Embargoed Until: 3 P.M. (CT), Monday, October 20, 2003
Embargoed Until: 3 P.M. (CT), Monday, October 20, 2003
Embargoed Until: 3 P.M. (CT), Monday, October 20, 2003
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 20, 2003
To contact Ellen Lokkegaard, M.D., Ph.D., e-mail loekkegaard{at}dadlnet.dk.
To contact editorialist Douglas A. Dulli, M.D., M.S., call Lisa Brunette at 608/263-5830.
DANISH STUDY SUGGESTS HORMONE THERAPY MAY INCREASE RISK OF STROKE AMONG POSTMENOPAUSAL WOMEN WITH HIGH BLOOD PRESSURE
CHICAGO—Postmenopausal women who use hormone therapy and have hypertension (high blood pressure) may be at an increased risk for stroke, according to an article in the October issue of The Archives of Neurology, one of the JAMA/Archives journals.
Stroke affects one out of 1,000 women per year aged 45 to 65 years old, according to information in the article. The use of hormone therapy (HT) in postmenopausal women may affect the development of stroke, however previous studies have produced conflicting results.
Ellen Lokkegaard, M.D., Ph.D., of the National Institute of Public Health, Copenhagen, Denmark, and colleagues studied the incidence of stroke among women who participated in the Danish Nurse Study, a study of Danish nurses older than 44 years who completed questionnaires (in 1993) on health, lifestyle and reproductive health, including questions about HT use.
The researchers analyzed data from 13,122 postmenopausal women in this study who, in 1993, were free of previous major cardiovascular or cerebrovascular disease and cancer. These nurses were followed up through 1998 for the occurrence of stroke.
In 1993, 28 percent of the women studied were current HT users, 14.3 percent were past users, and 57.7 percent never used HT. The median length of time of HT use among current users was six years. The median length of time of HT use for past users was two years.
Among HT users, 35.5 percent of women used unopposed estrogen (estradiol) and 59.2 percent of women used combination therapy (estrogen combined with norethisterone acetate).
Between 1993 and 1998, there were 144 strokes recorded among the women including 46 fatal strokes. Of the 144 strokes, 99 were classified as ischemic and 45 as hemorrhagic.
The researchers found that overall, there was no association between HT use and risk of stroke. However, among the 2,256 women with hypertension, the risk for stroke was more than twice as high for current HT users compared with never HT users and the risk was three times as high for HT users using an estrogen-progestin combination.
"When assessing whether the presence of risk factors for stroke modified the associations, we found a consistent significantly increased risk of total stroke and various subtypes of stroke associated with the use of HT among hypertensive nurses. This risk was most pronounced among nurses using estrogen-progestin therapy. Normotensive nurses [those without hypertension] using HT had no increased risk of stroke, " write the authors.
(Arch Neurol. 2003;60:1379-1384. Available post-embargo at archneurol.com)
Editor's Note: This study was funded by grants from the Danish Heart Foundation, Hauser Plads, Copenhagen.
EDITORIAL: STROKE RISK, HYPERTENSION, AND HRTLESS POSTMENOPAUSAL THERAPY
In an accompanying editorial, Douglas A. Dulli, M.D., M.S., of the University of Wisconsin Medical School, writes that the research by Dr. Lokkegaard et al, adds to new findings that hormone therapy may not be as protective against diseases in women as it was once thought to be.
"…the studies of Lokkegaard et al are published in an era of a large paradigm shift, in which HRT previously prescribed as a primary preventive becomes a potential hazard in which specific risk factors may make its prescription for a given patient unwarranted. Given the worldwide use of HRT in an estimated 20 million patients in the late 1990s, this is a significant shift indeed," Dr. Dulli writes.
"…the authors concluded that hypertensive postmenopausal women should not be given HRT, owing to the increased risk for (especially ischemic) stroke. This seems entirely reasonable given their data, and is immediately helpful, especially given the many patients who are taking HRT even as they experience stroke or transient ischemic attack," writes Dr. Dulli.
He concludes: "Directions for further study would thus include more sharply defining the remaining group and circumstances for which HRT treatment for menopausal symptoms are acceptably safe - and even beneficial - for selected protective effects in a given patient. Until such data are presented, the safe default therapy for most postmenopausal patients seems to be HRTless."
(Arch Neurol. 2003;60:1363-1364. Available post-embargo at archneurol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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CHICAGO—The prevalence of mild forms of cognitive impairment among the elderly increases with age and may be associated with cerebrovascular disease, depression, and racial factors, according to two articles in the October issue of The Archives of Neurology, one of the JAMA/Archives journals.
Mild cognitive impairment (MCI) is characterized by demonstrable cognitive impairment including memory problems but without dementia, according to the articles. Patients with MCI are at a higher risk for developing dementia, especially Alzheimer disease.
Oscar L. Lopez, M.D., of University of Pittsburgh School of Medicine and colleagues determined the prevalence of MCI, and examined risk factors associated with MCI among participants in the Cardiovascular Health Study (CHS) Cognition Study.
The CHS Cognition Study included 3,608 participants who had a magnetic resonance imaging (MRI) brain scan between 1991 and 1994, and underwent detailed neuropsychological, neurological and medical evaluations to identify the presence of MCI or dementia between 1998 and 1999. The researchers conducted further examinations in patients participating in the CHS Cognition Study who were located in Pittsburgh (n=927). Patients with MCI in this subset were classified as having either MCI amnestic-type (characterized by difficulty in remembering past events) or MCI multiple cognitive deficits-type, two variations of MCI classified by different symptoms.
The researchers found that the overall prevalence of MCI among CHS Cognition Study participants was 19 percent (465 of 2,470 participants who were still alive in 1998-1999). The prevalence increased with age from 19 percent in participants younger than 75 years old to 29 percent in those older than 85 years. In the Pittsburgh group, the overall prevalence of MCI was 22 percent (130 of 599 patients still alive in 1998-1999). Six percent of the Pittsburgh group with MCI had amnestic-type MCI and 16 percent had multiple cognitive deficits-type MCI.
The researchers also found that MCI was associated with being African American, low educational level, low Modified Mini-Mental State Examination score and low Digit Symbol Test score (tests that measure neuropsychological function), cortical atrophy (shrinkage of part of the brain), MRI-detected infarcts (tiny areas of damage in the brain caused by impaired circulation) and depression. Patients with MCI amnestic-type tended to have MRI-identified infarcts and the presence of the APOE e4 allele (genetic variation associated with Alzheimer disease). The MCI multiple cognitive deficits type was associated with low Modified Mini-Mental State Examination and Digit Symbol Test scores.
"Twenty-two percent of the participants aged 75 years or older had MCI," write the authors. "Most of the participants with MCI had comorbid conditions [other health problems] that may affect their cognitive functions."
"Early cognitive deficits seem to be a common denominator for the two forms of MCI; the presence of cerebrovascular disease and the APOE e4 allele is associated with the amnestic-type of MCI," the authors write.
(Arch Neurol. 2003;60:1385-1389.
Arch Neurol. 2003;60:1394-1399. Available post-embargo at archneurol.com)
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 20, 2003.
To contact Karen J. Cruickshanks, Ph.D., call Dian Land at 608/263-9893.
HEARING LOSS IS COMMON IN OLDER ADULTS, TENDS TO WORSEN WITH AGE
CHICAGO—Older adults have a high risk of developing hearing loss, and those that do are likely to experience further declines in hearing over time, according to an article in the October issue of The Archives of Otolaryngology Head & Neck Surgery, one of the JAMA/Archives journals.
According to the article, more than 2.2 million adults older than 70 years old have hearing impairment in the United States, making hearing impairment one of the most common chronic health conditions affecting older adults. As the age distribution of the U.S. population shifts, larger numbers of older adults will experience hearing impairment in the later years. However, few studies have examined the incidence of hearing loss, limiting information on which to base future public health initiatives.
Karen J. Cruickshanks, Ph.D., of the University of Wisconsin, Madison, and colleagues studied the incidence and progression of hearing impairment over five years in adults aged 48 to 92 years old. The researchers enrolled 1,636 participants without hearing loss and 1,085 with some hearing loss who had a baseline hearing examination in 1993-1995 and were reexamined five years later in 1998-2000.
The researchers found that the risk of developing hearing loss during the five year period was 21 percent. More than half of those with hearing loss at the beginning of the study experienced a further decline in hearing. When the researchers adjusted for age, the incidence of developing hearing loss over five years for men was 30.7 percent and 17 percent for women.
"The results indicate that the risk of developing hearing loss during a 5-year follow-up period was high for both men and women," write the authors. "Age was a significant risk factor for incidence of hearing loss. Although there were few older adults at risk of hearing loss, the incidence in these groups was high, suggesting that people remain at risk of hearing loss throughout the life span."
(Arch Otolaryngol Head Neck Surg. 2003;129:1041-1046. Available post-embargo at archoto.com)
Editor's Note: This study was supported by a grant from the National Institutes of Health, Bethesda, Md.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 20, 2003
To contact R. James Koch, M.D., call Michelle Brandt 650/723-0272.
MOST PATIENTS SATISFIED WITH RESULTS OF FACIAL LASER SKIN RESURFACING
CHICAGO—Most patients who undergo facial laser skin resurfacing to reduce the appearance of sun damage or acne scarring are satisfied with the results, according to an article in October issue of The Archives of Dermatology, one of the JAMA/Archives journals.
Laser skin resurfacing (LSR) for the rejuvenation of facial skin is an increasingly popular procedure, according to the article. Since the development in the early 1990s of pulsed and scanned carbon dioxide lasers for precise resurfacing and the more recent erbium:YAG (Er:YAG) laser resurfacing methods, many articles have focused on this surgical technique, but few articles discuss patient perceptions and satisfaction with LSR.
R. Sonia Batra, M.D., M.Sc., M.P.H., of Stanford University School of Medicine, Stanford, Calif., and colleagues documented patients' experiences after undergoing full facial (over the entire face) LSR.
The researchers surveyed 27 patients who underwent combination carbon dioxide/erbium:YAG full-facial laser resurfacing for acne scarring or sun damage. The average age of the patients was 50 years old. Patients were surveyed seven times after their procedures: one day; three days; within one week; three weeks; six weeks; three months and 30 months after undergoing LSR.
The researchers found that one day after LSR, ten patients (37 percent) were concerned about the outcome of their procedures, and three (11 percent) considered LSR a "terrible" experience. At 2.7 days after the procedure, 23 patients (85 percent) would recommend LSR, and after 3.7 days, 24 (89 percent) said they would have the procedure again.
Three months after LSR, the patients' average rating of their own appearance was 2.3 (on a scale of 0 to 3 with 3 being best appearance), and all 27 patients surveyed felt that their appearance had been improved by LSR. After approximately two and a half years, 18 patients (75 percent) would recommend the procedure, 17 patients (71 percent) would have LSR again, 21 patients (88 percent) felt that their appearance had been improved, and the average final rating for appearance among the patients was 1.8.
"Our data indicate that during the first 3 days after the procedure, the period when the patient is most likely to feel pain or observe erythema (redness), crusting, or swelling, patients experienced the greatest discomfort, and most were unwilling to recommend LSR to others or consider undergoing the procedure again themselves," the authors write. "In addition, patients' views of the results were obscured by an occlusive dressing for the first 3 postoperative days, possibly fueling concern. Most patients' attitudes changed between 2 and 4 days after the procedure, with all patients stating that the procedure was worthwhile at an average of 2 to 3 days postoperatively. In contrast to immediately after the procedure, by the eighth postoperative day, responses changed such that 22 patients (82 percent) considered the time thereafter 'restful'," write the authors.
"It is critical that the physician and patient have shared, realistic expectations concerning outcome both with respect to what the patient will experience at any given time postoperatively and how LSR will ultimately meet the patients needs. Application of this information on patient responses after LSR may help to achieve this goal," conclude the researchers.
(Arch Dermatol. 2003;139:1295-1299. Available post-embargo at archdermatol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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