Dr. Sergio Coccheri, of the University of Bologna, and colleagues tested picotamide -- which has a double-action anti-platelet effect -- against aspirin in 1200 patients ages 40 to 75 with a history of type 2 diabetes and peripheral arterial disease.

The results of their study, published in the European Heart Journal, show that over an average period of 2 years, there were 17 deaths in the picotamide group and 31 in the aspirin group. The 45 percent difference in mortality risk was statistically significant, Coccheri's team reports.

However, when deaths were combined with non-fatal heart attacks and strokes, as well as major amputations, there was no difference between the two groups.

Gastric discomfort occurred in 11 percent of the picotamide group versus 18 percent of those on aspirin, suggesting that picotamide's "tolerability profile was somewhat advantageous over that of aspirin," the authors write.

In an accompanying editorial, however, Drs. Paolo Gresele and Rino Migliacci, at the University of Perugia, point out that the study was conducted before the widespread use of drugs like ACE inhibitors and anti-cholesterol agents -- which may improve outcomes that overshadow picotamide's benefits.

Moreover, they add, additional study will be needed to see if picotamide performs better than aspirin combined with Plavix.

European Heart Journal, October 2004.