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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, December 20, 2005)
JAMA NEWS RELEASES
POOR FITNESS COMMON IN TEENS AND ADULTS, WITH ASSOCIATED INCREASE IN PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS
MEN WITH ERECTILE DYSFUNCTION HAVE INCREASED RISK FOR CARDIOVASCULAR EVENTS
USE OF GASTRIC ACID-SUPPRESSIVE AGENTS LINKED WITH INCREASED RISK FOR DIARRHEA INFECTION
NEW APPROACH FOR GENETIC SCREENING FOR SYNDROME LINKED TO CARDIAC IRREGULARITIES AND SUDDEN DEATH
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
ONE-THIRD OF U.S. TEENS AND NEARLY 15 PERCENT OF YOUNGER ADULTS
SHOW LOW FITNESS AND SIGNS OF HEART DISEASE RISK
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on the cardiorespiratory fitness of adolescents and adults in the U.S. The release will be fed Tuesday, December 20, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 20, 2005
Media Advisory: To contact Mercedes R. Carnethon, Ph.D., call Elizabeth Crown at 312-503-8928.
POOR FITNESS COMMON IN TEENS AND ADULTS, WITH ASSOCIATED INCREASE IN PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS
CHICAGO—Approximately one-third of adolescents and 14 percent of adults (aged 20 to 49 years) in the U.S. have poor cardiorespiratory fitness, with an associated increased prevalence of cardiovascular disease risk factors such as higher total cholesterol and blood pressure levels, according to a study in the December 21 issue of JAMA.
There is strong and consistent evidence from observational studies that physical inactivity and poor cardiorespiratory fitness (i.e., fitness) are associated with higher illness and death from all causes, including cardiovascular disease (CVD) and cancer, according to background information in the article. United States population reports describe an increasingly less physically active society, with marked downturns in reported physical activity during adolescence and young adulthood. Prior to the current National Health and Nutrition Examination Survey (NHANES), data were not available to quantify objectively determined cardiorespiratory fitness in the U.S. population. The extent to which physical inactivity affects the risk of heart disease through its negative impact on cardiorespiratory fitness, which is associated with a high prevalence of other CVD risk factors, is not known at the population level.
Mercedes R. Carnethon, Ph.D., and colleagues from the Feinberg School of Medicine, Northwestern University, Chicago, examined the prevalence of low fitness in the U.S. population of adolescents and adults younger than 50 years and determined the relation between low fitness and CVD risk factors in this population. Using data from NHANES 1999-2002, the researchers analyzed data for adolescents (aged 12-19 years; n = 3,110) and adults (aged 20-49 years; n = 2,205) who were free from previously diagnosed CVD. The participants underwent submaximal graded exercise treadmill testing to achieve at least 75 percent to 90 percent of their age-predicted maximum heart rate. Maximal oxygen consumption (Vo2max) was estimated by measuring the heart rate response to reference levels of submaximal work.
The researchers found that 19.2 percent of the surveyed population-an estimated 16 million U.S. adolescents and adults younger than 50 years-were in the low fitness category, and 33.6 percent of adolescents (approximately 7.5 million) and 13.9 percent of adults (approximately 8.5 million) had low fitness. Among adolescents, the prevalence of low fitness was similar between females (34.4 percent) and males (32.9 percent), but among adults the prevalence of low fitness was significantly higher in females (16.2 percent) compared with males (11.8 percent). Non-Hispanic blacks and Mexican Americans were less fit than non-Hispanic whites. Body mass index and waist circumference demonstrated the most consistent inverse associations with fitness. Total cholesterol levels and systolic blood pressure were higher and levels of high-density lipoprotein cholesterol were lower among participants with low vs. high fitness.
The researchers add that because older adults and individuals with existing risk factors for CVD were not tested on the treadmill because of possible health risks, the results of this study likely underestimate the true prevalence of low fitness in the population.
" ...this report indicates that low fitness is a prevalent and important public health problem in the U.S. population. The consequences of declines in physical activity over time are now evident by the large proportion of society with low levels of fitness. The correlations we report between low fitness and CVD risk factors suggest a potential trend of increasing morbidity and mortality from chronic diseases-the first sign of which is the burgeoning obesity epidemic. Historical evidence from the campaign to educate about the dangers of cigarette smoking indicates that education efforts, particularly among youth, can retard and reverse these negative health behaviors. Thus, it is plausible that a similar education campaign about the health benefits of physical activity to improve cardiorespiratory fitness, in combination with changes in health care policy to make environments more conducive to physical activity, could begin to reverse this serious public health problem," the authors conclude.
(JAMA. 2005;294:2981-2988. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial support for data collection was provided by the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention, Department of Health and Human Services. Dr. Carnethon was supported in part by a career development award from the National Heart, Lung, and Blood Institute, National Institutes of Health.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 20, 2005
Media Advisory: To contact Ian M. Thompson, M.D., call Will Sansom at 210-567-2579.
MEN WITH ERECTILE DYSFUNCTION HAVE INCREASED RISK FOR CARDIOVASCULAR EVENTS
CHICAGO—Men with erectile dysfunction have a higher risk of subsequent cardiovascular events such as heart attack, stroke, and angina, according to a study in the December 21 issue of JAMA.
More than 10 million men in the United States are affected by erectile dysfunction (ED), with an estimated 100 million men affected worldwide, according to background information in the article. The risk of erectile dysfunction is related to many factors, including age, smoking, diabetes, heart disease, depression, and hypertension. Because cardiovascular disease and erectile dysfunction share etiologies as well as pathophysiology (endothelial dysfunction) and because of evidence that degree of erectile dysfunction correlates with severity of cardiovascular disease, it has been postulated that erectile dysfunction is a sentinel symptom in patients with cardiovascular disease.
Ian M. Thompson, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues studied a group of men who were assessed for ED and subsequent cardiovascular disease over the course of 7 years. The study included men aged 55 years or older who were randomized to the placebo group (n = 9,457) in the Prostate Cancer Prevention Trial at 221 U.S. centers. Participants were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. In analysis, factors at study entry taken into account included age, body mass index, blood pressure, serum lipids, diabetes, family history of heart attack, race, smoking history, current use of antihypertensive medication, physical activity, and quality of life.
Of the 9,457 men randomized to placebo, 8,063 (85 percent) had no cardiovascular disease at study entry; of these men, 3,816 (47 percent) had erectile dysfunction at study entry. Among the 4,247 men without erectile dysfunction at study entry, 2,420 men (57 percent) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a 25 percent increased risk for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the increased risk was 45 percent.
"Our analysis of men in the placebo group of this study demonstrates the substantial association between incident as well as prevalent erectile dysfunction and subsequent cardiovascular disease, including angina, myocardial infarction, stroke, and transient ischemic attack," the authors write.
"The implications of this study are substantial. With the availability of effective pharmacotherapy, an increasing number of men are seeking care for erectile dysfunction. It is estimated that more than 600,000 men aged 40 to 69 years in the United States develop erectile dysfunction annually. Our data suggest that the older men in this group have about a 2-fold greater risk of cardiovascular disease than [younger] men without erectile dysfunction. With 70 percent to 89 percent of sudden cardiac deaths occurring in men and with many men not having regular physical examinations, this analysis suggests that the initial presentation of a man with erectile dysfunction should prompt the evaluating physician to screen for standard cardiovascular risk factors and, as appropriate, initiate cardioprotective interventions," they write.
"Our data provide the first evidence, to our knowledge, of a strong association between erectile dysfunction and subsequent development of clinical cardiovascular events. Acknowledging this association over a 5-year period and the high prevalence of vasculogenic/atherogenic etiologies in men of this age, the presenting symptom of erectile dysfunction should prompt an assessment of cardiovascular risk factors and vigorous interventions as appropriate. While a full cardiovascular evaluation is not necessary in response to findings of erectile dysfunction in asymptomatic patients, such findings should prompt diligent observation of at-risk men and reinforces the need for intervention for cardiovascular risk factors," the researchers conclude.
(JAMA. 2005;294:2996-3002. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by Public Health Service grants from the National Cancer Institute.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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For Immediate Release
Media Advisory: To contact Sandra Dial, M.D., M.Sc., call Jennifer Robinson at 514-398-6747.
USE OF GASTRIC ACID-SUPPRESSIVE AGENTS LINKED WITH INCREASED RISK FOR DIARRHEA INFECTION
CHICAGO—Use of gastric acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk for an infection that is a significant cause of diarrhea, according to a study in the December 21 issue of JAMA.
Clostridium difficile infection, an important cause of nosocomial (taking place or originating in a hospital) diarrhea, has also been reported to be an important cause of diarrhea in the community, according to background information in the article. A British study identified C difficile as the third most common cause of infectious diarrhea in patients aged 75 years and older seen by general practitioners. A French study performed in outpatients to whom antibiotics were prescribed reported an incidence of C difficile-associated disease (CDAD) of 1.5 percent and estimated that up to 920,000 outpatients nationwide could potentially develop toxinogenic CDAD yearly. Recent data suggest that both the rates and severity of nosocomial CDAD are increasing. While the rates of CDAD in the community are much lower than in the hospital setting, the absolute number of cases in the community could be significant.
Sandra Dial, M.D., M.Sc., and colleagues from McGill University, Montreal, conducted a study to determine whether the use of gastric acid-suppressant drugs is associated with the risk of community-acquired CDAD. This study consisted of two population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, the researchers identified all 1,672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice.
The researchers found that of these 1,672 patients, 1,233 (74 percent) had not been hospitalized in the year prior to diagnosis and were considered community-acquired. There has been a significant increase in the rate of C difficile cases diagnosed in the community from less than 1 per 100,000 persons in 1994 to 22 per 100,000 in 2004. During this period, the rate of prescriptions of antibiotics has decreased and that of proton pump inhibitors has increased. After controlling for certain variables, current use of proton pump inhibitors was associated with nearly 3 times the rate of CDAD; use of H2-receptor antagonists was associated with twice the rate of CDAD. Current use of NSAIDs but not aspirin was associated with a 30 percent increased rate of C difficile.
"Clostridium difficile-associated disease is becoming an important public health issue. Significant increases in number of cases of CDAD in Great Britain since the 1990s have been observed, including the exponential increase in the community observed in this study. Genetic mutations that may be associated with increased transmissibility and increased severity are also being reported. These factors combined with reports of outbreaks in the United States and the recent outbreak in the Canadian province of Quebec justify considering CDAD as an important public health concern. While the overall rate of CDAD in the GPRD is much lower than in the hospital setting, it appears to be increasing significantly even in the face of both our data and another report to suggest that outpatient antibiotic prescribing in the GPRD is decreasing. Acid-suppressive agents are among the most frequently prescribed medications in the United Kingdom and North America, and it is in this context that the contribution of these agents by potentially increasing the pool of susceptible hosts to the increasing rates of CDAD needs to be considered and more completely characterized," the authors conclude.
(JAMA. 2005;294:2989-2995. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by the Canadian Institutes of Health Research (CIHR) and the Canadian Foundation for Innovation (CFI). Dr. Dial is a Chercheur-Boursier Clinicien and co-author Dr. Barkun a Chercheur National awardee, both from the Fonds de la recherche en santé du Québec (FRSQ). Co-author Dr. Suissa is the recipient of a Distinguished Investigator award from CIHR. Dr. Barkun is a consultant for AstraZeneca Inc. and Altana Pharma Inc. No other authors reported financial disclosures.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 20, 2005
Media Advisory: To contact corresponding author Silvia G. Priori, M.D., Ph.D., email: spriori{at}fsm.it.
To contact editorial author Elizabeth S. Kaufman, M.D., call George Stamatis at 216-368-3635.
NEW APPROACH FOR GENETIC SCREENING FOR SYNDROME LINKED TO CARDIAC IRREGULARITIES AND SUDDEN DEATH
CHICAGO—Italian researchers have developed a novel approach for genetic screening for long QT syndrome (LQTS), an inherited disease that predisposes young individuals to cardiac arrhythmias and sudden death, according to a study in the December 21 issue of JAMA.
The clinical value of genetic testing has been demonstrated by the evidence that carriers of LQTS mutations lacking QT interval prolongation (certain measurement on an electrocardiogram), who therefore escape clinical diagnosis, have a 10 percent risk of major cardiac events by age 40 years whenever left untreated, according to background information in the article. In LQTS, disease severity and response to therapy vary according to the genetic mutation involved. There exists a critical need to devise more efficient genetic testing for LQTS.
Carlo Napolitano, M.D., Ph.D., of the S. Maugeri Foundation, Pavia, Italy, and colleagues performed genetic screening in patients with LQTS to determine the yield of genetic testing, as well as the type and the prevalence of mutations. The study involved genetic testing of 430 patients with LQTS and 1,115 family members between June 1996 and June 2004. The researchers confirmed their findings by testing for the identified mutations in a separate cohort of 75 patients.
The researchers identified 235 different mutations, 138 of which were new, in 310 (72 percent) of 430 patients. "The clinical value of molecular screening is influenced by the percentage of successfully genotyped individuals. Our data show that 70 percent of Romano Ward [a genetic mutation of LQTS] probands [an individual or member of a family being studied in a genetic investigation] can be successfully genotyped by standard methods based on the current knowledge about the molecular substrate of LQTS. This number, obtained in a population of consecutively genotyped patients, is high enough to support the introduction of genotyping into clinical medicine," the authors write.
"We have developed an approach to improve the efficiency of genetic screening for LQTS," the researchers write. "The novel strategy for LQTS genotyping may facilitate the access to genetic testing to a broader group of individuals, such as patients receiving drugs that … prolong QT interval; family members of individuals with idiopathic ventricular fibrillation; and depending on results of further investigation, members of the general population to define the prevalence of known genetic variants of LQTS."
(JAMA. 2005;294:2975-2980. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by grants from the National Institutes of Health. Co-author Dr. Priori has a patent pending for the proposed screening algorithm. Otherwise, none were reported.
EDITORIAL: EFFICIENT GENOTYPING FOR CONGENITAL LONG QT SYNDROME
In an accompanying editorial, Elizabeth S. Kaufman, M.D., of Metro Health Medical Center and Case Western Reserve University, Cleveland, comments on the study on LQTS.
"Napolitano et al have provided important new information about the yield of genetic testing and about the distribution of mutations, and their proposed efficient genotyping strategy could make genetic testing accessible to more families with LQTS but at the cost of some accuracy. As the authors note, 'the more complete the screening process the higher the accuracy of the results of genetic analysis. … [T]he ideal screening should include the evaluation of the entire coding region of each disease-related gene of each patient. However, this comprehensive approach may be neither possible nor cost-effective' everywhere based on current technology. Novel technologies for rapid and efficient DNA sequencing are on the horizon. Until these technologies are developed further, the medical community will have to decide how much accuracy is reasonable to sacrifice to make genetic testing more accessible."
(JAMA. 2005;294:3027-3028. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
ONE-THIRD OF U.S. TEENS AND NEARLY 15 PERCENT OF YOUNGER ADULTS
SHOW LOW FITNESS AND SIGNS OF HEART DISEASE RISK
VIDEO:
B-ROLL
Young woman running on treadmill
AUDIO:
PHYSICAL FITNESS IS THE BODY’S RESPONSE TO PHYSICAL ACTIVITY.
VIDEO:
SOT/FULL
@ :04
Super: Mercedes Carnethon, Ph.D.
Northwestern University
Runs :13
AUDIO:
"This is really important because fitness and the ability of your heart and your lungs and circulation system to respond to these challenges is related to heart disease risk factors later."
VIDEO:
B-ROLL
Dr. Carnethon and colleague going over data
People working out
GFX/JAMA Cover
AUDIO:
THAT’S WHY DR. MERCEDES CARNETHON (CAR-neh-thon) AND HER COLLEAGUES AT NORTHWESTERN UNIVERSITY’S FEINBERG SCHOOL OF MEDICINE STUDIED NATIONWIDE DATA ON PHYSICAL FITNESS. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
B-ROLL
SOT/FULL
Mercedes Carnethon, Ph.D.
Northwestern University
Runs :11
AUDIO:
"Approximately one in three teens are in low fitness in the U.S. population. And what we see is that already, these teens who are in low fitness have higher levels of heart disease risk factors."
VIDEO:
B-ROLL
Overweight teens
Older man lifting weights
Overweight adults walking on city street
AUDIO:
THAT MEANS HIGHER CHOLESTEROL, BLOOD PRESSURE, OBESITY AND DIABETES. THE STUDY ALSO LOOKED AT FITNESS IN ADULTS AGES TWENTY TO FORTY-NINE, AND FOUND ABOUT FIFTEEN PERCENT IN LOW FITNESS, WITH HEART DISEASE RISK FACTORS. AND THERE’S MORE.
VIDEO:
SOT/FULL
Mercedes Carnethon, Ph.D.
Northwestern University
Runs :12
AUDIO:
"Some individuals are in worse shape than others in this country, namely African Americans, Mexican Americans, and females as opposed to males."
VIDEO:
B-ROLL
Charles lifting weights
AUDIO:
THIS TEEN SAYS HE KNOWS MANY PEOPLE HIS AGE ARE NOT FIT, BUT THE STUDY FINDINGS PROVE HE’S DOING THE RIGHT THING.
VIDEO:
SOT/FULL
@: 1:12
Super: Charles Malone
Age 19
Runs :10
AUDIO:
"My working out now will help me not get heart disease later on in life and still be healthy and fit at an older age, so that’s basically what I’m doing."
VIDEO:
B-ROLL
Backtime Dr. Carnethon
AUDIO:
DR. CARNETHON AGREES.
VIDEO:
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Mercedes Carnethon, Ph.D.
Northwestern University
Runs :07
AUDIO:
"Your lifestyle and your lifestyle patterns as a teen or a young adult impact your later risk of having heart disease."
VIDEO:
B-ROLL
Charles working out
Young women lifting weights
AUDIO:
SHE WISHES MORE YOUNG PEOPLE WOULD UNDERSTAND THE IMPORTANCE OF PHYSICAL FITNESS, FOR ITS SHORT- TERM AND LONG-TERM HEALTH BENEFITS. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
