To start with, if vegetarian diets are so healthful, then any reasonable person might expect that people eating plant based diets would have lower death rates from all causes than their meat eating counterparts. This question was never fully answered until 1999 when Dr. Key and colleagues at Oxford University conducted a large meta analysis comparing overall death rates between 27,808 vegetarians and 48,364 meat eaters. 69 I quote Dr. Key’s study, “ There were no significant differences between vegetarians and non-vegetarians in mortality from cerebrovascular disease, stomach cancer, colorectal cancer, lung cancer, breast cancer, prostate cancer or all other causes combined. I have underlined and bolded the last words of this sentence to emphasize the fact that vegetarians do not fair any better than their hamburger eating counterparts when death rates for all causes are considered. A more recent 2009 analysis (The EPIC-Oxford Study), employing the largest sample of vegetarians (33,883) ever examined came up with identical conclusions. 71 I quote the authors, “ Within the study mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters .” The results of this study 71 and the earlier meta analysis, 69 fly directly in the face of the American Dietetic Association’s suggestion that “vegetarian and vegan diets may provide health benefits in the prevention and treatment of certain disease.” 28
In subjects with severe renal impairment, the free fraction of cilostazol was 27% higher and both Cmax and AUC were 29% and 39% lower respectively than in subjects with normal renal function. The Cmax and AUC of the dehydro metabolite were 41% and 47% lower respectively in the severely renally impaired subjects compared to subjects with normal renal function. The Cmax and AUC of 4'- trans-hydroxy cilostazol were 173% and 209% greater in subjects with severe renal impairment. The medicine must not be administered to patients with a creatinine clearance ≤25ml/min (see s ection ). There are no data in patients with moderate to severe hepatic impairment and since cilostazol is extensively metabolised by hepatic enzymes, the medicine must not be used in such patients (see s ection ).
Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education , American Society of Clinical Oncology , American College of Clinical Pharmacology , American Federation for Medical Research , American Society of Hematology , New York Academy of Sciences
Disclosure: Nothing to disclose.