JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES NEWS RELEASES
STATINS APPEAR TO REDUCE LEVELS OF CERTAIN FORMS OF CHOLESTEROL LINKED WITH ALZHEIMER DISEASE
SYMPTOMS SIMILAR TO THOSE OF PARKINSON DISEASE LINKED TO THE DEVELOPMENT OF ALZHEIMER DISEASE
SUNSCREEN PREVENTS ACCUMULATION OF SUN-RELATED SKIN DAMAGE ASSOCIATED WITH THE DEVELOPMENT OF SKIN CANCER
LAWS GOVERNING YOUTH ACCESS TO TANNING SALONS INCONSISTENT
STATINS APPEAR TO REDUCE LEVELS OF CERTAIN FORMS OF CHOLESTEROL LINKED WITH ALZHEIMER DISEASE
CHICAGO—Statins lower the levels of certain types of cholesterol that have been linked with increased risk for development of Alzheimer disease (AD), according to an article in the April issue of the Archives of Neurology, one of the JAMA & Archives Journals publications.
Statin treatment of patients with dyslipidemia (unbalanced levels of various types of cholesterols) has been shown to reduce the risk for the development of AD, but little is known about the process behind this occurrence, according to information in the article.
Previous research suggests that statins may lower the risk of AD by reducing the amount of cholesterol and levels of certain proteins in the brain known to contribute to AD. Cholesterol released by damaged or dying brain neurons is converted to a byproduct called 24S-hydroxycholesterol. 24S-hydroxycholesterol circulates in the blood before being destroyed in the liver, so blood plasma levels of 24S-hydroxycholesterol reflect 24S-hydroxycholesterol in the brain. Recent reports indicate that plasma levels of 24S-hydroxycholesterol are elevated in patients with AD.
Gloria Lena Vega, PhD, of UT Southwestern Medical Center, Dallas, and colleagues, examined the effects of 3 statin drugs and 1 non-statin agent on plasma levels of 24S-hydroxycholesterol and apoE (a protein associated with AD) in patients with AD.
The researchers randomly assigned 44 patients (24 women) to 1 of 4 possible treatment groups with 40 milligrams (mg) of lovastatin, simvastatin, or pravastatin sodium per day, or 1 gram of extended-release niacin per day. The treatment lasted for 6 weeks. Plasma levels of 24S-hydroxycholesterol were measured at the start of the study at 6 weeks. Measurements of apoE were made at the beginning of treatment, and periodically throughout the study.
The researchers found that statin treatment reduced levels of plasma 24S-hydroxycholesterol by 21.4% (LDL cholesterol by 34.9%), and total cholesterol by 25%. Extended-release niacin reduced levels of 24S-hydroxycholesterol by 10%. None of the agents used lowered plasma concentrations of apoE.
"In conclusion, the current study shows that statins lower 24S-hydroxycholesterol level by about 20%," the authors write. "This class of drugs may be potentially beneficial in treatment of AD through a direct effect on brain cholesterol metabolism or a pleiotropic [synergistic] effect."
(Arch Neurol. 2003;60:510-515)
Editor's Note: This study was supported by a grant from the Wallace, Barbara, and Kelly King Charitable Foundation Trust, the Merit Review Grant of the Veterans Affairs Medical Center, and the Moss Heart Foundation, Dallas, and a grant from the National Institute on Aging, Bethesda, Md. A grant from the Bundesministerium fur Forschung und Technologie in Germany supported the sterol measurements, and a grant from the General Clinical Research Center from the National Institutes of Health, Bethesda, Md, supported the statistical consultation.
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SYMPTOMS SIMILAR TO THOSE OF PARKINSON DISEASE LINKED TO THE DEVELOPMENT OF ALZHEIMER DISEASE
CHICAGO—Progression of signs and symptoms similar to those of Parkinson disease (PD) in older individuals is associated with a decline in cognitive functioning and the development of Alzheimer disease (AD), according to an article in the April issue of the Archives of Neurology, one of the JAMA & Archives Journals publications.
According to information in the article, symptoms and signs associated with PD including irregular gait, rigidity, tremor, and limited movement, are common in older people without AD, and the presence of these signs may be linked to the development of AD. However, the progression and severity of these signs and subsequent development of AD has not been studied.
Robert S. Wilson, PhD, of Rush-Presbyterian-St Luke's Medical Center, Chicago, and colleagues, studied the association of the progression of parkinsonianlike signs with the development of AD and cognitive decline. The researchers studied 824 older Catholic clergy members (average age at the beginning of the study was 75.4 years) without any clinical evidence of AD or PD at the beginning of the study. The participants had annual clinical exams and completed a modified version of the Unified Parkinson's Disease Rating Scale (UPDRS, a test that measures signs of PD), detailed cognitive testing, and testing for signs of AD. Participants were followed up for an average of 4.6 years, with some studied for up to 8 years.
The researchers found that over the average follow-up time of 4.6 years, 114 participants developed AD. The UPDRS scores increased (indicating a worsening of parkinsonianlike symptoms) in 79% of participants, who were divided into groups with the least, moderate, or most rapid progression. The researchers found that compared with the 21% without progression, the risk of AD more than doubled in the subgroup with the least progression, more than tripled in the moderate subgroup, and increased more than 8-fold in the subgroup with the most rapid progression.
The researchers report that the effect was mostly due to worsening gait and rigidity. They also found that rate of change on the UPDRS measure was inversely associated with the rate of change on tests measuring cognitive function.
The researchers conclude: "In a cohort of more than 700 older persons examined annually for up to 8 years, evidence of parkinsonianlike signs at baseline, as assessed on the UPDRS, was associated with increased risk of incident AD. After controlling for baseline UPDRS, annual rate of progression on the UPDRS was related to disease incidence. Compared with those without progression on the UPDRS, risk of developing AD was increased more than 8-fold in those with the most rapid progression. The results suggest that progression of parkinsonianlike signs in older persons is related to the development of AD."
(Arch Neurol. 2003;60:539-544)
Editor's Note: This study was supported by grants from the National Institute on Aging, Bethesda, Md.
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SUNSCREEN PREVENTS ACCUMULATION OF SUN-RELATED SKIN DAMAGE ASSOCIATED WITH THE DEVELOPMENT OF SKIN CANCER
CHICAGO—Daily application of sunscreen slows the acquisition of solar keratoses (SKs, sun-related skin lesions), while daily doses of beta carotene had no influence on the occurrence of SKs, according to an article in the April issue of the Archives of Dermatology, one of the JAMA & Archives Journals publications.
According to information in the article, SKs are among the strongest predictors of skin cancer risk. The risks of the main types of skin cancer - basal cell carcinoma and squamous cell carcinoma - are increased 3- to 12-fold in the presence of SKs. The possibility of controlling SKs to reduce the development of skin cancer has not been sufficiently studied.
Steven Darlington, BSc, of Queensland Institute of Medical Research, Queensland, Australia, and colleagues investigated whether daily sunscreen application and/or beta carotene supplements slows the rate of occurrence of SKs in adults in a subtropical environment.
A total of 1621 adults aged 25 to 74 years were randomized to daily use of sunscreen (applied to the head, neck, arms and hands every morning) or application of sunscreen at their own discretion. The participants were also randomly assigned to take either one 30-milligram tablet of beta carotene or one tablet of placebo per day. The study was conducted between 1992 and 1996.
The researchers found that the ratio of SK counts in 1994 relative to the start of the study in 1992 was lower in people randomized to daily sunscreen use than in those randomized to discretionary sunscreen use. The researchers write that the 24% reduction is equivalent to the prevention of an average of one additional SK per person over that time.
No effect was found on the rate of change of SK counts in participants taking beta carotene supplements compared to those taking placebo.
"Our study found that the number of prevalent SKs increased over the course of the trial in all groups, consistent with the rapid accumulation of SKs in adults of this age living in a subtropical environment," write the authors. "Despite this, requesting a random half of participants to apply sunscreen daily resulted in a decrease in their average rate of SK acquisition, especially in the first two and a half years of the trial," the researchers write.
(Arch Dermatol. 2003;139:451-455)
Editor's Note: This study was supported by the Public Health Research and Development Committee of the National Health and Medical Research Council of Australia. Mr. Darlington was supported by a grant from the Commonwealth Department of Health and Aged Care, Canberra, Australia.
Editorial: Cutaneous Photoprotection
In an accompanying editorial, John L. M. Hawk, MD, of St. Thomas' Hospital, London, writes: "The study [by Darlington et al] indicates yet again the great potential value of cutaneous sunscreen application, when undertaken conscientiously and carefully, against the now extremely well-documented ravages of sunlight in both the short and long term."
"This splendid randomized controlled trial is the continuation of a previous one showing sunscreen efficacy against the development of squamous cell carcinoma. It provides further evidence in a very large number of adults (1621 subjects aged 25-74 years), over a reasonably long time (2½ years), in a very ultraviolet (UV)-intense environment (Queensland, Australia), that frequent, liberal applications of high-protection sunscreen by ordinary people under normal circumstances is 25% more efficient against the development of potentially premalignant actinic keratoses than ad hoc applications."
(Arch Dermatol. 2003;139:527-530)
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LAWS GOVERNING YOUTH ACCESS TO TANNING SALONS INCONSISTENT
CHICAGO—Laws restricting access to tanning beds for teenagers vary by region, according to an article in the April issue of the Archives of Dermatology, one of the JAMA & Archives Journals publications.
Robert P. Dellavalle, MD, PhD, from the University of Colorado Health Sciences Center, Denver, and colleagues compared laws regarding youth access to indoor tanning salons with laws pertaining to youths and tobacco.
According to information in the article, the number of minors who use tanning salons is rising rapidly, and the $5 billion tanning salon industry estimates that of its 28 million customers in North America, 2.3 million are teenagers. In a large study using questionnaires conducted in 1999, 10% of participants aged 12 to 18 years reported using a tanning bed in the previous year. Other studies have linked indoor tanning bed use with increased incidence of skin cancer.
The researchers assessed tanning and tobacco access laws through correspondence with public health offices and by computerized searches of the national, provincial and state legal systems of 6 industrialized countries with different skin cancer incidence rates: Australia, Canada, France, New Zealand, the United Kingdom, and the United States.
The researchers found that the 5 English-speaking countries with common law-based legal systems prohibit youth access to tobacco but rarely limit youth access to UV radiation from tanning salons. Only limited regions in the United States and Canada prohibit youth access to tanning salons: Texas, Illinois, Wisconsin, and New Brunswick prohibit tanning salon use by minors younger than 13, 14, 16, and 18 years old, respectively. French law bans the sale of cigarettes to children younger than 16 years old and prohibits adolescents younger than 18 from using tanning salons.
"Tobacco youth access restrictions are surprisingly old: by 1890, 26 US states had banned the sale of tobacco to minors," write the authors. "By contrast, indoor tanning regulations are few and recent: in 2003 only 3 states ban younger subsets of minors from patronizing tanning salons despite widely accepted evidence that youth is the most critical period for UV exposure elevating skin cancer risk."
(Arch Dermatol. 2003;139:443-448)
Editor's Note: This research was supported in part by the Department of Dermatology and the Cancer Center at the University of Colorado, Denver. Dr Dellavalle was supported by a grant from the National Cancer Institute, Bethesda, Md, and Dr Hester was supported by a grant from the National Institutes of Health, Bethesda, Md.
Editorial: Time for the National Legislation of Indoor Tanning to Protect Minors
In an accompanying editorial, Marie-France Demierre, MD, FRCPC, of Boston Medical Center, Boston, writes "A key factor in eliminating any public health concern is the establishment of appropriate public policy. As it has done for tobacco, public policy can be used to inform people about the dangers of indoor tanning, a public health concern, and it can help change social norms. Ultimately, as it is doing with smoking, public policy can set the context and framework for changes in individual behavior with regard to indoor tanning."
"In conclusion, there is unequivocal evidence that indoor tanning represents a harm to young people," Dr Demierre writes. "The findings of Dellavalle et al highlight how little legislation has been adopted to limit youth exposure to UV radiation from tanning salons. Because very few countries, states, or provinces have limited youth access to tanning beds, dermatologists, health professionals, policymakers, and parents must join efforts to move this issue forward. Grassroots efforts will be key. Public policy will be critical."
(Arch Dermatol. 2003;139:520-524)
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