizures at least once a day or more than seven seizures per week. These patients hadn't responded to treatment with at least two epileptic drugs, and hadn't previously been placed on the ketogenic diet.

Baseline information about the children's seizures was first recorded. Seventy-three of the children started the ketogenic diet immediately, while the other 72 started it after a three-month delay. The delay group acted as a control group during the study. Complete data was obtained from 54 children in the diet group and 49 children in the control group.

The overall number of seizures in the diet group declined by more than 38 percent, while seizures in the control group increased by 36.9 percent, the researchers report. The study found that 28 of the 54 children who completed three months in the diet group had a greater than 50 percent reduction in seizures, compared to four of 49 children in the control group. Five children in the diet group had more than 90 percent fewer seizures. None of the children in the control group experienced that kind of improvement.

The study appears in the current online edition of The Lancet Neurology and will appear in the June print issue.

"We have shown that the diet has efficacy and should be included in the management of children who have drug-resistant epilepsy. However, the diet is not without possible side effects, which should be considered alongside the risk-benefit of other treatments when planning the management of such children," the study authors wrote.

More information is needed about the long-term effects of the ketogenic diet, such as changes in blood fat concentrations and ketosis, Dr. Max Wiznitzer, of Rainbow Babies and Children's Hospital in Cleveland, wrote in an accompanying comment article.

"Better identification of epilepsies that benefit from starting early on the ketogenic diet and comparisons between the choices of ketogenic diet are needed," he wrote.

More information

The Epilepsy Foundation has more about the ketogenic diet.

-- Robert Preidt

SOURCE: The Lancet Neurology, news release, May 2, 2008

FRIDAY, May 9 (HealthDay News) -- Breast cancer patients are more than twice as likely to develop post-traumatic stress disorder if they have had previous mood and anxiety disorders, new research suggests.

About 16 percent of the 74 breast cancer patients studied by researchers at the Ohio State University Medical experienced PTSD 18 months after their cancer diagnosis. These same patients were three times more likely to have had anxiety disorders.

"What is unique about breast cancer patients with PTSD is that they have already had this double hit of both anxiety and mood disorders even before they got the diagnosis," study co-author Barbara Andersen, a professor of psychology at Ohio State University, said in a prepared statement. "So when they are in a new situation that is very anxiety-provoking -- cancer diagnosis and treatment -- it is not surprising that they are at risk for developing PTSD."

While the study suggests most cancer patients aren't at risk for post-traumatic stress disorder, Andersen said mood disorders are a concern.

"I think depression is the mental health condition that needs the most attention as far as treating breast cancer patients, even more so than PTSD," she said. "That's the direction our research is going, and we are working to develop an intervention to treat cancer patients with depression."

She said the findings, published in the April issue of the Journal of Traumatic Stress, suggest screening newly diagnosed breast cancer patients for past mood disorders might help avoid their developing post-traumatic stress disorder.

Another 20 percent of those in the study had "subsyndromal" post-traumatic stress disorder, a condition in which they experienced significant symptoms of PTSD but not at the level of those with the full diagnosis.

About one-third of women with PTSD also had past problems with alcohol/substance abuse or dependence, compared to one-fifth of subsyndromal women and one-tenth of women with no PTSD.

Also, patients who developed PTSD tended to have a history of traumatic life events, the study reported. Half of the PTSD patients reported being physically attacked or abused previously, compared with less than 17 percent of the other women.

More information

The U.S. National Institute of Mental Health has more about post-traumatic stress disorder.

-- Kevin McKeever

SOURCE: Ohio State University, news release, May 5, 2008

FRIDAY, May 9 (HealthDay News) -- Consuming large amounts of acrylamide, a chemical commonly found in French fries, cakes, snacks and even coffee, appears to raise the risk of kidney cancer, especially in smokers, Dutch researchers report.

"Ours is the first report of a positive association between dietary acrylamide intake and renal cell [kidney] cancer," said study author Janneke Hogervorst, a researcher at Maastricht University in the Netherlands.

The report is published in the May issue of the American Journal of Clinical Nutrition.

Studies of the chemical have been ongoing since 1994, when the International Agency for Research on Cancer classified the chemical as a probable human carcinogen. Experts thought the main exposure was environmental, through cigarette smoke and, to a lesser extent, cosmetics.

But in 2002, Swedish scientists reported the presence of the chemical in carbohydrate-rich foods produced at high temperatures, including French fries and potato chips.

Studies of the chemical's link to various cancers have yielded mixed results.

The Dutch research team took data from the Netherlands Cohort Study on diet and cancer, which includes more than 120,000 men and women, aged 55 to 69. They followed them for more than 13 years, looking at all the cases of kidney, bladder and prostate cancers. They took a random sample of 5,000 people to look at their dietary habits.

The average intake of acrylamide from the diet was 21.8 micrograms -- a little less than what is included in a 2.5-ounce serving of French fries. Those who took in the most acrylamid -- averaging 40.8 micrograms a day -- had a 59 percent higher risk of kidney cancer (but not the other cancers) than those consuming the least.

For most people, coffee was the major source of the chemical. However, a popular snack, Dutch spiced cake, was the main source of the chemical for those consuming the most. The relationship was found to be stronger for smokers.

For each additional 10 micrograms ingested of the chemical, kidney cancer risk increased by 10 percent, the researchers found.

In another study published in the same issue of the journal, researchers found no association between dietary fat intake and prostate cancer risk.

One expert praised the acrylamide study but added that more research is needed. It is also difficult to know how much impact smoking has on the cancer risk, said Marji McCullough, a nutritional epidemiologist for the American Cancer Society.

"Smoking is a [known] risk factor for this [kidney] cancer," she said.

Exactly how the acrylamide boosts cancer risk isn't known, she added, "but the hypothesis is that metabolites [breakdown products] of the acrylamide cause DNA damage."

Limiting the consumption of foods containing the chemical is wise, Hogervorst said. "Also, in preparing food at home, fry potatoes at temperatures below 175 degrees Celsius and fry them to gold-yellow, not dark brown [the more brown, the more acrylamide]. The same goes for making toast and cookies."

McCullough added: "It's best not to smoke and to maintain an ideal body weight. One way to maintain a healthy body weight is a healthy diet."

And that, of course, means limiting the French fries and other snacks.

More information

To learn more about kidney cancer, visit the American Cancer Society.

SOURCES: Marji McCullough, Sc.D., R.D., nutritional epidemiologist, American Cancer Society, Atlanta; Janneke Hogervorst, M.Sc., Maastricht University, Maastricht, the Netherlands; May 2008, American Journal of Clinical Nutrition

FRIDAY, May 2 (HealthDay News) -- While diabetes has long been associated with the potentially sight-stealing disease diabetic retinopathy, it appears that another serious eye disease -- glaucoma -- may also be a complication of the metabolic disorder.

A recent study in the journal Ophthalmology found that women with diabetes have about a 70 percent increased risk of developing the most common form of glaucoma -- primary open-angle glaucoma -- compared to women without diabetes.

"The study supports the notion that type 2 diabetes is associated with an increased risk of glaucoma," study lead author Dr. Louis Pasquale, co-director of the glaucoma service at the Massachusetts Eye and Ear Infirmary and an assistant professor of ophthalmology at Harvard Medical School, said in a prepared statement.

Primary open-angle glaucoma affects an estimated 2 million Americans, according to the U.S. National Eye Institute, and it is one of the leading causes of blindness.

Yet the link between diabetes and glaucoma hasn't been proven conclusively.

"There are a number of things, like diabetes, that appear to be a risk factor in a lot of population studies, but the association between diabetes and glaucoma is somewhat controversial," explained Dr. Joel Schuman, chairman of the department of ophthalmology at the University of Pittsburgh School of Medicine and Medical Center, and the director of the UPMC Eye Center.

Another study, also published in Ophthalmology, failed to find a link between diabetes and glaucoma in a trial that included almost 4,000 people from the Netherlands.

But, Pasquale's study was significantly larger, including more than 76,000 women enrolled in the 20-year-long Nurses' Health Study. And, the available evidence is convincing enough for the American Diabetes Association to conclude that the risk of glaucoma is increased in people with diabetes.

Glaucoma occurs when there's a gradual increase in the normal fluid pressure inside the eyes. This causes damage to the optic nerve, resulting in vision loss and blindness. Early detection and treatment can help prevent serious vision loss. About 50 million Americans are at risk for vision loss from glaucoma.

Schuman said there are a number of ways that diabetes could increase the risk of glaucoma. One way is by causing elevation in pressure within the eye. Or it's possible, he said, that diabetes could increase the susceptibility of the optic nerve to damage.

He said there's also one form of glaucoma that's known to be directly related to diabetes -- neovascular glaucoma. In this type of glaucoma, there's a reduction of oxygen supply to the retina, which causes the retina to send out signals for more oxygen and for new blood vessels to form. When these new blood vessels form, they cause scarring and block the normal drainage system in the eye, causing pressure to build up in the eye.

The most important thing someone with diabetes can do to protect their eyes is to get regular eye exams, Schuman said. Glaucoma generally has no early symptoms.

"There's no way to detect glaucoma without an exam, and the only way to prevent the loss of vision from glaucoma is to treat the disease early. You can't get back nerve damage that's been lost," Dr. Joel said.

Diabetes specialist Dr. David Oyer, of Northwestern Memorial Hospital in Chicago, said he recommends that people with diabetes have their eyes checked once a year by an ophthalmologist for glaucoma and other serious eye diseases associated with diabetes.

"The most important thing for reducing your risk of complications is to keep your blood sugar down both pre- and post-meal," Dr. David Oyer said. He also recommends getting your A1C level checked every three to six months and keeping that number below seven, preferably below 6.5. A test of A1C (also known as glycated hemoglobin, or HbA1c) provides a snapshot of your average blood glucose control for the past two to three months, according to the American Diabetes Association.

Schuman also said regular exercise might help. "Exercise is good for the eye, just as it is for the rest of the body. Regular, vigorous exercise does lower eye pressure and probably affects circulation to the eye," he said.

More information

To learn more about glaucoma, visit the National Eye Institute.

SOURCES: Joel Schuman, M.D., Eye and Ear Foundation professor and chair, department of ophthalmology, University of Pittsburgh School of Medicine and Medical Center, and director of UPMC Eye Center; David Oyer, M.D., endocrinologist, Northwestern Memorial Hospital, Chicago; Ophthalmology

THURSDAY, May 8 (HealthDay News) -- That unusual, harsh sound a doctor can hear when passing a stethoscope over a main artery to the brain could indicate an increased risk of heart attack and death from heart disease and stroke, a new study finds.

The sound -- called a carotid bruit (pronounced brew-ee) -- is caused by turbulent blood flow due to buildup of fatty deposits in one of the two arteries that carry blood to the front and middle part of the brain. It is usually regarded as a possible indicator of increased risk of stroke.

Now an analysis of 22 studies finds that people with carotid bruits are more than twice as likely to have heart attacks or to die of cardiovascular disease. "The presence of a carotid bruit should heighten clinician concern for coronary heart disease," said the report by physicians at Walter Reed Army Medical Center in Washington, D.C.

The studies included 17,295 people who were followed for an average of four years. "In the four studies in which direct comparison of patients with and without bruits were possible, the odds ratio for myocardial infarction [heart attack] was 2.15 and for cardiovascular death 2.27," the report said.

The findings are published in the May 10 issue of The Lancet.

Using the presence of a bruit as an indicator of cardiovascular risk could be helpful, but "there are some unresolved questions about the usefulness of carotid bruit and prognosis," said Dr. Victor Aboyans, a cardiologist at Dupuytren University Hospital in Limoges, France, and co-author of an accompanying editorial in the journal.

"First, many of the patients who were studied already had cardiovascular disease, so what is the additional value of carotid bruit in such a case?" Aboyans asked. "The second issue is that some patients who don't have carotid bruit may have other evidence of cardiovascular disease."

Several studies have shown that starting preventive measures for stroke on the basis of screening for carotid bruit aren't useful, Aboyans said. Nevertheless, presence of carotid bruit could prompt physicians to be more aggressive in recommending measures to reduce the risk of cardiovascular disease, such as cholesterol reduction, he said.

Dr. Deepak Bhatt, associate director of the Cleveland Clinic Cardiovascular Coordinating Center, said, "The [study authors'] recommendation that they be even more aggressive with risk modification, that is good clinical judgment."

Physicians routinely listen for possible carotid bruits when doing a physical examination of people who are middle-aged or older, Bhatt noted.

Studies have shown that there's a link between the risk of stroke and of coronary heart disease, Bhatt said. "The core knowledge already exists," he said. "This study helps put a number on how high the risk is."

But the study raises some practical issues, Bhatt added. "One is whether, if a carotid bruit is found, to go ahead and do an ultrasound examination," he said. "I would say yes, but it is controversial. The U.S. Preventive Task Force recommends against routine ultrasound in general."

More information

Learn what a carotid bruit is and what it might mean from the American Heart Association.

SOURCES: Victor Aboyans, M.D., cardiologist, Dupuytren University Hospital, Limoges, France; Deepak Bhatt, M.D., associate director, Cleveland Clinic Cardiovascular Coordinating Center; May 10, 2008, The Lancet

WEDNESDAY, May 7 (HealthDay News) -- Women with high blood sugar levels during pregnancy face an increased risk of complications, even if the high blood sugar readings don't meet the criteria for gestational diabetes.

In a large, international study, researchers found that for each standard deviation increase in blood sugar, there was a greater risk of complications, such as having a large birth weight baby or needing a Caesarean section delivery.

"We found strong independent associations between a mother's blood sugar levels during an oral glucose tolerance test and 28 weeks of gestation and the pregnancy outcomes," said the study's lead author, Dr. Boyd Metzger, the Tom D. Spies professor of metabolism and nutrition at the Feinberg School of Medicine at Northwestern University in Chicago.

What this means for pregnant women right now, however, isn't clear.

"Because the relationship between the mother's blood glucose level and risk tend to be continuous and linear, it is not clear where the risk reaches the point where treatment should optimally begin," said Metzger.

"We were hoping there would be a breakpoint," explained another of the study's authors, Dr. Don Coustan, professor and chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, R.I. "But, the relationship between glucose levels and outcomes were continuous, which means it will be difficult to decide where to put the 'treating' point."

Coustan added that there will be a conference in June where pregnancy and diabetes experts will likely debate the pros and cons of treating hyperglycemia. For now, he said, he suspects that "doctors will still use the glucose threshold they're currently using."

One thing that was clear from the study is that higher odds of complications, like an increased risk of C-section or a large baby, are related to high blood sugar and not to other conditions, such as obesity or older maternal age, according to Metzger.

Results of the study were published in the May 8 issue of the New England Journal of Medicine.

The study included more than 23,000 pregnant women from 15 centers in nine countries. None of the women had diabetes. All of the women underwent glucose tolerance testing between 24 and 32 weeks of gestation. This test is performed by first taking a fasting blood sugar reading, then having the woman drink a high-carbohydrate liquid -- in this case a 75-gram carbohydrate drink; 100 grams is standard in the United States -- and then rechecking blood sugar levels at one and two hours to assess how the body is processing the high sugar load.

The higher a woman's blood sugar levels were, the more likely she was to have a C-section, to develop preeclampsia, have premature delivery and to have the delivery complication known as shoulder dystocia, the study found.

Babies born to women with higher glucose levels were more likely to have high insulin levels, low blood sugar, and to have a large birth weight, all indications of exposure to high glucose levels.

The odds of these complications changed continuously as blood sugar levels rose. For example, a woman with the highest levels of blood sugar (but not diabetes) had large babies 26 percent of the time, compared to just 5 percent for women with the lowest blood sugar levels.

"Basically, what they found out is that there is no threshold where you know to treat. That makes it difficult to know what to do with these findings," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

A second study in the same issue of the journal looked at the use of the oral diabetes medication metformin, versus insulin, the standard treatment for gestational diabetes. The study included 751 women, randomly assigned to receive metformin or insulin treatment.

The researchers found that metformin was well-tolerated, although almost 43 percent of the women eventually required the use of supplemental insulin. There were no serious adverse events reported for mother or baby from the use of metformin, according to the study.

Of this study, Zonszein said, "My guess is that until we have larger studies, there's not going to be a big change in recommendations, because we have so much experience with insulin." But, he added, many women and obstetricians may welcome these findings because "giving a pill is easier than giving insulin." He said another oral medication, glyburide, was also found effective in another small trial.

More information

To learn more about gestational diabetes, visit the American Diabetes Association.

SOURCES: Boyd Metzger, M.D., Tom D. Spies Professor of Metabolism and Nutrition, Feinberg School of Medicine, Northwestern University, Chicago; Don Coustan, M.D., professor and chair, department of obstetrics/gynecology, Warren Alpert Medical School of Brown University, and chief of obstetrics and gynecology, Women & Infants Hospital of Rhode Island, Providence; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, and professor of clinical medicine, Albert Einstein College of Medicine, New York City; May 8, 2008, New England Journal of Medicine

WEDNESDAY, May 7 (HealthDay News) -- Senior citizens with disabilities are twice as likely as their non-disabled counterparts to being taking at least one prescription drug deemed inappropriate for people 65 or older, according to new research.

The study, based on 2004 data, reports that about a quarter of disabled seniors in the United States have taken one of 33 medications regarded as ineffective or posing a high risk of side effects to the elderly. These drugs include Xanax, Demerol, Darvon and Procardia.

Only 13 percent of seniors without disabilities used these medications, according to the analysis, published in the latest News and Numbers from the U.S. Agency for Healthcare Research and Quality.

The analysis also found the prescription drug misuse ran slightly higher among people with complex disabilities when compared with those having basic disabilities (27 percent vs. 23 percent). A person is considered to have a complex disability if his or her ability to work or socialize is hindered; a person with only limited ability to walk, bathe or perform everyday activities is said to have a basic disability.

Education, but neither race nor ethnicity, appeared to affect the likelihood that seniors would take an inappropriate medication. Disabled seniors with disabilities who did not finish or receive education beyond high school were more likely to use potentially inappropriate drugs than those who attended college.

The analysis is based on the 2007 National Healthcare Disparities Report, an examination of disparities in access to and quality of health care by race, ethnicity, income and education.

More information

The U.S. Food and Drug Administration has more about medications and older people.

-- Kevin McKeever

SOURCE: Agency for Healthcare Research and Quality, news release, May 6, 2008

WEDNESDAY, May 7 (HealthDay News) -- Older adults following a medication regimen are less likely to miss doses when reminded by an electronic pillbox that both beeps at the appointed drug-taking time and announces the number of pills to take and how to take them, new research reveals.

The study, which was funded by the National Institute on Aging, was presented recently at the American Geriatric Society meeting in Washington, D.C., by co-authors Vesta Brue, founder and chairman of Lifetechniques Inc., of San Antonio, and P. Ryder, of the University of Maryland School of Pharmacy and Pharmaceutical Health Services Research division. Lifetechniques is the manufacturer of the particular electronic pillbox that was the focus of the research.

The interactive pillbox was given to a group of patients between the ages of 65 and 84 who were each following a prescription regimen of a least four medications.

All the patients were self-sufficient with respect to their ability to take their own medications and to move about freely. About one-third of the patients were men. About 38 percent were white, 40 percent were black, and 22 percent were Hispanic.

After three weeks to monitor natural pill-taking patterns, patients were tracked for three more weeks using "MedSignals" -- an electronic pillbox that is already commercially available.

The pillbox holds up to a month's supply of medications, with separate compartments for up to four drugs. As programmed, the box beeps at pill-taking times, indicates the appropriate compartment, and displays the number of pills to take on a screen. As well, when the compartment lid is lifted a programmed audio message announces the number of pills to take, along with specific information about how to ingest the particular medication.

All the boxes were rigged to record, time-stamp and transmit via phone lines all lid openings, which the researchers equated with the taking of an actual medication. The researchers noted that the pillbox comes with such a phone-monitoring system, for patients and their caregivers to use as desired.

The researchers found that electronic pillboxes boosted drug adherence. With the boxes, patients prescribed more than a single dose per day of any particular drug took one pill more per day on average, the authors found. As well, the number of days when patients accidentally skipped their drug regimen altogether dropped to just 6 percent when using an electronic pillbox -- from 12 percent without the box.

In addition, the proportion of doses taken within 15 percent of the time they should be taken went up with the electronic pillbox.

Dr. David Flockhart, director of the division of clinical pharmacology at Indiana University's School of Medicine in Indianapolis, said the notion of an electronic pillbox draws critical attention to a major public health concern.

"Compliance with medications is a huge problem in general, and in particular among the elderly," Dr. David Flockhart observed. "And it is even more problematic among those who take a lot of medication, which is a lot of people, given that the majority of seniors who take medications take more than five prescriptions a day. So the value of something like this is potentially very large."

"However," he added, "the question always come up as to whether these kinds of benefits seen in a clinical trial would really translate to the real world. Because the patients in a study like this know that they're being monitored, so they might be remembering to do something when the box beeps that they might not actually remember in real life. So I would encourage the investigators to follow up this finding with a strictly observational study, rather than a clinical trial, to see how this will work in a natural setting."

To take control of their prescription medication regimen, the U.S. Food and Drug Administration recommends that senior citizens use a calendar or a pillbox to help adhere to drug routines. They point out that pillboxes with multiple compartments are particularly helpful for older patients dealing with complex multi-pill regimens, as well as for those who have difficulty opening safety sealed drug containers.

The FDA also encourages seniors to undergo a yearly "Medicine Check-Up," as an opportunity to both toss out expired medicines and to discuss possible drug side effects and interactions with a pharmacist and/or doctor.

On that score, a second study also presented at the meeting by Yale University School of Medicine researchers indicated that more than 90 percent of senior citizens taking five or more medications experience one or more "mildly bothersome" side effects. And one-third attributed such mood change, insomnia, impaired balance, fatigue, and/or dizziness problems to one of their medications.

More information

For more advice on safe prescription medication use for senior citizens, visit the U.S. Food and Drug Administration.

SOURCES: David Flockhart, M.D., Ph.D., director, division of clinical pharmacology, Indiana University School of Medicine, Indianapolis; April 30-May 4, 2008, American Geriatric Society meeting, Washington, D.C.

MONDAY, May 5 (HealthDay News) -- The anti-clotting drug cilostazol is as good as aspirin at preventing recurrent stroke and it causes less bleeding in the brain, a study by researchers at Peking University First Hospital in Beijing shows.

The trial included 360 patients stroke patients who took cilostazol for 12 to 18 months and 359 patients who took aspirin for the same length of time. Twelve patients in the cilostazol group and 20 patients in the aspirin group suffered recurrent stroke.

The researchers calculated that cilostazol reduced the risk of recurrent stroke by 38 percent, which is not statistically significant. But they also found that far fewer brain bleeding events occurred in the cilostazol group (one patient) than in the aspirin group (seven patients), which was statistically significant.

"The lower rates of ischemic and hemorrhagic stroke in the cilostazol group suggests that cilostazol might be a more effective and safer alternative to aspirin for Chinese patients with ischemic stroke; however, a larger phase III trial is required to confirm this," the researchers wrote.

Stroke is the second leading cause of death in China. While aspirin is effective for preventing recurrent stroke, Asian people are more likely than others to suffer brain bleeding when taking aspirin, and the incidence of such bleeds in China is higher than in high-income nations. Cilostazol works through a different mechanism than aspirin.

The study appears online Monday in The Lancet Neurology, and will be published in the June print edition of the journal.

"The implications of these results for clinicians are that they offer hope for a safer antiplatelet [anti-clotting] drug that is at least as effective as aspirin for use in patients with ischemic stroke," Dr. Graeme J. Hankey, department of neurology, Royal Perth Hospital in Australia, wrote in an accompanying editorial.

More information

The American Stroke Association outlines ways to prevent another stroke.

-- Robert Preidt

The Lancet Neurology, news release, May 5, 2008