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THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, July 24, 2006
LIGHT TO MODERATE DRINKING REDUCES RISK OF CARDIAC EVENTS, DEATH
COMPLEMENTARY AND ALTERNATIVE THERAPIES SHOW LITTLE BENEFIT IN TREATING MENOPAUSE SYMPTOMS
ESTROGEN PLUS TESTOSTERONE THERAPY MAY INCREASE RISK OF BREAST CANCER IN POSTMENOPAUSAL WOMEN
LOW-GLYCEMIC INDEX DIET PROMOTES WEIGHT LOSS, CARDIOVASCULAR RISK REDUCTION
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 24, 2006
Media Advisory: To contact Cinzia Maraldi, M.D., call Denise Trunk at 352-273-5819.
LIGHT TO MODERATE DRINKING REDUCES RISK OF CARDIAC EVENTS, DEATH
CHICAGO—Older adults who consume one to seven alcoholic beverages a week may live longer and have a reduced risk for cardiac events than those who do not drink-an association that appears independent of the anti-inflammatory effects of alcohol, according to a report in the July 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Alcohol may worsen some chronic diseases and the overall effect of drinking on survival is not clear, according to background information in the article. However, several studies have shown that alcohol may reduce the risk of coronary heart disease and heart failure and contribute to a lower death rate. Light to moderate alcohol intake has been shown to reduce levels of C-reactive protein and interleukin-6, compounds that circulate in the blood due to inflammation. Therefore, researchers have suspected that the mechanism linking alcohol to reduced risk of cardiovascular disease may be related to inflammation.
Cinzia Maraldi, M.D., University of Florida, Gainesville, and colleagues investigated the relationship between alcohol, death and cardiac events (such as hospitalization for heart attack, cardiac pain or heart failure) in 2,487 adults without heart disease age 70 to 79 years. Participants (average age 73.5 years, 55 percent women) were recruited between April 1997 and June 1998 and answered questions about disease diagnoses, medication use and drinking habits during an initial interview. They were classified based on how many drinks they consumed in a typical week over the past year; the categories were former; never or occasional (less than one drink per week); light to moderate (one to seven); and heavier (more than seven). During the study, each individual was contacted by telephone every six months and had a clinical assessment every year. Levels of C-reactive protein and interleukin-6 were tested in blood collected after an overnight fast at the beginning of the study.
Almost half of the participants were never or occasional drinkers. During an average 5.6 years of follow-up, 397 participants died and 383 experienced a cardiac event. Compared with never or occasional drinkers, those who drank lightly to moderately had a 26 percent lower risk of death overall and an almost 30 percent lower risk of cardiac events, even after controlling for inflammatory markers. In contrast, heavy drinkers were more likely to die or experience a cardiac event than never or occasional drinkers.
The findings indicate that the anti-inflammatory properties of alcohol alone do not explain the reduced risk of death or cardiovascular disease associated with light to moderate drinking, the authors write. Alcohol may have cellular or molecular effects that reduce the risk of cardiovascular disease, or it may interact with genetic factors to produce a protective effect.
The health effects of alcohol may not be the same for everyone, the authors caution. "The net benefit of light to moderate alcohol consumption may vary as a function of sex, race and background cardiovascular risk," they conclude. "From this point of view, recommendations on alcohol consumption should be based, as any medical advice, on a careful evaluation of an individual's risks and benefits, in the context of adequate treatment and control of established cardiovascular risk factors."
(Arch Intern Med.
2006;166:1490-1497. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported through the National Institute on Aging. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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 24, 2006
Media Advisory: To contact Anne Nedrow, M.D., call Christine Decker at 503-494-8231.
COMPLEMENTARY AND ALTERNATIVE THERAPIES SHOW LITTLE BENEFIT IN TREATING MENOPAUSE SYMPTOMS
CHICAGO—Insufficient evidence exists to support the use of complementary and alternative therapies to relieve menopause-related symptoms, according to a review article in the July 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Twenty-five million women will go through menopause in the next decade, and many of them will experience hot flashes, night sweats, vaginal dryness, sleep problems and other associated symptoms. Approximately 40 percent of women seek medical help for these complaints, according to background information in the article. After the Women's Health Initiative, a large clinical trial of hormone therapy, was halted because of an increased risk of breast cancer, many physicians and patients began to seek other options for menopausal symptoms.
Anne Nedrow, M.D., Oregon Evidence-based Practice Center and Oregon Health and Science University, Portland, and colleagues reviewed 70 previous studies of alternative and complementary therapies for menopause-related symptoms. Forty-eight of the studies examined vitamins, proteins, complete diets or other biologically based treatments; nine focused on mind-body therapies, including meditation and guided imagery; one studied osteopathic manipulation, a body-based therapy; two looked at the energy-based treatments reflexology and magnet therapy; and 10 assessed whole medical systems, such as traditional Chinese medicine or ayurvedic medicine (a traditional therapy from India that includes yoga and dietary modifications).
Although some of the individual studies suggested benefits for certain therapies, the overall quality and quantity of data was not sufficient to recommend any of the treatments, the authors write. The 48 studies of biologically based treatments had mixed results. For example, of 15 fair- or good-quality studies of the soy-derived compounds known as phytoestrogens, only four suggested the supplements provided a benefit in relieving menopause symptoms. In the four qualifying studies of black cohosh, the root of a native North American shrub, one large study showed an overall improvement in several symptoms, while three did not show any benefit for hot flashes. The studies of energy, mind-body and other types of therapies suggested few benefits for these treatments for menopause-related symptoms.
Many of the studies had a large placebo effect, meaning that even women who were not assigned to receive active therapy still reported improvement in their symptoms. "The large placebo effect is consistent with preexisting work of menopausal hormonal therapies," the authors write. "A study of estrogen compared with placebo reported a 50 percent improvement in frequency of hot flashes in the placebo group. The placebo effect likely plays an important role in the expanding number of dietary supplements marketed to menopausal women."
Because many women are using alternative and complementary therapies to treat their symptoms, often without telling their physicians, additional rigorous studies are needed to identify which of these treatments are safe and effective, the authors write. In the meantime, "the most important thing that the health professionals can do for symptomatic menopausal women is to encourage open communication that allows patients to disclose treatments they are using," they conclude. "Women value partnership, choice and shared decision making. Because there is no universal menopausal presentation or treatment, it is essential that health care professionals provide accurate information and options for midlife women."
(Arch Intern Med.
2006;166:1453-1465. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded in part by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Md. Additional support came from the National Institutes of Health and the Portland Veterans Affairs Medical Center Women's Health Fellowship. The NIH Office of Medical Applications of Research funded this research through the Agency for Healthcare Research and Quality Evidence-based Practice Centers Program for the NIH-sponsored State of the Science Conference on Managing Menopause-related Symptoms. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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 24, 2006
Media Advisory: To contact Rulla M. Tamimi, Sc.D., call Lori J. Shanks at 617-534-1604.
ESTROGEN PLUS TESTOSTERONE THERAPY MAY INCREASE RISK OF BREAST CANCER IN POSTMENOPAUSAL WOMEN
CHICAGO—Women who take a combination of estrogen and testosterone to treat the symptoms of menopause may have an increased risk of breast cancer, according to an article in the July 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
As women age, their natural levels of the hormone testosterone tend to decrease, according to background information in the article. Some evidence suggests that many of the symptoms of menopause-including decreased sex drive, worse moods and poorer quality of life-are related to this decline in testosterone. Clinical trials have shown that taking testosterone in combination with estrogen may reduce these symptoms and also promote bone health. Only one estrogen plus testosterone therapy is currently available to U.S. women, but the number and prevalence of such treatments are expected to increase in coming years, the authors write.
Rulla M. Tamimi, Sc.D., Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues studied the long-term effects of estrogen plus testosterone therapy in 121,700 women who were part of the Nurses' Health Study. The study enrolled female nurses between the ages of 30 and 55 years beginning in 1976. The women completed an initial questionnaire and follow-up surveys every two years that included questions about menopausal status, medical conditions and the use of postmenopausal hormone therapy. For those who reported a diagnosis of breast cancer, medical records were reviewed for verification.
During 24 years of follow-up, 4,610 cases of breast cancer occurred among postmenopausal women. Overall, only 33 women included in this analysis reported current use of estrogen and testosterone in 1988. Women who were currently taking estrogen plus testosterone (29 women) had a 77 percent higher risk of developing breast cancer than those who had never used hormone therapy; this was higher than the increased risk associated with current estrogen use (15 percent) and current use of estrogen plus progestin (58 percent). When the researchers considered only women who had gone through menopause naturally rather those whose menopause began when they had a hysterectomy, those who took estrogen plus testosterone (17 women) had 2.5 times the risk of breast cancer than those who had never used hormones.
Enzymes in the breast tissue may convert testosterone to estradiol, an estrogen-like hormone that may contribute to the development of breast cancer, the authors write. Previous studies have indicated that women who use estrogen plus testosterone therapy have higher levels of estradiol and testosterone circulating in their bodies than women who take estrogen alone. Higher levels of testosterone alone have also been linked to increased breast cancer risk in postmenopausal women.
The number of women in the study who used estrogen plus testosterone therapy increased dramatically over time, from 33 in 1988 to 550 in 1998. This reflects a broader trend that makes the results especially important, the authors write. "Given the substantial evidence implicating combined estrogen plus progestin therapy in breast cancer and the results of the present study regarding estrogen plus testosterone therapy, women and their physicians should reconsider use and, more specifically, long-term use of these therapies," they conclude. "Although postmenopausal therapies may provide improvement with respect to sexual functioning, general well-being and bone health, the increased risk of breast cancer may outweigh these benefits."
(Arch Intern Med. 2006;166:1483-1489. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a Public Health Service grant and a SPORE in Breast Cancer grant from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and the Breast Cancer Research Fund. Dr. Colditz is supported in part by an American Cancer Society Cissy Hornung Clinical Research Professorship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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 24, 2006
Media Advisory: To contact corresponding author Jennie Brand-Miller, Ph.D., e-mail: j.brandmiller{at}mmb.usyd.edu.au. To contact editorialist Simin Liu, M.D., Sc.D., call Sarah Anderson at 310-267-0440.
LOW-GLYCEMIC INDEX DIET PROMOTES WEIGHT LOSS, CARDIOVASCULAR RISK REDUCTION
CHICAGO—A diet high in carbohydrates but low on the glycemic index, which measures the impact of carbohydrates on blood sugar levels, may help promote weight loss, decrease body fat and reduce cardiovascular disease risk, according to a report in the July 24 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Carbohydrates have been at the center of recent debates about the best diet for weight loss, according to background information in the article. Public attention has focused on low-glycemic index and high-protein regimens. Clinicians continue to recommend low-fat, high-carbohydrate plans; concerned that many sources of protein are high in saturated fats, physicians and nutrition experts have called for more research into the benefits and risks of each diet. The theory behind low-glycemic index diets holds that rapidly digested, high-glycemic index carbohydrates cause fluctuations in blood glucose (sugar) and insulin levels, contributing to hunger and preventing the breakdown of fat.
Joanna McMillan-Price, M.Nutr.Diet., University of Sydney, Australia, and colleagues recruited 129 obese or overweight young adults (ages 18 to 40 years) and randomly assigned them to one of four reduced-calorie, reduced-fat diets for a 12-week period. Two were high-carbohydrate diets and two were high-protein diets; one of each had a high glycemic load (the total contribution of all foods in the diet to blood glucose levels) and the others had low glycemic loads. At the beginning and end of the study, participants underwent body composition testing. They were weighed weekly on electronic scales and blood samples were taken at weeks six and 12.
At the end of the study, participants on all four diets had lost weight, and there were no significant differences between diets in the reduction in body fat, decrease in waist size or amount of weight loss (an average of 4.2 to 6.2 percent of body weight). There were significant differences, however, in the likelihood of reaching the clinical goal of 5 percent weight loss. Between the two high-carbohydrate diets, lowering the glycemic index nearly doubled fat loss; this effect was stronger in women and did not occur among those on high-protein diets. Participants on the high-protein, high-glycemic index diet had increased levels of total and LDL (bad) cholesterol, while those on the high-protein, low-glycemic index diet and high carbohydrate, low-glycemic index diet experienced reductions in total and LDL cholesterol. All other cardiovascular risk factors, including levels of HDL (good) cholesterol, free fatty acids and C-reactive protein, were similar among the four groups.
"In conclusion, at least in the short term, our findings suggest that dietary glycemic load, and not just overall energy intake, influences weight loss and postprandial glycemia [blood sugar levels after eating]," the authors write. "Moderate reductions in glycemic load appear to increase the rate of body fat loss, particularly in women. Diets based on low-glycemic index whole grain products (in lieu of whole grains with a high glycemic index) maximize cardiovascular risk reduction, particularly if protein intake is high. Reassuringly, this advice can optimize clinical outcomes within current nutrition guidelines, without the concerns that apply to low-carbohydrate diets."
(Arch Intern Med. 2006;166:1466-1475. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Ms. McMillan-Price and Dr. Brand-Miller are co-authors of The Low GI Diet Revolution (Marlowe & Co., New York, NY, 2005). Dr. Brand-Miller is a co-author of The New Glucose Revolution book series (Hodder Mobius, UK; Marlowe & Co., New York; and Hachette Livre, Australia, and elsewhere). This study was supported in part by the National Heart Foundation of Australia and Meat and Livestock Australia. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MOUNTING EVIDENCE SUPPORTS IMPORTANCE OF GLYCEMIC INDEX
In light of these results and other recent research, physicians should work to gradually incorporate the concept of the glycemic index into dietary recommendations for patients, writes Simin Liu, M.D., Sc.D., University of California, Los Angeles, in an accompanying editorial.
As a first step, physicians should help patients understand what the glycemic index is and then teach them to identify foods low on the index. "Typically, foods with a low degree of starch gelatinization, such as pasta, and those containing a high level of viscous soluble fiber, such as whole grain barley, oats and rye, have slower rates of digestion and lower glycemic index values," Dr. Liu writes. "Without any drastic change in regular dietary habits, for example, one can simply replace high-glycemic index grains with low-glycemic index grains and starchy vegetables with less starchy ones and cut down on soft drinks that are often poor in nutrients yet high in glycemic load."
(Arch Intern Med. 2006;166:1438-1439. 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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