EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 27, 2003
To contact Anne B. Newman, M.D., M.P.H., call Kathryn Duda at 412/624-2607.

UNDETECTED CARDIOVASCULAR DISEASE MAY BE LINKED TO POORER CHANCE OF MAINTAINING HEALTH IN LATER YEARS

CHICAGO—Subclinical cardiovascular disease (the presence of the disease without apparent symptoms) may be associated with a poorer likelihood of maintaining general health in older age, according to an article in the October 27 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Cardiovascular diseases are the primary cause of death in older adults, and high levels of subclinical cardiovascular disease are also associated with poor survival, according to the article. Recent studies of subclinical cardiovascular disease suggest that some measures of the extent of vascular disease are associated with adverse health effects even in people with no symptoms or history of events associated with the disease such as myocardial infarction (heart attack), stroke, or other events.

Anne B. Newman, M.D., M.P.H., of University of Pittsburgh School of Medicine, and colleagues investigated the effect of the extent of subclinical cardiovascular disease on quality of life in the later years.

The researchers studied 2,932 men and women aged 65 years or older who had "successfully aged". The researchers defined successful aging as remaining free of cardiovascular disease (including angina, heart attack, congestive heart failure or stroke), cancer, chronic obstructive pulmonary disease (including chronic bronchitis, emphysema, or asthma), and having intact physical and cognitive functioning with no difficulty performing activities of daily living. Participants were enrolled in the study between 1989-1990 (a small subset of participants enrolled in 1992-1993) and were followed up for eight years to determine the likelihood of maintaining successful aging. Subclinical cardiovascular disease was based on the results of various tests that had been performed at baseline (such as ultrasound tests to measure the thickness of the wall of the carotid artery, and electrocardiogram findings).

The researchers found that 48 percent of participants continued to successfully age throughout the follow up period. Being younger at the beginning of the study, and having less subclinical cardiovascular disease were independently associated with the likelihood of successful aging. Participants with subclinical cardiovascular disease experienced a decline in health similar to participants who were five years older without any subclinical cardiovascular disease.

Further analysis showed that the decline associated with subclinical cardiovascular disease was equivalent to 6.5 years of aging for women and 5.6 years of aging for men. The researchers also found that individual measures of the extent of cardiovascular disease, diabetes mellitus and smoking were also independent predictors of fewer years of successful aging, but none of these factors substantially reduced the effects of aging alone.

"There is a graded relationship between the extent of cardiovascular disease measured noninvasively and the likelihood of maintaining intact health and function," write the authors.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 27, 2003
To contact Judith Garrard, Ph.D., call Molly Portz 612/625-2640.

LABEL INFORMATION VARIES WIDELY FOR COMMONLY PURCHASED HERBS

CHICAGO—The listed ingredients and recommended dosages for frequently purchased herbal products vary widely, according to an article in the October 27 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information provided in the article, over the past ten years, the use of botanicals and dietary supplements (BDS, including herbs, neutraceuticals, complementary or alternative medications, phytomedicines or phytopharmaceuticals) by the American public has increased by an estimated 380 percent, with sales of over $600 million in 1998 for herbal products alone. Standards for ingredients and recommended daily doses of BDS have not been established by any regulatory arm of the U.S. federal government. Standardization of these products may be difficult because plant products are composed of a number of chemical components and each may have varying levels of biological activity. Additionally, components may differ depending on the part of the plant used (e.g., root vs. leaves) growing and harvesting conditions, and formulation (e.g., capsule, extract or tea), so that even products using the same plant parts may not be identical.

Judith Garrard, Ph.D., of the University of Minnesota, Minneapolis, and colleagues examined product variability based on label information for the ten herbs with the greatest sales in 1998: echinacea, St. John's wort, Ginko biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian. Products available to consumers for each of the ten herbs were collected from 20 retail stores (six grocery stores, three retail pharmacies, six discount stores and five health food stores) in a large metropolitan area in January 2000. The researchers did not analyze the actual ingredients in these products.

The researchers used information from a recent textbook on botanicals and dietary supplements written by clinical/academic pharmacists as a benchmark for ingredients and recommended doses for each herb. The researchers compared products for each herb with the benchmark, evaluating ingredients and doses given on the product label against the doses and ingredients recommended by the benchmark. They also looked at the proportion of products for each herb that was consistent with the benchmark-recommended doses and ingredients; and looked for markers (such as brand, type of store, or price) for each herb that might be used to identify products that were consistent with the benchmark.

The researchers found that in their sample, consumers had a choice of 880 products marketed under 241 different brands for the 10 herbs. Among the 880 products, 43 percent were consistent with the benchmark in ingredients and recommended doses, 20 percent were consistent in ingredients only, and 37 percent were either not consistent, or label information was insufficient to make a comparison with the benchmark.

"In four of the ten herbs (echinacea, St. John's wort, saw palmetto, and valerian), half or fewer of the products were consistent with benchmark ingredients. Among all ten herbs, echinacea had the fewest number of products (30 [33 percent]) consistent in ingredients, while ginseng had the most (113 [100 percent])," write the authors.

The researchers also found that price per label-recommended dose was a significant predictor of consistency with the benchmark, but store type was not.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, OCTOBER 27, 2003
To contact Ilan Goldenberg, M.D., e-mail heart{at}sheba.health.gov.il

SMOKING INCREASES RISK OF SUDDEN DEATH IN PATIENTS WITH HEART DISEASE

CHICAGO—Being a current cigarette smoker is associated with a significantly increased risk of sudden cardiac death in people with coronary artery disease, according to an article in the October 27 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Sudden cardiac death (SCD) makes up about one quarter of all coronary artery disease (CAD)- related major events and more than half of all CAD-related deaths, according to the article. Ventricular arrhythmia (loss of normal heart beat rhythm) is believed to be the most common direct cause of CAD. Nicotine may disturb the normal rhythm of the heart, and quitting smoking is universally recommended in patients with CAD. However, few studies have looked at the effects of smoking status on SCD in patients with CAD.

Ilan Goldenberg, M.D., of The Chaim Sheba Medical Center, Tel Hashomer, Israel, and colleagues evaluated the effect of cigarette smoking on SCD risk in a subset of 3,122 patients who participated in the Bezafibrate Infarction Prevention Trial (BIP Trial). The BIP Trial was initiated in 1990 and was designed to determine whether bezafibrate (a drug which lowers triglyceride and cholesterol levels in the blood) would reduce CAD-related deaths and nonfatal myocardial infarction (heart attacks) in patients with established CAD and moderately elevated cholesterol levels.

Dr. Goldenberg and colleagues prospectively followed up the 3,122 participants (aged 45 to 74 years) for an average of about eight years. All participants had a previous myocardial infarction or stable angina. Smoking status was determined at the beginning of the BIP Trial and each of the four-month follow-up visits. Never smokers were people who had never smoked more than 100 cigarettes in their lifetime; past smokers were people who had smoked more than 100 cigarettes, but quit before their baseline examination or before the first four-month follow-up visit; and current smokers were people who continued to smoke after the first four-month follow up visit.

The researchers found that among the 370 participants who were current smokers, 30 (8.1 percent) experienced sudden cardiac death; 83 (4.6 percent) of the 1,821 participants who had quit smoking and 43 (4.6 percent) of the 931 participants who had never smoked experienced SCD. Current smoking was associated with an increased risk (almost two and one half times) of SCD. Participants who stopped smoking had no significant increase in the risk of SCD compared with participants who had never smoked. Current smokers also had a substantially greater cardiac-related and all-cause death rate compared with never smokers and past smokers.

The researchers also found that there was no correlation between the risk of SCD and the number of years without smoking in patients who had quit smoking before the beginning of the trial.

The authors write: "The findings of this long-term prospective follow-up of 3,122 patients with preexisting CAD suggest the following: (1) continued cigarette smoking is associated with a significantly increased risk of SCD; (2) in patients who quit smoking, the risk of SCD is significantly lower and comparable to the risk of patients who had never smoked; and (3) the decline in the risk of SCD with smoking cessation is immediate and not time dependent."