CHICAGO—Some patients that experience migraines may be at an increased risk for lesions in certain areas of the brain, according to a study in the January 28 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, research has suggested an increased prevalence of cerebral infarction and white matter lesions (WMLs) is present in migraine patients. Infarction involves tissue which has died due to lack of oxygen resulting from a blood clot blocking an artery. It is not known whether WMLs are prevalent in the general migraine population.

Mark C. Kruit, M.D., of Leiden University Medical Center, Leiden, The Netherlands, and colleagues investigated whether persons with migraines from the general population are at increased risk of brain infarcts and WMLs or whether this risk varies by migraine subtype and attack frequency.

The study involved a sample of Dutch adults aged 30 to 60 years who were randomly selected patients with migraine with aura (visual disturbance ) (n=161), patients with migraine without aura (n=134), and controls (n=140). Brain magnetic resonance images (MRIs) were evaluated for infarcts and for WMLs.

The researchers found no significant difference between patients with migraine and controls in overall infarct prevalence (8.1 percent vs. 5.0 percent). "However, in the cerebellar region of the posterior circulation territory, patients with migraine had a higher prevalence of infarct than controls [5.4 percent vs. 0.7 percent; more than seven times the risk]," the authors write. Patients with migraine with aura had more than 13 times the risk for infarct than controls. In patients with migraine with a frequency of attacks of 1 or more per month, there was a 9.3 times increased risk. The highest risk for infarct was in patients with migraine with aura with 1 attack or more per month (15.8 times increased risk).

Women with migraine had twice the risk for deep WMLs compared with controls. This risk increased with attack frequency (highest in those with 1 of more attacks per month, 2.6 times increased risk) but was similar in patients with migraine with or without aura. Male controls and patients with migraine did not differ in the prevalence of deep WMLs.

CHICAGO— Levels of the biomarker placental growth factor (PlGF) in the blood may predict the risk of heart attack or death for patients with coronary heart disease, according to a study in the January 28 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, PlGF, a member of the vascular growth factor family, acts as a primary inflammatory instigator of atherosclerotic (hardening and narrowing of the arteries) plaque instability and thus may be useful as a risk-predicting biomarker in patients with acute coronary syndromes (ACS).

Christopher Heeschen, M.D., of Johann Wolfgang Goethe University, Frankfurt, Germany and colleagues conducted a study to determine whether blood levels of PlGF predict risk for death or nonfatal heart attack in patients with acute chest pain. Various measurements were taken of 547 patients with angiographically validated ACS participating in the CAPTURE (c7E3 Fab Anti-Platelet Therapy in Unstable Refractory Angina) trial and in a cohort of 626 patients presenting with acute chest pain to an emergency department in Germany between December 1996 and March 1999.

In patients with ACS, elevated PlGF levels indicated a markedly increased risk of heart attack or death at 30 days (14.8 percent vs. 4.9 percent; more than three times increased risk). In patients with acute chest pain, elevated levels of PlGF predicted three fold increased risk of heart attack or death (21.2 percent vs. 5.3 percent).

The authors write that "... elevated PlGF levels did not only identify those patients with acute chest pain who developed ACS, but also those patients with an increased risk of recurrent instability after hospital discharge."

CHICAGO—Breast augmentation may interfere with the interpretation of mammography examinations for asymptomatic women, however, there is no evidence that women are diagnosed with more advanced cancers compared with women without augmentation, according to a study in the January 28 issue of The Journal of the American Medical Association (JAMA).

Breast augmentation (implants) is the third most common type of plastic surgery performed for cosmetic reasons in the United States with 268,888 procedures performed in 2002, according to background information provided by the authors.

Diana L. Miglioretti, Ph.D., from the Group Health Cooperative, Seattle, and colleagues, evaluated data from seven U.S. mammography registries that participate in the Breast Cancer Surveillance Consortium. The researchers compared data between women with and without augmentation to determine mammography accuracy and tumor characteristics to determine if there was a difference between the two groups.

"Among asymptomatic women, the sensitivity of screening mammography based on the final assessment was lower in women with breast augmentation versus women without (45 percent versus 66.8 percent)," the authors report. The authors define sensitivity of mammography as the proportion of positive mammograms among women diagnosed with breast cancer within one-year of their examination. "And specificity was slightly higher in women with augmentation (97.7 percent vs. 96.7 percent)." Specificity was defined as the proportion of negative mammograms among women without cancer. The authors state that the prognostic characteristics of tumors (stage, size, estrogen-receptor status, and nodal status) were not significantly different in women with breast augmentation compared with those without augmentation.

BREAST IMPLANTS & MAMMOGRAPHY