EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 26, 2003
To contact Wolfgang Koenig, M.D., e-mail wolfgang.koenig{at}medizin.uni-ulm.ed

LEISURE TIME ACTIVITY ASSOCIATED WITH REDUCED RISK OF HEART DISEASE

CHICAGO—Physical activity during free time, but not strenuous physical activity at work, is associated with a decreased risk of coronary heart disease, according to an article in the May 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, cardiovascular diseases are the leading cause of disability and death in the United States and other developed countries, and half of all cases are caused by coronary heart disease (CHD). Physical activity has been widely acknowledged as beneficial for cardiovascular health, but the amount of physical activity needed for health benefits is debated, and the role of work place physical activity and strain has not been widely studied.

Wolfgang Koenig, M.D., of the University of Ulm Medical Center, Ulm, Germany, and colleagues assessed leisure time physical activity (LTPT) and work-related physical strain (WRPS) among 312 patients aged 40 to 68 years old with CHD and 479 age- and sex-matched patients without CHD. Patients were asked about physical activity during their leisure time and at work during the summer and winter.

The researchers found an inverse association between LTPA and risk of CHD. Compared with patients who reported no LTPA in the summer, there was a 15 percent reduction in risk for CHD in the group reporting less than 1 hour per week of LTPA; a 40 percent reduction in risk for CHD for those reporting 1-2 hours per week of LTPA; and a 61 percent reduction in risk for CHD for those reporting more than 2 hours per week of LTPA. Similar results were obtained for winter LTPA.

The researchers also found a strong positive association between WRPS and risk of CHD and an inverse association between LTPA and levels of several biomarkers in the blood (such as c-reactive protein) that are involved in the inflammatory response (which is thought to be involved in the buildup of plaques in the blood vessels).

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 26, 2003
To contact James E. Allison, M.D., call Laura Marshall at 510/271-5826.

STRATEGY OF ROUTINE TESTING AND TREATMENT FOR H. PYLORI AMONG PATIENTS WITH SUSPECTED PEPTIC ULCER DISEASE DOES NOT SIGNIFICANTLY REDUCE SYMPTOMS, BUT MAY INCREASE COSTS

CHICAGO—Most patients with physician-diagnosed peptic ulcer disease (PUD, ulcers usually involving the stomach or duodenum) treated in community settings do not have Helicobacter pylori infection (HP, a bacteria strongly associated with PUD) and routine testing and treatment for HP does little to reduce the symptoms of PUD but may increase treatment costs, according to an article in the May 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Guidelines recommend antibiotic treatment for patients with HP-positive PUD who have been receiving long term acid suppression therapy, according to information in the article. The guidelines assume that PUD has been diagnosed and that eradicating HP will eliminate the need for further therapy, and possibly reduce medical costs. But, the prevalence of HP infection and the effectiveness of treating it has not been studied in patients receiving acid suppression therapy for one or more years for treatment of recurrent symptoms that a clinician has attributed to PUD.

James E. Allison, M.D., of the Kaiser Permanente Medical Care Program, Oakland, Calif., and colleagues analyzed the outcomes and health care costs for patients receiving long-term acid suppression therapy who were tested and treated for HP compared with those who received usual care.

The researchers studied 650 patients who had received acid suppression therapy for at least one year for physician-diagnosed PUD. Patients were randomly assigned to be tested and treated for HP (n=321) or to usual care (n=329). Patients in the usual care group were not routinely tested or treated for HP infection, but continued to receive medical care and/or medication for PUD.

The researchers found that only 17 percent of the patients had PUD confirmed by x-ray studies or endoscopy, and only 38 percent of the test and treat group tested positive for HP. After 12 months, patients in the test and treat group were less likely to report ulcer-like symptoms or use acid reducing therapy, but 75 percent used antacids during the second half of the 12 month follow-up. During the 12 months of the study, patients in the test and treat group had higher total costs related to PUD symptom treatment than the usual care group.