JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, October 24, 2005
CHOLESTEROL LEVELS AND USE OF LIPID-LOWERING DRUGS ARE NOT ASSOCIATED WITH BREAST CANCER RISKS
ALERT SYSTEM ASSOCIATED WITH INCREASED CLINICAL TRIAL RECRUITMENT
JUSTICE AT WORKPLACE ASSOCIATED WITH REDUCED RISK OF CORONARY HEART DISEASE
ANEMIA ASSOCIATED WITH HIGHER RISK OF DEATH IN THE ELDERLY
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 24, 2005
Media Advisory: To contact A. Heather Eliassen, Sc.D., call Amy Smith at 617-534-1603.
CHOLESTEROL LEVELS AND USE OF LIPID-LOWERING DRUGS ARE NOT ASSOCIATED WITH BREAST CANCER RISK
CHICAGO—Cholesterol levels and use of statins or other lipid-lowering drugs are not associated with breast cancer risk, according to a study in the October 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Although some evidence suggests that statins (the most commonly used type of lipid-lowering drugs) may inhibit tumor development and may work in combination with chemotherapy drugs against cancer, studies on the association between the use of statins and breast cancer have had conflicting results, according to background information in the article.
A. Heather Eliassen, Sc.D., of the Brigham and Women's Hospital, Boston, Mass., and colleagues analyzed data from the Nurses' Health Study to evaluate the associations of statins, lipid-lowering drugs and serum cholesterol levels (blood levels of cholesterol) with breast cancer. Serum cholesterol levels and use of statins and lipid-lowering drugs were determined for 79,994 women through questionnaires completed in 1988, 1994, 1996, 1998 and 2000. Cases of breast cancer, diagnosed from the start of follow-up (1988) through May 31, 2000, were identified on biennial questionnaires. Medical records were used to confirm cancer reports.
There were 3,177 incident cases of invasive breast cancer, including 1,727 in the analysis among statin users. Neither current nor long-term use of statins nor other lipid-lowering drugs were associated with breast cancer risk, the researchers report. There was no association between reported total serum cholesterol levels and breast cancer risk in either pre-menopausal or post-menopausal women.
"In summary, the results of this study suggest that the beneficial effect of statins on breast cancer observed in experimental studies may not be applicable to humans," the authors conclude. "We also found no associations of general lipid-lowering drugs and serum cholesterol levels with breast cancer risk. Further study is warranted to evaluate the associations of longer durations of statin use and specific types of statins with breast cancer risk."
(Arch Intern Med.
2005;165:2264-2271. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Cancer Institute, Bethesda, Md., the Department of Defense, Washington, D.C. and a Cissy Hornung Clinical Research Professorship from the American Cancer Society, Atlanta, Ga.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 24, 2005
Media Advisory: To contact Peter J. Embi, M.D., M.S., call Dama Kimmon at 513-558-4519. To contact editorialist Al B. Benson III, M.D., call Liz Crown at 312-503-8928.
ALERT SYSTEM ASSOCIATED WITH INCREASED CLINICAL TRIAL RECRUITMENT
CHICAGO—An electronic health record-based clinical trial alert system increased recruitment rates and physicians' participation in an ongoing clinical trial, according to a study in the October 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
The success of clinical trials, critical to the advancement of medical science, depends on the recruitment of enough eligible participants in a timely manner, according to background information in the article. Unfortunately, achieving recruitment goals is difficult and failing to meet these goals can hamper the development and evaluation of new therapies and can increase health care system costs. When treating physicians identify and recruit potentially eligible participants for clinical trials, the likelihood that a given patient will participate in a trial increases.
Peter J. Embi, M.D., M.S., from the University of Cincinnati College of Medicine, and colleagues determined whether a clinical trial alert (CTA) system could increase physicians' participation in the recruitment of patients to a clinical trial. After one year of traditional recruitment to a clinical trial, the researchers used their electronic health record (EHR)-based CTA system at The Cleveland Clinic. When a patient's records met selected trial criteria, the CTA alerted the physician about the ongoing trial.
The researchers found that the CTA intervention was associated with a 10-fold increase in the number of referrals generated by physicians, 5.7 per month before intervention to 59.5 per month after. The number of physicians making referrals also increased, from five before intervention to 42 after. The clinical trial enrollment rate more than doubled from 2.9 participants per month to 6.0 participants per month. During the four-month intervention, all of the 114 participating physicians received at least one CTA. Of the 48 physicians who participated, 42 (88 percent) referred at least one patient to the trial coordinator, and 11 (23 percent) of them generated at least one enrollment.
"Use of an EHR-based CTA led to significant increases in physicians' participation in and recruitment rates to an ongoing clinical trial," the authors write. "Given the trend toward the EHR implementation in health care centers engaged in clinical research, this approach may represent a much-needed solution to the common problem of inadequate trial recruitment."
(Arch Intern Med.
2005;165:2272-2277. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by a career development award from the National Library of Medicine, National Institutes of Health, Bethesda, Md.
EDITORIAL: IN SEARCH OF EVIDENCE
Is There the Will and a Way?
In an accompanying editorial, Al B. Benson III, M.D., from Northwestern University, Feinberg School of Medicine, Chicago, discusses the clinical trial research process.
"Even under the most optimal circumstances, obstacles confront most clinical research projects that can delay the reporting of important clinical information. …Because important obstacles to the successful maintenance of a given clinical trials program include recruitment strategies, costs, and time commitments, the integration of an institution's electronic records system with the research record could help to reduce some of the barriers to the accrual of patients to clinical trials," Dr. Benson writes.
"Our country must weigh the risks vs. benefits of clinical research for current and future generations, as well as the costs, training of health care personnel, donation of human biological specimens for research purposes, regulatory and ethical requirements, and the commitment to actively participate in research trials in far greater numbers. …For our clinical research enterprise to thrive and to better promote evidence-based medicine, the public and leaders in medicine, industry, and government must have the will to find the way to guarantee sustainable medical advances."
(Arch Intern Med.
2005;165:2194-2195. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 24, 2005
Media Advisory: To contact Mika Kivimäki, Ph.D., e-mail mika.kivimaki{at}tt.fi.
JUSTICE AT WORKPLACE ASSOCIATED WITH REDUCED RISK OF CORONARY HEART DISEASE
CHICAGO—A sense of fair treatment in the workplace was associated with a reduced risk of coronary heart disease in a large long-term study of British office workers published in the October 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
People feel a sense of justice at work when they believe their supervisor considers their viewpoint, shares information concerning decision-making and treats individuals fairly and in a truthful manner, according to background information in the article. An earlier study had shown that employees had lower blood pressure on days spent working with a supervisor they perceived as fair. The authors suggest that it is plausible to connect a high level of justice with a reduction in chronic stress and its attendant association with coronary heart disease (CHD).
Mika Kivimäki, Ph.D., of the Finnish Institute of Occupational Health, Helsinki, Finland, and colleagues analyzed data from 6,442 male office staff in 20 civil service departments in London, England. Justice at work was measured at phase one (1985-1988) and two (1989-1990). Each participant was given a score based on a self-reported justice scale. They were divided into three groups based on their average score. Participants were followed for incidence of coronary heart disease from 1990 to 1999. Conventional risk factors for coronary heart disease were measured at phase one.
"These data enable us to determine whether the addition of justice would add to risk estimates based on other risk factors," the researchers write. "In the present study, we examined whether justice at work predicted incidence of new CHD among employees and whether this association was independent of coronary risk factors, including cholesterol concentration, hypertension, body mass index (BMI), smoking, alcohol consumption, physical inactivity, and other psychosocial characteristics of the work environment."
"In men who perceived a high level of justice, the risk of incident CHD was 30 percent lower than among those who perceived a low or an intermediate level of justice," the researchers report. "This finding was not accounted for by baseline factors such as age, ethnicity, marital status, educational attainment, socio-economic position, cholesterol level, obesity, hypertension, smoking, alcohol consumption, and physical activity. The association between the level of justice and CHD was also independent of other psychosocial factors at work, as indicated by the two leading stress models, job strain and effort-reward imbalance."
"Most people care deeply about just treatment by authorities," the authors conclude. "Just treatment may communicate status and value, whereas lack of justice may be a source of oppression, deprivation, and stress. Justice, equity, and altruism have been the drivers of benign developments in human societies according to a wide range of studies across a broad spectrum of disciplines. Our findings on CHD, the leading cause of death in all Western societies, suggest that organizational justice is also a topic worthy of consideration in health research."
(Arch Intern Med. 2005;165:2245-2251. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Health and Safety Executive, London; projects from the Academy of Finland and the Finnish Environmental Foundation, Helsinki; grants from the Medical Research Council, London, and the British Heart Foundation, London; and a research fellowship from the Medical Research Council. Complete funding information is available in the article.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 24, 2005
Media Advisory: To contact corresponding author Mary Cushman, M.D., M.Sc., call Jennifer Nachbur at 802-656-7875. To contact editorial author Jerry L. Spivak, M.D., call John Lazarou at 410-502-8902.
ANEMIA ASSOCIATED WITH HIGHER RISK OF DEATH IN THE ELDERLY
CHICAGO—Elderly people with the lowest and highest hemoglobin concentrations (the component of red blood cells that carries oxygen) are at increased risk of death, according to a study in the October 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Increasing evidence indicates that anemia is common in the elderly population, but few studies have assessed the association of anemia with clinical outcomes, such as illness and death, according to background information in the article. Anemia is defined by the World Health Organization (WHO) as a hemoglobin concentration of less than 12 g/dL (grams per one tenth liter) for women and less than 13 g/dL for men.
Neil A. Zakai, M.D., of the University of Vermont College of Medicine, Burlington, compared the association of hemoglobin concentration and anemia status with subsequent death over the course of eleven years in elderly adults living in four U.S. communities. Hemoglobin concentrations were determined for participants recruited between 1989 and 1993. Participants were contacted biannually; telephone and clinic examinations were conducted alternately. Deaths were reviewed and classified as cardiovascular or noncardiovascular. Complete follow-up was available through June 2001 for this analysis.
Hemoglobin concentration was analyzed in two ways: by dividing the participants' baseline hemoglobin into five equal levels and by the WHO criteria for anemia. Based on the WHO criteria for anemia, 498 individuals were anemic on enrollment (8.5 percent of the 5,797 included in the analysis), the researchers report. The hemoglobin concentration for the 1,205 individuals in the lowest fifth was higher than the WHO criteria for anemia, and 41.3 percent of these 1,205 people did qualify as anemic by WHO standards.
"In this elderly cohort, the prevalence of anemia was 7.0 percent among white and 17.6 percent among black individuals," the authors write. "After 11.2 years of follow-up, lower hemoglobin concentrations were associated with increased mortality risk, independent of many potentially confounding factors. The magnitude of this association was similar whether the lowest quintile [fifth] of hemoglobin or the WHO criteria for anemia was used; however, the number of participants was much larger when considering the lowest quintile of hemoglobin concentration." Another finding of the study was that there was also elevated mortality among those in the highest hemoglobin quintile, even after extensive adjustment for other factors.
"In conclusion, a lower hemoglobin concentration was independently associated with mortality in this elderly cohort," the authors write. "The bottom hemoglobin quintile defined a larger group at risk than anemia status based on WHO criteria. Future areas of investigation should determine the optimal hemoglobin value that defines an abnormal concentration in elderly individuals, study the causes of low hemoglobin concentrations in elderly individuals and how these relate differentially to outcomes, evaluate the causes of increased mortality in individuals with low and high hemoglobin concentrations, and assess whether treatment of low hemoglobin in the general population reduces mortality."
(Arch Intern Med.
2005;165:2214-2220. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by contracts from the National Heart, Lung, and Blood Institute, Bethesda, Md. Dr. Cushman has received research funding in the form of a subcontract with the University of Alabama funded by Amgen; the project is not related to this article.
EDITORIAL: ANEMIA IN THE ELDERLY
Time for New Blood in Old Vessels?
In an accompanying editorial, Jerry L. Spivak, M.D., of The Johns Hopkins University School of Medicine, Baltimore, Md., writes, "The four articles in this issue of the Archives usefully highlight and advance our conceptions of the cause of anemia in the elderly and anemia's health-related impact. Anemia, of course, is always the consequence of another disorder, and correction of the underlying disorder is the most effective means of alleviating the anemia. However, anemia in the majority of the elderly is caused by conditions such as chronic renal insufficiency, chronic inflammation, cancer, or bone marrow failure, some of which are actually an aftermath of the aging process and most of which defy correction. It is now also well established that anemia frequently exacerbates the illness causing it, while having its own independent adverse effects."
"What remains to be determined is whether pharmacologic correction of anemia … can slow disease progression, reduce morbidity [illness], improve quality of life, and prolong survival, and whether there is a favorable cost-benefit ratio to society for such improvements," Dr. Spivak continues. "Recent failed attempts to answer these questions in the setting of renal failure or cancer indicate that this will not be an easy task, but the prospect of a doubling in the number of elderly persons over the next 25 years indicates that it is a task that cannot be ignored or deferred."
(Arch Intern Med.
2005;165:2187-2189. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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