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 of 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, July 10, 2006)
NEW RISK FACTORS DO NOT IMPROVE ASSESSMENT OF CORONARY HEART DISEASE RISK
HEALTHY LIFESTYLE REDUCES WOMEN'S STROKE RISK
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 10, 2006)
MEASURING PROTEINS IN SPINAL FLUID MAY PROVIDE EARLY CLUE TO ALZHEIMER'S DISEASE
SPECIAL ONLINE PUBLICATION — NEUROLOGISTS WITH EXPERTISE IN MOVEMENT DISORDERS AND BRAIN STIMULATION THERAPY MAY HELP IMPROVE OUTCOMES FOR SOME PATIENTS WITH PARKINSON'S DISEASE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 10, 2006)
RESEARCH HIGHLIGHTS RISK FACTORS FOR AGE-RELATED VISION LOSS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 10, 2006
Media Advisory: To contact Aaron R. Folsom, M.D., M.P.H., call Liz Bryan at 612-624-5680. To contact editorialist Donald M. Lloyd-Jones, M.D., Sc.M., call Liz Crown at 312-503-8928.
NEW RISK FACTORS DO NOT IMPROVE ASSESSMENT OF CORONARY HEART DISEASE RISK
CHICAGO—Screening for levels of C-reactive protein and other compounds recently found to be associated with coronary heart disease may not help physicians predict risk for the condition with any more accuracy than traditional major risk factors, according to a report in the July 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Major risk factors for coronary heart disease (CHD), which include age, race, sex, blood pressure, diabetes, total and HDL (good) cholesterol levels, smoking status and the use of medications to control blood pressure, predict an individual's probability of developing the condition with reasonable accuracy. Most are also modifiable, so physicians can advise patients on how to change their lifestyle to reduce their risk, according to background information in the article. In recent years, researchers have identified additional risk factors and chemical markers associated with CHD, such as C-reactive protein, a compound in the blood that signifies inflammation caused by injury or infection.
Aaron R. Folsom, M.D., M.P.H., University of Minnesota, Minneapolis, and colleagues with the Atherosclerosis Risk in Communities (ARIC) Study assessed the benefits of screening patients' levels of 19 novel chemical markers, including C-reactive protein, antibodies against infectious diseases, B vitamins and compounds involved in the functioning of blood vessel lining. The ARIC Study enrolled a total of 15,792 adults between the ages of 45 and 74 years in 1987-1989. The participants underwent a physical examination, including assessment of major risk factors, at the beginning of the study and every three years afterward. At four times during the follow-up period, researchers collected blood and DNA samples for analysis. Patients continue to be tracked for the development of CHD.
Several of the compounds tested, including C-reactive protein and vitamin B6, were significantly associated with CHD. The researchers looked at each marker and assessed the probability that a participant who developed CHD within a five-year period had a higher risk score than a participant who did not develop CHD. Using this method, they determined that most of the novel markers did not significantly increase the ability of physicians to predict CHD.
"Although the significant and independent association of a novel risk factor with CHD often does not equate to improved prediction of CHD beyond that of basic risk factors, this does not imply that the novel risk factor is pathophysiologically unimportant or unsuitable as a target for intervention," the authors write. "Based on the totality of evidence, however, C-reactive protein level does not emerge as a clinically useful addition to basic risk factor assessment for identifying patients at risk of a first CHD event."
Routine screening is not warranted for any of the other 18 novel risk factors tested either, the authors conclude. "On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for CHD for preventive action," they write.
(Arch Intern Med. 2006;166:1368-1373. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The ARIC Study is a collaborative study supported by contracts from the National Heart, Lung and Blood Institute.
EDITORIAL: IMPROVE PREVENTION BY FOCUSING ON CURRENT RISK FACTORS
The 19 novel markers studied may someday be useful in assessing risk in certain subpopulations, but for now physicians must focus on improving already recognized risk factors, write Donald M. Lloyd-Jones, M.D., Sc.M., Northwestern University Feinberg School of Medicine, Chicago, and Lu Tian, Sc.D., in an accompanying editorial.
"We need to ensure that the tools we currently have for risk prediction are applied more broadly and routinely throughout clinical practice," they write. "We must also address the enormous gaps between the promise of cardiovascular disease prevention and its reality. We have improved our recognition of those with an elevated blood pressure or cholesterol level, but fewer than one of three Americans with adverse levels of these factors are controlled to goal levels. These issues must be addressed and improved urgently."
(Arch Intern Med. 2006;166:1342-1344. Available to the media pre-embargo 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, July 10, 2006
Media Advisory: To contact Tobias Kurth, M.D., Sc.D., call Lori J. Shanks at 617-534-1604.
HEALTHY LIFESTYLE REDUCES WOMEN'S STROKE RISK
CHICAGO—Women who are non-smokers, exercise regularly, have a healthy diet, including moderate alcohol consumption, and otherwise live a healthy lifestyle may have a reduced risk of stroke, according to a report in the July 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
About 700,000 strokes occur each year in the United States, approximately one-fourth of which are fatal and an additional one-fourth of which leave patients permanently disabled, according to background information in the article. There are two main types of stroke: ischemic, the more common type, in which a blocked artery causes a lack of blood flow to the brain; and hemorrhagic, which occurs when a ruptured blood vessel causes blood to leak into the brain. Several individual risk factors, including smoking, exercise and body mass index (BMI), have been linked to stroke. However, in contrast to studies assessing risk for heart disease and diabetes, researchers have not previously examined how the combination of these behaviors may contribute to stroke.
Tobias Kurth, M.D., Sc.D., Brigham and Women's Hospital and Harvard School of Public Health, Boston, and colleagues studied the association between healthy lifestyles and stroke risk in 37,636 women age 45 years or older. At the beginning of the study, in 1993, the women answered questions about their smoking habits, alcohol consumption, diet, exercise routine and body mass index. From their responses, the researchers gave each woman a health index score that ranged from zero to 20, with a higher score indicating a healthier lifestyle. Healthy behavior was defined as never smoking, consuming four to 10.5 alcoholic drinks per week, exercising four or more times per week, having a body mass index of less than 22 and maintaining a healthy diet. This included consuming high levels of cereal fiber, folate and omega-3 fatty acids, a high ratio of polyunsaturated to saturated fat and low levels of trans fat and glycemic load.
During an average of 10 years of follow-up, 450 women had strokes; 356 were ischemic, 90 were hemorrhagic and four were undefined. The 4.7 percent of women with 17 to 20 health index points had a significantly lower risk of stroke overall and of ischemic stroke specifically than women with zero to four health index points. This association remained significant even when the researchers considered some of the common consequences of unhealthy lifestyles, including high blood pressure, diabetes and high cholesterol.
"In this large prospective cohort of apparently healthy women, a healthy lifestyle was associated with a substantial and statistically significant reduction in the risk of total and ischemic stroke with no apparent benefit in the incidence of hemorrhagic stroke," the authors conclude. "Our findings show the importance of healthy behaviors in the prevention of total and ischemic stroke."
(Arch Intern Med. 2006;166:1403-1409. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Heart, Lung and Blood Institute and the National Cancer Institute. The authors thank Elisabeth and Alan Doft and their family for their philanthropic support of this project.
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, July 10, 2006
Media Advisory: To contact Elaine R. Peskind, M.D., call Jeri Rowe at 206-764-2589. To contact editorialist Roger N. Rosenberg, M.D., call Aline McKenzie at 214-648-3404.
MEASURING PROTEINS IN SPINAL FLUID MAY PROVIDE EARLY CLUE TO ALZHEIMER'S DISEASE
CHICAGO—Early signs of the development of Alzheimer's disease can be seen in the cerebrospinal fluid of middle-aged adults who are genetically predisposed to the neurologic condition, according to a report in the July issue of the Archives of Neurology, one of the JAMA/Archives journals.
The two strongest risk factors for Alzheimer's disease are aging and the presence of an allele (type of gene) known as apolipoprotein E*4 (APOE*4), according to background information in the article. Those with the APOE*4 allele develop clinical dementia about 10 to 15 years earlier than those who do not have the APOE*4 allele. Previous studies have shown that the plaques that form in the brain during Alzheimer's disease, which are made of proteins known as β-amyloids, begin forming years before affected individuals experience any symptoms of the disease. As β-amyloid proteins, predominately of a type known as Aβ42, clump together, fewer are available to circulate through the nervous system. Therefore, lower levels of the Aβ42 in the cerebrospinal fluid surrounding the brain and spinal cord serve as biomarkers or chemical indicators of the development of Alzheimer's disease.
Elaine R. Peskind, M.D., VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, and colleagues estimated the combined effect of aging and the APOE*4 allele on levels of Aβ42 and another β-amyloid, Aβ40, in 184 adults (94 men and 90 women, average age 50 years). The participants underwent clinical and laboratory screening and were found to be cognitively normal-that is, they had no difficulties with thinking, learning or memory. Researchers took samples of cerebrospinal fluid in the morning after an overnight fast and measured participants' Aβ42 and Aβ40 levels in addition to determining whether each individual had the APOE*4 allele.
Those who were older and who had the APOE*4 allele were more likely to have lower levels of Aβ42. For those who did not have the APOE*4 allele, Aβ42 levels rose slightly until about age 50 years then begin to decline slowly. On the other hand, those with the APOE*4 allele experienced a slight decline in Aβ42 in their younger years and then a dramatic drop between ages 50 and 60 years. Levels of Aβ42 were not associated with scores on any cognitive or memory tests. "In persons with the APOE*4 allele, decline in cerebrospinal fluid Aβ42 concentration possibly begins in young adulthood, followed by marked acceleration of this decline beginning in midlife-decades before clinical manifestations of Alzheimer's disease," the authors write. The same relationship did not hold true for Aβ40, which, although it is also found in amyloid plaques, is less prevalent there than Aβ42; levels of Aβ40 did not change with age in those with the APOE*4 allele and decreased with age in those without the APOE*4 allele.
"These findings have implications for the preclinical diagnosis of Alzheimer's disease, as well as for treatment," the authors conclude. "Therapeutic strategies aimed at prevention of Alzheimer's disease may need to be applied in early midlife or even younger ages to have maximal effect on amyloid deposition. Primary prevention trials for Alzheimer's disease targeting elderly persons may be too late to affect the early stages of disease pathology."
(Arch Neurol. 2006;63:936-939. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the U.S. National Institute on Aging; the National Alzheimer's Coordinating Center; Friends of Alzheimer's Research; Alzheimer's Association of Western and Central Washington; and the Department of Veterans Affairs.
EDITORIAL: EARLY DETECTION NEEDED TO TREAT ALZHEIMER'S DISEASE
Research has indicated that the processes associated with Alzheimer's disease can be changed and even reversed-if they are detected in the early stages, writes Roger N. Rosenberg, M.D., University of Texas Southwestern Medical Center and editor, Archives of Neurology, in an accompanying editorial.
"...Peskind and colleagues offer an additional means to identify the earliest phase of Alzheimer's disease, when the effectiveness of future agents will have the most benefit," he writes. "Time matters in most issues, including treating the patient who has Alzheimer's disease."
(Arch Neurol. 2006;63:926-928. Available to the media pre-embargo 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, July 10, 2006
Media Advisory: To contact Elena Moro, M.D., Ph.D., call Mary Thring at 416-946-8369.
NEUROLOGISTS WITH EXPERTISE IN MOVEMENT DISORDERS AND BRAIN STIMULATION THERAPY MAY HELP IMPROVE OUTCOMES FOR SOME PATIENTS WITH PARKINSON'S DISEASE
CHICAGO—Patients with Parkinson's disease who are undergoing a treatment known as deep brain stimulation may benefit from the direct involvement of a neurologist with expertise both in movement disorders and in deep brain stimulation, according to an article posted online today that will appear in the September 2006 print issue of the Archives of Neurology, one of the JAMA/Archives journals.
Deep brain stimulation is a surgical procedure that involves implanting electrodes into the brain to electronically stimulate areas that control movement, treating Parkinson's disease symptoms such as tremor, stiffness and problems walking. It is the most effective surgical treatment for advanced cases of Parkinson's disease. Deep brain stimulation involves intensive patient management, including adjustments of electrical currents and medication dosages as a patient's condition changes. Many medical centers in North America delegate these responsibilities to personnel who do not have extensive experience in Parkinson's disease care, such as surgical nurses, fellows or neurophysiologists, according to information in the article.
Elena Moro, M.D., Ph.D., and colleagues at University Health Network, University of Toronto, Ontario, studied whether the outcomes resulting from deep brain stimulation could be improved with the direct involvement of a neurologist with specific expertise both in the treatment of movement disorders in general and in deep brain stimulation in particular. Forty-four consecutive patients at the hospital who had already been receiving regular deep brain stimulation treatments for an average of 3.5 years underwent evaluation by such a neurologist-in other words, the neurologist changed the electric stimulation settings during the procedure and also adjusted the medications that patients received afterward. The patients underwent assessments for Parkinson's disease symptoms before and after their reprogrammed treatment, with following assessments at an average of 5 months (range 1 hour to 14 months) after the reprogramming.
Of the 44 patients, 24 (54.6 percent) showed additional improvement in their Parkinson's disease symptoms; 16 (36.4 percent) were unchanged; and four (9.1 percent) worsened. The patients who did improve experienced fewer tremors and less rigidity and bradykinesia (slowness of movement) and also had reductions in their medication dosages. The four patients who worsened had more speech and gait problems and were returned to their original settings.
"Further improvement of parkinsonian signs can be achieved in the majority of patients even after long-term stable stimulation," the authors conclude. "Improved patient outcomes from subthalamic nucleus deep brain stimulation are obtained when postoperative care is personally managed by a neurologist expert in movement disorders and deep brain stimulation who is directly responsible for stimulation programming and simultaneous drug adjustments based on observed clinical responses to changing stimulation parameters."
(Arch Neurol. 2006;63:(doi:10.1001/archneur.63.9.noc60069). Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was partially funded through a Center of Excellence grant from the National Parkinson Foundation and a grant from Medtronic in support of fellow and nurse salaries. Please see full article for complete financial disclosure information.
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, July 10, 2006
Media Advisory: To contact Johanna M. Seddon, M.D., Sc.M., call Mary Leach at 617-573-4170. To contact corresponding author Paul Mitchell, M.D., Ph.D., e-mail: paul_mitchell{at}wmi.usyd.edu.au. To contact Mary N. Haan, M.P.H., Dr.P.H., call Karl Bates at 734-647-1842.
RESEARCH HIGHLIGHTS RISK FACTORS FOR AGE-RELATED VISION LOSS
CHICAGO—Eating fish frequently may be associated with decreased chances of developing age-related macular degeneration, while smoking nearly doubles the risk for this common cause of vision loss and hormone therapy appears to have no effect, according to three articles in the July issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
Age-related macular degeneration (AMD) occurs when the macula, the area at the back of the retina that produces the sharpest vision, begins to deteriorate. The condition affects approximately 30 percent of Americans age 75 years and older, with 6 to 8 percent developing advanced cases, according to background information in one of the articles. It is the most prevalent cause of vision loss and blindness in the elderly population. Researchers have hypothesized that many of the risk factors for cardiovascular disease, including atherosclerosis or blocked arteries, may also contribute to the development of AMD, possibly by affecting blood flow to the eye.
In the first study, Johanna M. Seddon, M.D., Sc.M., of the Massachusetts Eye and Ear Infirmary, Boston, and colleagues studied genetic and environmental risk factors for AMD in 681 elderly male twins. The men underwent an examination by an ophthalmologist, filled out a food questionnaire and participated in a telephone interview to assess other risk factors, including demographics, smoking, alcohol consumption and physical activity habits. AMD was diagnosed using photographs of the inner eye.
Of the 681 men, 222 (average age 75.9 years) had intermediate or late-stage AMD and 459 (average age 74.5 years) had no AMD or were in the very early stages. Those who currently smoked had a 1.9-fold increased risk of AMD and those who had smoked in the past had a 1.7-fold increased risk. Those who ate more fish and more omega-3 fatty acids (found in salmon and other fish), were less likely to have AMD. The greatest reduction in risk was seen among individuals who ate two or more servings of fish per week. The benefits of eating more omega-3 fatty acids were most apparent among those who consumed less linoleic acid, an omega-6 fatty acid, suggesting that the proper balance of fats is key, the authors write.
"About a third of the risk of AMD in this twin study cohort could be attributable to cigarette smoking, and about a fifth of the cases were estimated as preventable with higher fish and omega-3 fatty acid dietary intake," they conclude. "Age-related macular degeneration is a common eye disease in older persons, smoking is a common avoidable behavior and dietary habits are modifiable; therefore, a proportion of visual impairment and blindness due to AMD could be prevented with attention to healthy lifestyles."
(Arch Ophthalmol. 2006;124:995-1001. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by a grant from the National Institutes of Health, Bethesda, Md.; the Foundation Fighting Blindness Inc., Owings Mills, Md.; DSM Inc., Parsippany, N.J.; the Retirement Research Foundation, Chicago; the Massachusetts Lions Eye Research Fund Inc., Northboro; and the Epidemiology Unit Research Fund, Massachusetts Eye and Ear Infirmary, Boston.
EATING FISH PROTECTS AGAINST MACULAR DEGENERATION
In a second study, Brian Chua, B.Sc., M.B.B.S., M.P.H., Westmead Millennium Institute and Vision Co-operative Research Centre, Syndney, Australia, and colleagues examined the association between dietary fat intake and AMD risk in 2,895 Australians age 49 years or older, beginning in 1992-1994. At the beginning of the study and again five years later, participants had a comprehensive eye exam that included photographs of the retina. They also filled out a questionnaire with data about food types and portion sizes consumed, including specific information about margarines, butters, oils and supplements.
Of the 2,335 participants who participated in the five-year follow-up, 158 had developed early AMD and 26 late-stage AMD. After adjusting for other factors that may influence risk, including smoking, age, sex and vitamin C intake, those in the group with the highest intake of polyunsaturated fat had a 50 percent reduced chance of developing early AMD compared with those who ate the least. Those who ate fish once a week had reduced risk of early AMD by 40 percent compared with those who ate fish less than once per month, and those who ate fish three or more times per week also had reduced risk for late-stage AMD. Contrary to previous studies showing an increased risk for AMD with higher unsaturated fat intake, no link was found between AMD and consumption of butter, margarine or nuts, which all contain high levels of unsaturated fats.
"To explain our findings, we suggest that insufficient essential fatty acid intake could result in abnormal retinal metabolism and cell renewal," the authors write. "Studies have shown cardioprotective benefits of monounsaturated fatty acids in the Mediterranean diet and that diets high in n[omega]-3 fatty acids, particularly docosahexaenoic acid, derived largely from fish, may protect against retinal oxidation and degeneration. Our finding that at least weekly fish consumption was protective against incident early age-related maculopathy provides support for this hypothesis."
(Arch Ophthalmol. 2006;124:981-986. Available to the media pre-embargo at www.jamamedia.org)
HORMONE THERAPY DOES NOT AFFECT AGE-RELATED VISION LOSS
Postmenopausal hormone therapy does not appear to increase or decrease the overall risk of AMD among women, although combination hormones may slightly reduce the chances of developing certain risk factors or types of the condition, according to a third report in the same issue.
Mary N. Haan, M.P.H., Dr.P.H., University of Michigan, Ann Arbor, and colleagues studied 4,262 women age 65 years and older who were part of the Women's Health Initiative Sight Exam Study, part of the larger Women's Health Initiative clinical trial of hormone therapy. Of those, 1,627 were in the estrogen-only group of the study, with 48.1 percent taking hormones and 51.9 percent taking placebo. The other 2,635 women were in the combination hormone trial; 52.3 percent of those participants were taking estrogen plus progestin pills and 47.7 percent received placebo. Participants underwent eye assessments and retinal photography at the beginning of the study, between April 2000 and June 2002.
After an average of five years of follow-up, 21 percent of the women had developed AMD. Neither combination nor estrogen-alone therapy was found to be associated with developing AMD. Among women in the combination trial only, active hormone therapy was associated with a slightly reduced risk of developing soft drusen-deposits in the eye that may precede AMD-and also lower odds of having neovascular AMD, a less common form of the condition in which blood vessels grow underneath the retina, impairing vision.
"We conclude that treatment with hormones does not influence the occurrence of early AMD," the authors conclude. "As an exception, a possible protective effect was found for soft drusen or neovascular AMD in relation to combined equine estrogens plus progestin."
(Arch Ophthalmol. 2006;124:988-992. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The WHI program is supported by the National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services (this study is an ancillary study to the WHI CT and Observational Study); and support for the evaluation of macular degeneration in women recruited into the WHISE Study was provided by Wyeth Ayerst Laboratories. Dr. Musch has been a consultant to Iridex, Inc., and MacuSight, Inc.
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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