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 27, 2005)
JAMA NEWS RELEASES
MEDICATION REDUCES RISK OF HEART IRREGULARITIES AFTER CARDIAC SURGERY
HIGH DIETARY INTAKE OF ANTIOXIDANTS ASSOCIATED WITH REDUCED RISK OF AGE-RELATED MACULAR DEGENERATION IN ELDERLY
HAVING SIBLING WITH CARDIOVASCULAR DISEASE ASSOCIATED WITH HIGHER CVD RISK, COMPARED TO OTHER COMMON RISK FACTORS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
HAVING SIBLING WITH HEART DISEASE EVEN GREATER RISK FACTOR THAN
PARENTAL HEART DISEASE
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 risk factor of having a sibling with cardiovascular disease. The release will be fed Tuesday, December 27, 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).
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 27, 2005
Media Advisory: To contact L. Brent Mitchell, M.D., call Colleen Donahue at 403-210-8522.
To contact editorial co-author Joseph P. Mathew, M.D., call Chris DiFrancesco at 919-684-4148.
MEDICATION REDUCES RISK OF HEART IRREGULARITIES AFTER CARDIAC SURGERY
CHICAGO—Use of the medication amiodarone is associated with one-half the incidence of atrial tachyarrhythmias (rapid, abnormal heart beat) following cardiac surgery, according to a study in the December 28 issue of JAMA.
Atrial tachyarrhythmias, usually atrial fibrillation or atrial flutter, often occur immediately after cardiac surgery and are the most common postoperative complication, according to background information in the article. The incidence of sustained atrial tachyarrhythmias after coronary artery bypass graft (CABG) surgery is approximately 30 percent; after valve surgery, approximately 40 percent; and after combined CABG and valve replacement/repair surgery, approximately 50 percent. The consequences of these atrial tachyarrhythmias include discomfort or anxiety, stroke, exposure to the risks of tachyarrhythmia treatments, prolongation of hospital stay, and increased health care costs. Atrial tachyarrhythmias have recently been reported to increase hospital stay after cardiac surgery by an average of 1.4 days at an additional cost of $6,356 per patient. Substantial effort has been invested in finding an effective, safe, and widely applicable preventive treatment for atrial tachyarrhythmia occurring after cardiac surgery. Previous trials of amiodarone were relatively small and yielded conflicting results.
L. Brent Mitchell, M.D., and colleagues from the University of Calgary, Canada, conducted the Prophylactic Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement, or Repair (PAPABEAR) trial to test the hypothesis that amiodarone is an effective, well-tolerated, and safe therapy for prevention of atrial tachyarrhythmias after cardiac surgery. The placebo-controlled, randomized trial compared younger patients (less than 65 years) with older patients (65 years or older), patients undergoing CABG surgery compared with patients undergoing cardiac valve surgery or combined CABG and valve replacement/repair surgery, and patients who received preoperative beta-blocker therapy with those who did not.
The study included 601 patients who had CABG surgery and/or valve replacement/repair surgery between February 1, 1999, and September 26, 2003. The patients were followed up for 1 year. Patients received oral amiodarone or placebo, administered 6 days prior to surgery through 6 days after surgery (total of 13 days).
Amiodarone was associated with a halving of the overall incidence of atrial tachyarrhythmias lasting 5 minutes or longer.
Postoperative sustained ventricular tachyarrhythmias occurred less frequently in amiodarone patients (1/299; 0.3 percent) than in placebo patients (8/302; 2.6 percent). There were no differences in serious postoperative complications, in-hospital mortality, or readmission to the hospital within 6 months of discharge or in 1-year mortality.
"The number needed to treat [with amiodarone] to prevent 1 patient from developing postoperative atrial tachyarrhythmia was only 7.5 overall and was even lower in older patients, in patients having valve surgery, and in patients not receiving concomitant beta-blocker therapy," the authors write.
"The PAPABEAR trial demonstrates that a 13-day perioperative course of oral amiodarone is an effective, possibly safe, well-tolerated, and widely applicable therapy for the prevention of postoperative atrial tachyarrhythmia after cardiac surgery. This benefit was associated with a reduction in the probability of perioperative sustained ventricular tachyarrhythmia and a trend toward a reduction in postoperative hospital stay," the researchers conclude.
(JAMA. 2005;294:3093-3100. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support and financial disclosure information, please see the JAMA article.
EDITORIAL: PROPHYLAXIS AGAINST POSTOPERATIVE ATRIAL FIBRILLATION - CURRENT PROGRESS AND FUTURE DIRECTIONS
In an accompanying editorial, Mihai V. Podgoreanu, M.D., and Joseph P. Mathew, M.D., of Duke University Medical Center, Durham, N.C., comment on the study by Mitchell and colleagues.
"Future study of atrial fibrillation prophylaxis should consider three important methodological issues. First, when addressing the relationship between postoperative atrial fibrillation and complications, it is essential to capture the precise time of onset of both atrial fibrillation and the complications, thus allowing for a detailed examination of the temporal relationship between the two. Second, patients experiencing multiple episodes of atrial fibrillation should be targeted for therapeutic intervention because the incidence of complications is much greater in these patients than in those experiencing a single episode. Amiodarone therapy has potential benefit in this setting as well, having been associated with a lower risk of recurrence in an observational trial. Third, a majority of the known risk factors for postoperative atrial fibrillation should be recorded and accounted for in statistical analyses. The use of a risk index offers statistical advantages and may be used to define patient selection criteria or identify patients for whom prophylactic therapy might be most effective."
"In the meantime, to help prevent postoperative atrial fibrillation, more widespread use of amiodarone for patients undergoing elective cardiac surgery should be considered."
(JAMA. 2005;294:3140-3142. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 27, 2005
Media Advisory: To contact corresponding author Paulus T. V. M. de Jong, M.D., Ph.D., email: p.dejong{at}ioi.knaw.nl.
HIGH DIETARY INTAKE OF ANTIOXIDANTS ASSOCIATED WITH REDUCED RISK OF AGE-RELATED MACULAR DEGENERATION IN ELDERLY
CHICAGO—A diet with a high intake of beta carotene, vitamins C and E, and zinc is associated with a substantially reduced risk of age-related macular degeneration in elderly persons, according to a study in the December 28 issue of JAMA.
Age-related macular degeneration (AMD) is a degenerative disorder of the macula, the central part of the retina, and is the most common cause of irreversible blindness in developed countries, according to background information in the article. Late-stage AMD results in an inability to read, recognize faces, drive, or move freely. The prevalence of late AMD steeply increases with age, affecting 11.5 percent of white persons older than 80 years. In the absence of effective treatment for AMD, the number of patients severely disabled by late-stage AMD is expected to increase in the next 20 years by more than 50 percent to 3 million in the United States alone. Epidemiological studies evaluating both dietary intake and serum levels of antioxidant vitamins and AMD have provided conflicting results. One study (called AREDS) showed that supplements containing 5 to 13 times the recommended daily allowance of beta carotene, vitamins C and E, and zinc given to participants with early or single eye late AMD resulted in a 25 percent reduction in the 5-year progression to late AMD.
Redmer van Leeuwen, M.D., Ph.D., of Erasmus Medical Centre, Rotterdam, the Netherlands, and colleagues investigated whether antioxidants, as present in normal daily foods, play a role in the primary prevention of AMD. Dietary intake was assessed at baseline in the Rotterdam Study (1990-1993) using a semiquantitative food frequency questionnaire. Follow-up continued through 2004. The Rotterdam Study included inhabitants aged 55 years or older from a middle-class suburb of Rotterdam, the Netherlands. Of 5,836 persons at risk of AMD at baseline, 4,765 had reliable dietary data and 4,170 participated in the follow-up.
Average follow-up of participants was 8.0 years. During this period, 560 persons (13.4 percent) were diagnosed as having new AMD, the majority of whom had early-stage AMD. A significant inverse association was observed for intake of vitamin E, iron, and zinc. After adjustment, a 1-standard deviation increase in intake was associated with a reduced risk of AMD of 8 percent for vitamin E and 9 percent for zinc. An above-median (midpoint) intake of beta carotene, vitamins C and E, and zinc, compared with a below-median intake of at least 1 of these nutrients, was associated with a 35 percent reduced risk of AMD, adjusted for all potential confounders. In persons with a below-median intake of all 4 nutrients, the risk of AMD was increased by 20 percent. Adding nutritional supplement users to the highest quartile of dietary intake did not change the results.
"This study suggests that the risk of AMD can be modified by diet; in particular, by dietary vitamin E and zinc. A higher intake of vitamin E can be achieved by consumption of whole grains, vegetable oil, eggs, and nuts. High concentrations of zinc can be found in meat, poultry, fish, whole grains, and dairy products. Carrots, kale, and spinach are the main suppliers of beta carotene, while vitamin C is found in citrus fruits and juices, green peppers, broccoli, and potatoes. Based on this study, foods high in these nutrients appear to be more important than nutritional supplements. Until more definitive data are available, this information may be useful to persons with signs of early AMD or to those with a strong family history of AMD. Although in need of confirmation, our observational data suggest that a high intake of specific antioxidants from a regular diet may delay the development of AMD," the authors conclude.
(JAMA. 2005;294:3101-3107. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 27, 2005
Media Advisory: To contact Joanne M. Murabito, M.D., Sc.M., call 508-935-3461, or call co-author Christopher J. O’Donnell, M.D., M.P.H., at 508-935-3435.
HAVING SIBLING WITH CARDIOVASCULAR DISEASE ASSOCIATED WITH HIGHER CVD RISK, COMPARED TO OTHER COMMON RISK FACTORS
CHICAGO—Middle-aged adults who have a sibling with cardiovascular disease (CVD) have a 45 percent increased risk for CVD, a risk that is greater than that conferred by having parents with CVD, according to a study in the December 28 issue of JAMA.
Cardiovascular disease in a first-degree relative confers increased risk for CVD, but whether familial CVD is truly an independent risk factor remains controversial, according to background information in the article. Risk associated with CVD in siblings is uncertain because published estimates are largely derived from case-control studies that generally lack sibling CVD event validation. Furthermore, estimates regarding magnitude of risk associated with a history of sibling CVD vary greatly. Accurate information about familial CVD will have increasing importance in prevention and treatment of CVD in the post-genome era.
Joanne M. Murabito, M.D., Sc.M., of the Framingham Heart Study, Framingham, Mass., and colleagues conducted a study to determine whether the occurrence of a validated sibling CVD event predicted CVD events in a cohort of middle-aged adults, and examined the impact of sibling CVD over and above that of parental CVD. The researchers analyzed data from the Framingham Offspring Study, a part of the Framingham Heart Study, a population-based study initiated in 1948 with the offspring cohort initiated in 1971. Participants were members of the offspring cohort aged 30 years or older, free of CVD, and with at least 1 sibling in the study. All were followed up for eight years.
Among 973 person-examinations in those who had a sibling with CVD group (average age, 57 years) and 4,506 person-examinations in those with no sibling with CVD group (average age, 47 years), 329 CVD events occurred during follow-up. The researchers found that sibling CVD was associated with a 55 percent increased risk for incident CVD; this association persisted even after adjustment for risk factors (45 percent increased risk). The attributable risk percentage for sibling CVD was 27.4 percent; this represents the proportion of the 8-year CVD risk among those in the sibling CVD group that theoretically would not have occurred if members of the group had not had a sibling with CVD.
"Using validated events and a prospective design, our study substantially extends the knowledge base regarding the importance of sibling CVD. We observed that sibling CVD confers increased risks of CVD events above and beyond traditional risk factors and parental premature CVD. Thus, sibling CVD should be considered as important as parental premature CVD in the assessment of risk. Further investigation is needed to better understand why sibling history may be a stronger predictor for CVD than parental history, including exploration of the contribution of an early shared environment to increased sibling risk. Moreover, investigation of whether to incorporate sibling CVD as well as parental CVD into existing risk prediction and prevention algorithms is warranted," the authors conclude.
(JAMA. 2005;294:3117-3123. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
HAVING SIBLING WITH HEART DISEASE EVEN GREATER RISK FACTOR THAN
PARENTAL HEART DISEASE
VIDEO:
NAT SOT UP FULL FOR :05
Three sisters sitting together interview style
AUDIO:
"I’m Martha. I’m Moira. I’m Carol Jane."
VIDEO:
B-ROLL
Sisters walking down hall
AUDIO:
THESE THREE SISTERS DON’T HAVE HEART DISEASE. BUT THEIR BROTHER DIED FROM A HEART ATTACK. THAT SIBLING ASSOCIATION COULD PUT THE SISTERS AT INCREASED RISK FOR HEART DISEASE, ALSO KNOWN AS CARDIOVASCULAR DISEASE.
VIDEO:
SOT/FULL
@ :16
Super: Joanne Murabito, M.D., Sc.M.
Framingham Heart Study
Runs :13
AUDIO:
"Having a sibling with cardiovascular disease increases your risk for a heart attack by as much as 45 percent compared to people without a sibling with cardiovascular disease."
VIDEO:
B-ROLL
Dr. Murabito and colleague looking at CT scans on light board
AUDIO:
DR. JOANNE MURABITO AND HER COLLEAGUES AT THE FRAMINGHAM HEART STUDY IN MASSACHUSETTS TRACKED ABOUT 25-HUNDRED PEOPLE WHO DIDN’T HAVE HEART DISEASE, BUT HAD SIBLINGS WHO DID.
VIDEO:
SOT/FULL
Joanne Murabito, M.D., Sc.M.
Framingham Heart Study
Runs :14
AUDIO:
"We followed them for eight years, looking for the occurrence of a cardiovascular event, such as a heart attack, stroke or blockage in the artery in their legs."
VIDEO:
B-ROLL
GFX/JAMA Cover
AUDIO:
THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Joanne Murabito, M.D., Sc.M.
Framingham Heart Study
Runs :10
AUDIO:
"We were surprised that sibling cardiovascular heart disease may actually be a stronger risk factor than parental cardiovascular disease."
VIDEO:
B-ROLL
Pre-teen twin brothers playing basketball
Sisters sitting in lobby talking together
AUDIO:
DR. MURABITO SAYS IT MAY BE THAT SHARED CHILDHOOD EATING AND EXERCISE HABITS, ALONG WITH GENETICS, COULD EXPLAIN THE SIBLING RISK. SHE SAYS ADULT SIBLINGS NEED TO TELL EACH OTHER, AND THEIR DOCTORS, ABOUT ANYTHING TO DO WITH THEIR HEART HEALTH.
VIDEO:
NAT SOT UP FULL FOR :03
Three sisters sitting together interview style
AUDIO:
"We don’t really have dinner-table discussions about our health."
VIDEO:
B-ROLL
Sisters eating
AUDIO:
BUT THEY SAY THEY’LL START DOING JUST THAT, TO LEARN MORE ABOUT THEIR OWN RISKS FOR HEART DISEASE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
