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 Early Release: 10:30 a.m. CT, Tuesday, November 15, 2005)
JAMA NEWS RELEASES
AGGRESSIVE LOWERING OF LDL-CHOLESTEROL LEVEL SHOWS LIMITED BENEFIT FOR PATIENTS WITH PREVIOUS HEART ATTACK
PARTIALLY SUBSTITUTING CARBOHYDRATES IN DIET WITH PROTEIN OR UNSATURATED FATS LOWERS BLOOD PRESSURE AND IMPROVES CHOLESTEROL LEVELS AND MAY REDUCE CARDIOVASCULAR RISK
HIGHER PLACENTAL WEIGHT ASSOCIATED WITH INCREASED MATERNAL BREAST CANCER RISK
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
INCREASING DIETARY PROTEIN AND MONOUNSATURATED FAT CAN LOWER BLOOD PRESSURE AND CHOLESTEROL, IMPROVING HEART HEALTH
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 effect of various diets on blood pressure and cholesterol levels. The release will be fed Tuesday, November 15, 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 Early Release: 10:30 a.m. CT, Tuesday, November 15, 2005
Media Advisory: To contact Terje R. Pedersen, M.D., Ph.D., email: t.r.pedersen@medisin.uio.no. To contact editorial author Christopher P. Cannon, M.D., call Melanie Franco at 617-534-1605.
AGGRESSIVE LOWERING OF LDL-CHOLESTEROL LEVEL SHOWS LIMITED BENEFIT FOR PATIENTS WITH PREVIOUS HEART ATTACK
CHICAGO—Patients who have had a heart attack and are treated with a high dose of a statin drug
did not have significant reduction in the primary outcome of major cardiac events (coronary death, nonfatal acute heart attack, or cardiac arrest with resuscitation), but did appear to have reduced risk when certain secondary outcomes (composite end points of any coronary heart disease event) were examined, according to a study in the November 16 issue of JAMA. This study is being released early to coincide with its presentation at the American Heart Association’s annual meeting.
Lowering of low-density lipoprotein cholesterol (LDL-C) with statins has in the last decade become part of the standard treatment regimen in patients with established coronary heart disease (CHD), according to background information in the article. The most common treatment regimen for such patients in northern Europe has been simvastatin, 20 to 40 mg/d. In a recent trial among patients with acute coronary syndromes, incremental benefit was demonstrated with more intensive lowering of LDL-C to well below 100 mg/dL. Another study comparing high and low doses of atorvastatin in stable nonacute CHD found significant improvement in prognosis with respect to cardiovascular disease. In that study, however, the benefit of reduced cardiovascular death appeared to have been offset by a higher number of deaths due to noncardiovascular causes. Although this difference did not reach statistical significance and could well be due to chance, it led to a call for further safety information on the use of atorvastatin at a dose of 80 mg/d.
Terje R. Pedersen, M.D., Ph.D., of Ulleval University Hospital, Oslo, Norway and colleagues with the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study examined whether intensive lowering of LDL-C with atorvastatin at the highest recommended dose would be more beneficial compared with the moderate, most widely used dose of simvastatin. The randomized trial was conducted at 190 cardiology care and specialist practice centers in northern Europe between March 1999 and March 2005, with a median (mid-point) follow-up of 4.8 years.
The study included 8,888 patients aged 80 years or younger with a history of acute myocardial infarction (MI; heart attack). Patients were randomly assigned to receive a high dose of atorvastatin (80 mg/d (n=4,439), or usual-dose simvastatin (20 mg/d; n=4,449).
During treatment, mean LDL-C levels were 104 mg/dL in the simvastatin group and 81 mg/dL in the atorvastatin group. The primary end point of coronary death, acute myocardial infarction, or cardiac arrest with resuscitation occurred in 463 patients (10.4 percent) in the simvastatin group and in 411 (9.3 percent) in the atorvastatin group and was not statistically significantly different between the two groups. There were 178 coronary deaths (4.0 percent) in the simvastatin group vs. 175 (3.9 percent) in the atorvastatin group. Nonfatal myocardial infarction occurred in 321 patients (7.2 percent) in the simvastatin group and in 267 (6.0 percent) in the atorvastatin group.
The composite secondary end point of a major cardiovascular event including stroke was reduced in the atorvastatin group. Similarly, there were reductions in the risk of nonfatal MI, any CHD event, and any cardiovascular event. The risk of death from any cause was similar in both study groups. There were no significant differences in noncardiovascular deaths between the treatment groups. There were no significant differences in the frequency of serious adverse clinical events between the 2 groups. Patients in the atorvastatin group had higher rates of drug discontinuation due to nonserious adverse events.
"In summary, when comparing standard and intensive LDL-C–lowering therapies in patients with previous myocardial infarction, there was no statistically significant reduction in the primary end point of major coronary events, but there was reduced risk of other composite secondary end points and nonfatal acute MI. There were no differences in cardiovascular and all-cause mortality. The results indicate that patients with myocardial infarction may benefit from intensive lowering of LDL-C without increase in noncardiovascular mortality or other serious adverse reactions," the authors conclude.
(JAMA. 2005;294:2437-2445. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was sponsored by Pfizer Inc. For the financial disclosures of the authors, please see the JAMA article.
EDITORIAL: THE IDEAL CHOLESTEROL - LOWER IS BETTER
In an accompanying editorial, Christopher P. Cannon, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, discusses the results of the study by Pedersen et al.
"What are the messages for patients from the IDEAL and other statin trials? First, for the ‘bad’ cholesterol, LDL-C, lower is better for preventing MI stroke, need for cardiac procedures, and death. Second, statins are safe overall, even for patients with extremely low treatment LDL-C levels. However, patients and physicians have to work as partners to monitor for adverse effects, which can occur in up to 5 percent of patients but that only rarely can be life-threatening. Fortunately, these are almost always reversible and do not lead to any permanent damage. Third, patients should know their cholesterol numbers, for both LDL-C and HDL-C, to enable them to see how much lowering is needed to reach targets of an LDL-C level of less than 100 mg/dL for patients with risk factors or less than 70 mg/dL for patients with heart disease."
"And fourth, any drug treatment should be taken together with an appropriate diet and exercise program to lower cholesterol and overall vascular risk. The amount of LDL-C lowering with diet is only in the range of 7 percent to 12 percent. Clearly, diet is a central part of the treatment, but to get the benefits of very low cholesterol levels, drug treatment is often necessary. Optimal use of diet and appropriate use of medications will dramatically reduce the risk of MI, stroke, and death from heart disease. These new data should help motivate any patients who have been hesitating about treating their cholesterol to talk with their physician to get the benefits of intensive cholesterol lowering."
"Finally, the scientific community needs to continue to pursue new avenues of treatment, with approaches that may well be ‘beyond statins.’ Even with intensive statin therapy, the current best evidence-based treatment available, many patients still will have recurrent cardiovascular events. New strategies may include development of new agents to achieve even lower target LDL-C levels, substantially increase HDL-C levels, reduce triglycerides, reduce C-reactive protein and other components of inflammation, and modify many other identified components of vascular disease," Dr. Cannon writes.
(JAMA. 2005;294:2492-2494. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For the financial disclosures of Dr. Cannon, 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 Early Release: 10:30 a.m. CT, Tuesday, November 15, 2005
Media Advisory: To contact Lawrence J. Appel, M.D., M.P.H., call David March at 410-955-1534 or 410-598-7056. To contact editorial author Myron H. Weinberger, M.D., call Eric Schoch at 317-274-7722.
PARTIALLY SUBSTITUTING CARBOHYDRATES IN DIET WITH PROTEIN OR UNSATURATED FATS LOWERS BLOOD PRESSURE AND IMPROVES CHOLESTEROL LEVELS AND MAY REDUCE CARDIOVASCULAR RISK
CHICAGO—As part of a healthy diet, partially substituting protein and monounsaturated fat for carbohydrates can improve cholesterol levels, further lower blood pressure and reduce estimated cardiovascular risk, according to a study in the November 16 issue of JAMA. This study is being released early to coincide with its presentation at the American Heart Association’s annual meeting.
Despite widespread consensus that a reduced intake of saturated fat lowers cardiovascular disease (CVD) risk, the optimal type of macronutrient (protein, unsaturated fat, or carbohydrate) that should replace saturated fat is uncertain, according to background information in the article. Two major goals of dietary recommendations are to lower blood pressure and improve serum lipids, two of the primary determinants of CVD risk.
Lawrence J. Appel, M.D., M.P.H., of Johns Hopkins University, Baltimore, and colleagues with the Optimal Macronutrient Intake Trial to Prevent Heart Disease (OmniHeart) study compared the effects on blood pressure and serum lipids of three healthful diets: a carbohydrate-rich diet, similar to the DASH diet (Dietary Approaches to Stop Hypertension); a diet rich in protein, approximately half from plant sources; and a diet rich in unsaturated fat, predominantly monounsaturated fat. Each diet was reduced in saturated fat, cholesterol, and sodium and rich in fruits, vegetables, fiber, potassium, and other minerals at recommended levels. The randomized feeding study involved 164 adults with prehypertension or stage 1 hypertension. Participants ate each diet for 6 weeks and body weight was kept constant. The study was conducted from April 2003 to June 2005.
The researchers found that blood pressure, low-density lipoprotein cholesterol, and estimated coronary heart disease risk were lower on each diet in comparison to baseline. "In OmniHeart, [compared to a carbohydrate-rich diet], a diet that partially replaced carbohydrates with protein, about half from plant sources, lowered blood pressure, LDL cholesterol levels, and triglyceride levels, as well as HDL cholesterol levels among adults with prehypertension or stage 1 hypertension. A diet that partially replaced carbohydrates with unsaturated fat, predominantly monounsaturated fat, lowered blood pressure and triglyceride levels and increased HDL cholesterol levels but had no significant effect on LDL cholesterol levels. Estimated coronary heart disease risk was similar on the protein and unsaturated fat diets and lower than that of the carbohydrate diet," the authors write.
"Results from OmniHeart have important implications. First, our results provide strong evidence that, in addition to salt, potassium, weight, alcohol, and the DASH diet, macronutrients also affect blood pressure. Second, the DASH diet, as tested in this trial [under weight-stable conditions], can be improved; partial substitution of carbohydrates with protein, about half from plant sources, or with unsaturated fat, predominantly monounsaturated fat, has beneficial effects on blood pressure and serum lipid levels. Third, the magnitude of effects have both public health and clinical importance. The blood pressure reductions and improved lipid profiles should reduce CVD risk in the general population and mitigate the need for drug therapy in persons with risk factor levels above treatment thresholds."
"In conclusion, in the setting of recommended levels of saturated fat, cholesterol, fiber, fruit, vegetables, and minerals, diets that partially replace carbohydrates with protein or monounsaturated fat can further lower blood pressure, improve lipid risk factors, and reduce CVD risk," the researchers write.
(JAMA. 2005;294:2455-2464. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Funding for this study was provided through grants from the National Institutes of Health. The following companies donated food: The Almond Board, International Tree Nut Council, Olivio Premium Products Inc., and The Peanut Institute.
EDITORIAL: MORE NOVEL EFFECTS OF DIET ON BLOOD PRESSURE AND LIPIDS
In an accompanying editorial, Myron H. Weinberger, M.D., of Indiana University Medical Center, Indianapolis, discusses whether the results from the OmniHeart trial can be applied to the general population.
"The participants in both of the DASH trials and in the OmniHeart Trial were highly selected from a motivated group of relatively young, well-educated, overweight individuals, a majority of whom were ethnic urban dwellers. Previous studies have shown that individuals with similar characteristics are likely to respond to sodium reduction and the DASH-type diets with a reduction in blood pressure and lipid levels. Thus the blood pressure responses of the participants in the present trial are not very surprising. Although the benefit of blood pressure reduction in those in the prehypertensive group is clear, the ability to control blood pressure adequately with diet alone among the stage 1 hypertensives studied in the OmniHeart Trial has not been presented. It is likely that more than diet will be required to reach goal blood pressures for the majority of these individuals, particularly with the lowering of blood pressure goals being advocated at present."
"The provision of all meals and snacks for a period of several months may have served as an inducement for study participants to remain in the trial. This may not be applicable to unselected patients or to the general population who have to purchase and prepare their own meals. Moreover, the practical application of these findings requires the demonstration that the lifestyle changes inherent in the tested diets can be maintained for periods longer than the few weeks studied in the OmniHeart trial. The composition of and the apparent lack of commercial availability of these very carefully designed diets also may be limitations to the broader application of these findings. Finally, because the OmniHeart Trial only used the surrogate outcomes of blood pressure and lipid levels, longer trials examining actual cardiovascular event outcomes will be needed to convince a skeptical public of the benefit of yet another unique and difficult-to-achieve dietary regimen," Dr. Weinberger concludes.
(JAMA. 2005;294:2497-2498. 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 Early Release: 10:30 a.m. CT, Tuesday, November 15, 2005
Media Advisory: To contact Sven Cnattingius, M.D., Ph.D., email: sven.cnattingius{at}mep.ki.se.
HIGHER PLACENTAL WEIGHT ASSOCIATED WITH INCREASED MATERNAL BREAST CANCER RISK
CHICAGO—Women with a higher placental weight in prior pregnancies have an increased risk of breast cancer, possibly from the hormones produced by the placenta, according to a study in the November 16 issue of JAMA.
Hormonal factors play a key role in the development of breast cancer, according to background information in the article. Early menarche (first menstruation), late menopause, and long-term use of hormone therapy have been shown to be associated with increased risk of breast cancer. Serum levels of estrogens, progesterone and placental growth hormones are many times higher during pregnancy than during other periods of life, and pregnant women also are exposed to elevated levels of insulin-like growth factors. During pregnancy, these markers have been inconsistently associated with subsequent risk of breast cancer in the mother. It has been hypothesized that placental weight could be an indirect measure of hormone exposure during pregnancy.
Sven Cnattingius, M.D., Ph.D., of Karolinska Institutet, Stockholm, Sweden, and colleagues investigated the possible associations between indirect markers of hormonal exposures during pregnancy, such as placental weight, offspring’s birth weight, pregnancy complications, and subsequent maternal risk of developing breast cancer. The researchers used data from the Swedish Birth Register, the Swedish Cancer Register, the Swedish Cause of Death Register, and the Swedish Register of Population and Population Changes. The study included women in the Sweden Birth Register who delivered single births between 1982 and 1989, with complete information on date of birth and gestational age. Women were followed up until the occurrence of breast cancer, death, or end of follow-up (December 31, 2001).
Of 314,019 women in the cohort, 2,216 (0.7 percent) developed breast cancer during the follow-up through 2001, of whom 2,100 (95 percent) were diagnosed before age 50 years. The researchers found that compared with women who had placentas weighing less than 500 g in 2 consecutive pregnancies, the risk of breast cancer was increased among women whose placentas weighed between 500 and 699 g in their first pregnancy and at least 700 g in their second pregnancy (or vice versa), and the corresponding risk was doubled among women whose placentas weighed at least 700 g in both pregnancies. A high birth weight (4000 g or greater) in 2 successive births was associated with an increased risk of breast cancer before but not after adjusting for placental weight and other covariates. Compared with women who had a placental weight of less than 500 g, women who had a placental weight of at least 700 g had a 38 percent increase in risk of breast cancer.
"Our finding of a positive association between placental weight and breast cancer risk may reflect that exposures to elevated levels of pregnancy hormones influence the risk of breast cancer. The role of estrogens in breast carcinogenesis is well established, and serum estrogen levels are at least 10 times higher during pregnancy compared with other times of life," the authors write.
"In addition, placental weight appears to be a better indicator of the hormonal milieu than birth weight or other included birth parameters. Underlying biological mechanisms responsible for the observed associations may not only be limited to a direct growth enhancing effect on breast cells during childbearing, but also may be due to maternal characteristics or genetic factors associated with placental growth," the researchers conclude.
(JAMA. 2005;294:2474-2480. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was financially supported through a grant from the U.S. Army Breast Cancer Research Program.
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
INCREASING DIETARY PROTEIN AND MONOUNSATURATED FAT CAN LOWER BLOOD PRESSURE AND CHOLESTEROL, IMPROVING HEART HEALTH
VIDEO:
B-ROLL
Margaret preparing food Garbanzo beans,
chicken Olive oil, canola oil, almonds
Tight shot of Margaret’s fork in bean salad
AUDIO:
MARGARET SMITH IS PREPARING FOODS HIGH IN PROTEIN, LIKE GARBANZO BEANS AND CHICKEN, AND FOODS HIGH IN MONOUNSATURATED FAT, LIKE OLIVE OIL, CANOLA OIL AND ALMONDS. WHY? BECAUSE BEFORE SHE ATE THESE THINGS, SHE HAD HIGH BLOOD PRESSURE.
VIDEO:
SOT/FULL
@:15
Super: Margaret Smith
Had high blood pressure
Runs :09
AUDIO:
"150, approximately over 90, I think was the starting range, and it got as low as 132 over 83."
VIDEO:
NAT SOT UP FULL FOR :03
Dr. Appel taking Margaret’s blood pressure
AUDIO:
"Sound of blood pressure cuff being pumped up"
VIDEO:
B-ROLL
Dr. Appel taking Margaret’s blood pressure
AUDIO:
MARGARET TOOK PART IN A STUDY AT JOHNS HOPKINS UNIVERSITY TO SEE WHAT EFFECT DIET HAD ON HIGH BLOOD PRESSURE AND CHOLESTEROL, WHICH CAN LEAD TO HEART DISEASE OR STROKE.
VIDEO:
SOT/FULL
@:36Super: Lawrence Appel, M.D., M.P.H.
Johns Hopkins University
Runs :13
AUDIO:
"The study involved three diets. One diet that is rich in carbohydrates, another diet that is rich in protein, about half from plant sources, and a third diet that is rich in monounsaturated fat."
VIDEO:
B-ROLL
Dr. Appel and colleagues discussing data at conference table
GFX/JAMA COVER
AUDIO:
DR. LAWRENCE APPEL (apple) AND HIS COLLEAGUES STUDIED ABOUT ONE-HUNDRED-SIXTY PEOPLE WITH HIGH BLOOD PRESSURE, EACH OF WHOM TRIED EACH DIET. THE STUDY APPEARS IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Lawrence Appel, M.D., M.P.H.
Johns Hopkins University
Runs :10
AUDIO:
"It turns out that the lowest levels of blood pressure and cholesterol were on the protein diet and on the monounsaturated fat diet."
VIDEO:
B-ROLL
Margaret preparing veggie burger
Tight shot pouring oil on salad
AUDIO:
PEOPLE ON THOSE DIETS LOWERED THEIR HEART DISEASE RISK BY UP TO 20 PERCENT. AND THOSE DIETS ONLY CUT CARBS A LITTLE. THE POINT WAS TO INCREASE PROTEIN OR MONOUNSATURATED FAT. SO WHICH OF THOSE DIETS IS BEST?
VIDEO:
SOT/FULL
Lawrence Appel, M.D., M.P.H.
Johns Hopkins University
Runs :11
AUDIO:
"I would pick a hybrid of the two, a mixture of the two. My sense is that a bit more protein and a bit more monounsaturated fat are good for your health."
VIDEO:
B-ROLL
Tight shot of Margaret’s fork in lentil loaf
AUDIO:
MARGARET LIKED THE FOOD ON THE PROTEIN DIET THE BEST, ESPECIALLY THE LENTIL LOAF
VIDEO:
SOT/FULL
Margaret Smith
Had high blood pressure
Runs :09
AUDIO:
"I really believe in eating right and eating healthily and this gave me the opportunity to really see the results of a positive diet."
VIDEO:
B-ROLL
Margaret cooking vegetables at stove
AUDIO:
SO SHE’LL KEEP COOKING HER WAY TO A HEALTHY HEART. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
