EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 23, 2004
To contact R. Graham Barr, M.D., Dr.P.H., call Amy Dayton at 617/534-1603.

POSTMENOPAUSAL HORMONE THERAPY ASSOCIATED WITH INCREASED RISK FOR DEVELOPING ASTHMA

CHICAGO—Postmenopausal women who use hormone therapy are at a higher risk for developing asthma, but not chronic obstructive pulmonary disease (COPD), according to an article in the February 23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, because the incidence of asthma changes depending on a person's age, researchers suspect that reproductive hormone therapy may influence the development of the disease, which affects 5 percent to 8 percent of the United States population. Studies also suggest that incidence of COPD, the fourth leading cause of death in the United States, may also be influenced by sex hormones.

R. Graham Barr, M.D., Dr.P.H., of Brigham & Women's Hospital, Boston, and colleagues evaluated whether postmenopausal women using hormone therapy were at an increased risk for newly diagnosed asthma or COPD. Dr. Barr is now at Columbia Presbyterian Medical Center, New York.

The researchers used data from the Nurse's Health Study, which enrolled 121,700 married female registered nurses, aged 30 to 55 years old in 1976. Participants were mailed questionnaires biennially (once every two years) which included questions about medical history, diet and lifestyle, exercise, and hormone use. From 1988 to 1996, biennial follow-up questionnaires were sent inquiring about new asthma and COPD diagnoses.

The researchers found that current use of estrogen alone was associated with increased risk (2.29 times higher) of asthma compared with women who never used hormones. Women who used estrogen plus progestin had a similar increased rate of newly diagnosed asthma. However, the rates of newly diagnosed COPD among hormone users and non-hormone users were similar.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 23, 2004
To contact Mark A. Pereira, Ph.D., call Brenda Hudson at 612/624-5680.

FIBER INTAKE FROM FRUITS AND CEREALS MAY REDUCE RISK OF CORONARY HEART DISEASE

CHICAGO—Consumption of dietary fiber from fruits and cereals may lower the risk of coronary heart disease, according to an article in the February 23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, dietary fiber, found in fruits, vegetables, grains, and cereals may reduce the risk of heart disease by lowering blood pressure and reducing cholesterol levels. Although studies suggest that the more fiber a person eats, the lower the risk of heart disease, few studies have looked at the relationship between dietary fiber from different sources and heart disease.

Mark A. Pereira, Ph.D., of Harvard University, Boston, and colleagues analyzed the pooled results of several studies (from the United States and Europe, including 91,058 men and 245,186 women) to determine whether the source of dietary fiber (from fruit, vegetables or grains) had any effect on the reduction in heart disease risk. Each study recorded what kind of foods and how much the participants ate. Although there was considerable variation in the level of dietary detail across the studies, all studies had some measurement of dietary fiber. Dr. Pereira is now at the University of Minnesota, Minneapolis.

Among the total participants from the studies, there were 5,249 incident (new) coronary heart disease cases, and 2,011 participants died of coronary heart disease over six to ten years of follow-up.

The researchers found that for each 10 gram per day increment of fiber consumed, there was a 14 percent decrease in risk for coronary heart disease (CHD) events (such as non-fatal and fatal heart attack) and a 27 percent decreased risk of dying from coronary heart disease. The researchers also found that "Associations were stronger for coronary deaths than for all events, with reductions in risk of 25 percent for cereal fiber and 30 percent for fruit fiber for each 10 gram per day increment," write the researchers. "In contrast, vegetable fiber was not associated with CHD incidence or mortality [death]."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 23, 2004
To contact Alain Combes, M.D., Ph.D., e-mail: alain.combes{at}psl.ap-hop-paris.fr.

STUDY COMPARES CLINICAL DIAGNOSES AND AUTOPSY DIAGNOSES IN ICU DEATHS

CHICAGO—Comparing clinical diagnoses with autopsy findings for patients who died in intensive care units (ICUs) provides information about underlying missed diagnoses, according to an article in the February 23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, autopsy rates have decreased worldwide. The reasons for the decline in autopsy rates are attributed to fear of potential legal repercussions should misdiagnoses be discovered, reluctance of families to give permission for the procedure, and doubt regarding the usefulness of autopsies given today's modern diagnostic techniques. Recent studies suggest that major discrepancies between clinical and autopsy diagnoses exist, and may be discovered in 19 percent to 27 percent of autopsies performed on patients who die in intensive care units.

Alain Combes, M.D., Ph.D., from Groupe Hospitalier Pitie-Salpetriere, Paris, and colleagues conducted a three-year study of 1,492 intensive care unit patients. Of these patients, 315 died, and 167 were autopsied.

The most common reason for not performing an autopsy (79.7 percent) was family refusal, according to the researchers. Among the 694 clinical diagnoses, 33 (4.8 percent) were refuted and 13 (1.9 percent) were judged incomplete by autopsy findings. However, autopsies also revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 heart attacks, 10 pulmonary emboli (blood clot in the lungs) and 9 endocarditis (inflammation of the heart valves).

"With an autopsy rate of 53 percent, major diagnostic errors were identified for 31.7 percent of the autopsied patients, and the correct diagnosis would have changed management and possibly resulted in a cure or prolonged survival for up to 10 percent of patients," the authors write.