CHICAGO—Patients with coronary heart disease who received intensive lipid-lowering treatment had less progression of coronary atherosclerosis (plaque buildup in the arteries) than patients treated with a moderate lipid-lowering regimen, according to a study in the March 3 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, statin drugs (lipid-lowering medications) have been shown to reduce both atherogenic (development of plaque in arterial walls) lipoproteins and cardiovascular illness and death. However, the optimal approach and target level for lipid reduction with statins in patients with established coronary artery disease (CAD) remains uncertain.

Steven E. Nissen, M.D., of the Cleveland Clinic Lerner School of Medicine, Cleveland, and colleagues compared the effects of two statin regimens. The Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study was a double-blind, randomized trial at 34 centers in the United States. Intravascular ultrasound, which provides detailed images within a blood vessel, was used to measure plaque buildup in the wall of the coronary arteries.

Between June 1999 and September 2001, 654 patients were randomized and received a study drug; 502 had intravascular ultrasound examinations at baseline and after 18 months of treatment. Patients were randomly assigned to receive a regimen designed to moderately reduce low-density lipoprotein cholesterol (LDL-C) using 40 mg of pravastatin, or an intensive LDL-C lowering regimen, using 80 mg of atorvastatin.

The researchers found that patients with moderate cholesterol levels who received 18 months of intensive lipid-lowering therapy had greater reductions in LDL-cholesterol than patients who received the moderate lipid lowering regimen, and also had greater reductions in C-reactive protein (a measure of inflammation). Patients in the intensive therapy group also showed significantly less progression of coronary atherosclerosis in comparison with patients who received a more moderate regimen. The change in volume of plaque buildup was positive in the pravastatin group (2.7 percent), indicating net progression compared with the baseline measurement, whereas in the atorvastatin group, the change was negative (?-0.4 percent), showing no disease progression since baseline.

CHICAGO—An intervention that includes interaction with a depression care manager reduces levels of depression and thoughts of suicide among older patients with depression, according to a study in the March 3 issue of the Journal of the American Medical Association (JAMA).

Older Americans comprise about 13 percent of the U.S. population, yet account for 18 percent of all suicide deaths, according to background information in the article. Depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation (thoughts of suicide). The majority of older adults who die by suicide have seen a primary care physician in preceding months. Recent national reports emphasize the public health need for intervention trials to reduce the risk for suicide in late life.

Martha L. Bruce, Ph.D., M.P.H., of Weill Medical College of Cornell University, White Plains, N.Y., and colleagues conducted a study to test the impact of a primary care-based intervention on reducing depression and major risk factors for suicide in older patients. The randomized trial, known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), was conducted at 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions, May 1999 through August 2001. The trial included a two-stage, age-stratified (60-74; 75 years and older) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened negative patients. This analysis included patients with a depression diagnosis (N=598).

The intervention focused on two major components of care. First was physician knowledge, addressed by a clinical algorithm for treating geriatric depression in a primary care setting. The second was treatment management, put into practice by depression care managers. The intervention was compared with usual care after the physicians were educated about treatment guidelines and notified when a patient had a depression diagnosis.

The researchers found that in the intervention group, over two-thirds of patients expressing suicidal ideation were no longer suicidal at 4 months, an improvement rate resembling that observed among specialty mental health patients in an academic-based clinic.

CHICAGO—A new method to increase the recovery of DNA from unborn babies in a blood sample from their mothers may be helpful for future development of non-invasive prenatal genetic tests to identify fetal abnormalities, according to an article in the March 3 issue of the Journal of the American Medical Association (JAMA).

"Prenatal diagnosis is useful in managing a pregnancy with an identified fetal abnormality and may allow for planning and coordinating care during delivery and the neonatal period," the authors provide as background information. "... invasive diagnostic tests (e.g., amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling) for fetal chromosomal abnormalities are highly reliable, but the procedure used for each test carries a risk for loss of pregnancy. Many patients who are candidates for these tests decline them because of the risk of pregnancy loss." The authors continue, "... the use of free fetal DNA for detecting chromosomal abnormalities has been limited by the seemingly low percentage of free fetal DNA in the maternal circulation."

Ravinder Dhallan, M.D., Ph.D., from Ravgen, Inc., Columbia, Md., and colleagues, analyzed blood samples from pregnant women to determine if the percentage of free fetal DNA could be increased by using formaldehyde to stabilize blood cell membranes and reduce the number of the mother's blood cells that are destroyed during sample collection, handling, and processing, which reduces the amount of maternal DNA released, thereby increasing the percentage of fetal DNA. The study was conducted in two phases from January through February 2002 at one clinical site and March 2002 through May 2003 at a network of 27 clinical sites in 16 U.S. states. The first phase collected two samples of blood from ten pregnant women - one blood sample was treated with formaldehyde and the other blood sample was untreated. In the second phase, all 69 blood samples were treated with formaldehyde.

"In the first phase of the study, the mean (average) percentage of free fetal DNA in the untreated samples was 7.7 percent, while the mean percentage of free fetal DNA in the formaldehyde-treated samples was 20.2. percent. In the second phase, a median (half-way point) of 25 percent free fetal DNA was obtained for the 69 formaldehyde-treated maternal blood samples. Approximately 59 percent of the samples in this study had 25 percent or greater fetal DNA, and only 16 percent of the samples had less than 10 percent fetal DNA. In addition, 27.5 percent of the samples in this study had 50 percent or greater fetal DNA."

STATIN REDUCED HEART DISEASE