EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 10, 2004
To contact corresponding author Elsa-Grace V. Giardina, M.D., call Brian Dotson at 212/305-5587.

WOMEN AND HEART DISEASE: THE ROLE OF DIABETES AND HYPERGLYCEMIA

In a special article in the May 10 issue of the Archives of Internal Medicine, Elizabeth Barrett-Connor, M.D., of the University of California, San Diego, and colleagues explore the role of diabetes among women with cardiovascular disease (CVD).

According to the article, CVD is the primary cause of death in women, and women with type 2 diabetes mellitus are at a greater risk of CVD compared to nondiabetic women. "In the United States, 498,863 women died from CVD in 2001, compared with 266,693 deaths from cancer," the authors write. However, in a large survey of women conducted in 2003, fewer than half of the women surveyed perceived heart disease as their greatest health threat.

In addition to high blood glucose levels (the hallmark of diabetes), there are other risk factors that contribute to a higher risk for CVD among diabetic women, including hypertension, dyslipidemia (an imbalanced lipid and cholesterol profile) and cigarette smoking.

"With the diagnosis of diabetes, the relative risk of CVD increases more in women than in men," write the authors. "For instance, the risk of acute myocardial infarction (MI, or heart attack) is 150 percent greater in diabetic than in nondiabetic women but only 50 percent greater in diabetic than in nondiabetic men, according to the Framingham [a large study] data."

The authors outline several strategies for treating women with diabetes and CVD, including controlling blood glucose levels in order to get the diabetes under control. "The Diabetes Control and Complications Trial, a study conducted in patients with type 1 diabetes, demonstrated a 41 percent reduction (albeit nonsignificant...) in cardiovascular events in those undergoing intensive therapy and better blood glucose control."

Preventing diabetes is another strategy the researchers discuss. "Type 2 diabetes mellitus is preventable, and hyperglycemia [high blood glucose], the universal feature of diabetes, is treatable," they write. "Preventive measures include weight loss and increased physical activity. Now that prevention has been shown to be feasible, it is important to identify those at high risk of developing diabetes, as well as those with undiagnosed diabetes."

Cholesterol can also be managed to help reduce CVD among women with type 2 diabetes. "Cholesterol is the most important risk factor for CVD in men and women, with and without diabetes," the authors write. "In light of [studies] highlighting the benefits of lipid-lowering medications, as well as data that show underutilization in individuals with diabetes and particularly women, clinicians should make special efforts not to neglect treatment of dyslipidemia in these populations."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 10, 2004
To contact Nancy L. Keating, M.D., M.P.H., call Melanie Franco at 617/534-1605. To contact editorialist Joel S. Levine, M.D., call Dana Berry at 303/315-5571.

PATIENTS REPORT HIGH LEVELS OF TRUST IN MEDICAL SPECIALISTS

CHICAGO—Most patients report having high levels of trust and confidence in their specialist physicians after an initial visit, according to an article in the May 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, "Patients with greater trust in their physicians are more satisfied with their care, more likely to adhere to their physicians' recommendations, and less likely to change physicians." Little is known about how patients' characteristics and experiences are related to trust in their specialist physicians.

Nancy L. Keating, M.D., M.P.H., of Harvard Medical School, Boston, and colleagues surveyed 417 patients who were seeing a medical specialist (cardiologist, neurologist, nephrologist, gastroenterologist or rheumatologist) for the first time in a hospital-based practice. The average age of the patients surveyed was 50 years, and 74 percent were white, 76 percent were women, and 56 percent were college graduates.

The researchers found that most patients reported having good experiences with their specialists, and 79 percent reported complete confidence and trust in their specialist when they were interviewed one to two weeks after their initial visit. However, the authors also found that black patients had lower levels of trust than white patients.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 10, 2004
To contact Frederick L. Ferris III, M.D., call Mike Coogan at 301/496-5248

PRESENCE OF CERTAIN EYE DISORDERS LINKED WITH POORER SURVIVAL RATES

CHICAGO—Individuals with age-related macular degeneration (AMD) and cataract may have a decreased life span compared with those without these eye disorders, suggesting that these conditions may also reflect other underlying processes, according to an article in the May issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

According to information in the article, various eye disorders have been reported to be significant predictors of a shorter life span, and cataract in particular may be a sign of physiological processes that are associated with aging and death. The reason that eye disorders are associated with decreased survival is unclear, the article states.

Frederick L. Ferris III, M.D., of the National Eye Institute, Bethesda, Md., and colleagues investigated whether various types of visual impairment and eye disorders were associated with death in participants in the Age-Related Eye Disease Study (AREDS), a long-term study of age-related cataract and AMD. AREDS included a subgroup of participants randomly assigned to take high-dose antioxidants, zinc, antioxidants plus zinc, or placebo. A total of 4,753 people aged 55 to 81 years entered AREDS between November 13, 1992 and January 15, 1998. During the median follow up of 6.5 years, 534 (11 percent) of AREDS participants died.

The researchers found that participants with AMD compared with participants with little or no drusen (opaque deposits under the retina associated with AMD) had about a 41 percent higher risk of death, and advanced AMD was associated with cardiovascular deaths. Compared with participants with good vision, those with vision worse than 20/40 (indicative of poor vision) in one eye and those who had cataract surgery had increased risks of death (36 percent and 55 percent, respectively). Patients who had been assigned to receive zinc had lower mortality than those not taking zinc (approximately 27 percent lower).

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 10, 2004
To contact corresponding author Ronald Klein, M.D., M.P.H., call Jane Miller at 608/265-1604.

EXTENDED EXPOSURE TO SUNLIGHT MAY BE RELATED TO THE DEVELOPMENT OF CERTAIN AGE-RELATED EYE DISEASES

CHICAGO—Extended exposure to summer sunlight in early adulthood may increase the risk for developing age-related maculopathy, an eye disorder that can cause blindness, according to an article in the May issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

According to background information, age-related maculopathy (ARM) is the leading cause of vision loss in older Americans, and few therapies exist to treat patients with this disease. ARM is characterized by the growth of abnormal blood vessels on the retina (the light-sensitive layer of cells at the back of the eye), the development of drusen (opaque deposits on the retina), and increased retinal pigment.

Sandra C. Tomany, M.S., of the University of Wisconsin Medical School, Madison, and colleagues examined the association between sunlight exposure and sunlight sensitivity and the ten-year incidence of ARM among people aged 43 to 86 years who were first examined between 1988 and 1990 as part of the Beaver Dam Eye Study. Of the total participants, 3,684 were followed up for five years, and 2,764 were followed up for ten years.

Information on sun exposure and indicators of sun sensitivity was collected at the beginning of the study and/or during follow-up visits.

Participants who reported being exposed to the sun for more than five hours a day during their teens, 30s, and at the beginning of the study were three times as likely to develop increased retinal pigment and were more than twice as likely to develop early ARM within ten years compared to participants who reported being exposed to less than two hours per day of sunlight during the same periods.

In participants who reported being exposed to the most sunlight, the use of hats and sunglasses at least half the time was associated with an approximately 50 percent lower risk of developing drusen and retinal pigment. Participants who reported more than ten severe sunburns during their youth were 2.5 times more likely than those who experienced one or no sunburns to develop drusen within ten years.