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, September 25, 2006)
JAPANESE ADULTS WITH DIABETES HAVE INCREASED CANCER RISK
STUDY SUGGESTS MENTHOL CIGARETTE SMOKERS MAY HAVE MORE DIFFICULTY QUITTING SMOKING
EARLY STATIN THERAPY FOR PATIENTS WHO HAVE HAD ACUTE CORONARY SYNDROMES REDUCES DEATH, CARDIOVASCULAR EVENTS
PHYSICIANS OFTEN DO NOT COMMUNICATE IMPORTANT MEDICATION INFORMATION
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 25, 2006
Media Advisory: To contact Manami Inoue, M.D., Ph.D., e-mail mnminoue{at}gan2.res.ncc.go.jp.
JAPANESE ADULTS WITH DIABETES HAVE INCREASED CANCER RISK
CHICAGO—Japanese adults with diabetes may have a higher risk of cancer overall and in several specific organs, including the liver, pancreas and kidney, according to results of a large study published in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Researchers have long suspected that there might be an association between diabetes and cancer, but no conclusive evidence has been obtained, according to background information in the article. Diabetes is rapidly becoming more common in Japan, as it is in many other countries. More than 7.4 million Japanese individuals were estimated to have diabetes in 2002, and by 2025, 8.7 percent of the population is expected to develop the disease. “Clarification of the association between diabetes mellitus and cancer in populations with an increasing prevalence, such as Japanese persons, is a crucial task, not only from the causative point of view but also with regard to the formulation of clinical strategies and public health policies for the target population,” the authors write.
Manami Inoue, M.D., Ph.D., National Cancer Center, Tokyo, and colleagues studied the association in 97,771 Japanese individuals (46,548 men and 51,223 women) age 40 to 69 who were enrolled in the study between 1990 and 1994. The participants, who had an average age of 51 at the beginning of the study, completed a lifestyle questionnaire at that time that included information about smoking, alcohol drinking, medical history, physical activity and food and beverage intake. They were also asked if they had ever been diagnosed with diabetes or taken diabetes medications. Researchers consulted the national registry of Japanese residents, major hospitals, cancer registries and death certificates to track deaths and cancer cases.
At the beginning of the study, 3,097 men (6.7 percent) and 1,571 women (3.1 percent) had a history of diabetes. By the end of the study’s follow-up in 2003, 6,462 participants had developed cancer, including 3,907 men (366 of whom had diabetes) and 2,555 women (104 with diabetes). Men with diabetes had a 27 percent higher risk of developing cancer than men without diabetes; the risk was especially high for liver, kidney and pancreatic cancer. Among women, those with diabetes had a 21 percent higher risk of cancer than those without (although this increased risk was not statistically significant). However, there was a significantly higher risk for stomach and liver cancer and a borderline higher risk for ovarian cancer.
It is unclear exactly how diabetes might contribute to cancer; many discussions of the issue have focused on the particular type of cancer, such as liver or pancreatic cancer, the authors write. Researchers suspect that excess insulin in diabetic patients may promote growth in the cells of these organs, increasing cancer risk. In addition, changes in sex hormone levels associated with diabetes could contribute to ovarian cancer in women and prostate cancer in men. “Despite the biological plausibility of the association, several issues should be considered when discussing the role of diabetes mellitus as a cause of cancer,” the authors warn. For example, common health conditions and risk factors such as obesity might contribute to both diabetes and cancer, and some types of cancer may actually cause diabetes. In addition, those being treated for diabetes often visit a physician more frequently than those without a chronic health condition, and this increased vigilance could lead to more cancer diagnoses. “These issues should likely be considered as alternative factors affecting the association between diabetes mellitus and cancer, directly or otherwise.”
Regardless of whether diabetes causes cancer, cancer causes diabetes or a common third cause links them both, it is likely that the rapidly increasing incidence of diabetes among Japanese residents in recent years heralds a future increase in cases of cancer, especially those kinds most closely linked with diabetes, they conclude.
(Arch Intern Med. 2006;166:1871-1877. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a Grant-in-Aid for Cancer Research and for the Third Term Comprehensive Control Research for Cancer from the Ministry of Health, Labour and Welfare, Japan. 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, September 25, 2006
Media Advisory: To contact Mark J. Pletcher, M.D., M.P.H., call Wallace Ravven at 415-476-2557.
STUDY SUGGESTS MENTHOL CIGARETTE SMOKERS MAY HAVE MORE DIFFICULTY QUITTING SMOKING
CHICAGO—Menthol and non-menthol cigarettes appear to be equally harmful to the arteries and to lung function, but smokers of menthols may be less likely to attempt or succeed at quitting, according to a report in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Cigarette smoking causes about 440,000 deaths in the United States each year, according to background information in the article. African Americans tend to smoke less than European Americans, but have disproportionately high rates of cancer, cardiovascular disease and other smoking-related illnesses. “For a variety of historical and cultural reasons, including targeted advertising by the tobacco industry, African American smokers are much more likely to smoke menthol cigarettes than European American smokers (approximately 70 percent vs. 30 percent),” the authors write. Menthol is a mint-flavored compound derived from peppermint oil that could potentially increase the harm caused by cigarettes through a variety of biological mechanisms. “If menthol cigarettes were more harmful than non-menthol cigarettes, the higher exposure to menthol cigarette smoke among African American smokers could help explain racial/ethnic disparities in disease rates.”
Mark J. Pletcher, M.D., M.P.H., University of California, San Francisco, and colleagues examined this hypothesis in 1,535 smokers who were part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The researchers measured the association between exposure to menthol cigarettes and smoking cessation (quitting); coronary calcification, or a build-up of calcium in the arteries leading to the heart that is a sign of coronary artery disease; and change in pulmonary (lung) function over a 10-year period. Participants were women and men age 18 to 30 at the beginning of the study, in 1985. Each underwent a medical examination and answered questions about demographics and smoking habits in 1985 and again two, five, seven, 10 and 15 years later.
Among the smokers, 808 were women and 727 men. In 1985, 972 (63 percent) preferred menthol cigarettes and 563 (36 percent) preferred non-menthol cigarettes; 89 percent of African Americans, compared with 29 percent of European Americans, smoked menthol cigarettes. Menthol smokers were also more likely to be younger, female and unemployed, to have a lower level of education and a higher body mass index, and to drink less alcohol and smoke fewer cigarettes per day.
Those who smoked menthol cigarettes in 1985 were more likely to still be smoking at follow-up examinations—in 2000, for example, 69 percent were still smokers vs. 54 percent of non-menthol smokers. However, once the researchers factored in other social and demographic variables, most of this difference was explained by the fact that African Americans were both more likely to smoke menthols and less likely to quit smoking. “Among smokers who tried to quit, menthol seemed unrelated to quitting, but menthol was associated with a lower likelihood of trying to quit in the first place,” the authors write. Analyzing the data over time, they found that menthol smokers were almost twice as likely to relapse after quitting and also were less likely to stop for a sustained period of time. Both coronary calcification and a decline in lung function over 10 years were associated with the number of cigarettes smoked, but whether the cigarettes were menthol or not did not appear to make a difference.
“Mentholation of cigarettes does not seem to explain disparities in ischemic heart disease and obstructive pulmonary disease between African Americans and European Americans in the United States but may partially explain lower rates of smoking cessation among African American smokers,” the authors conclude. “It is possible, therefore, that switching from menthol cigarettes to non-menthol cigarettes might facilitate subsequent smoking cessation, especially in African Americans, and thereby reduce tobacco-related health disparities.”
(Arch Intern Med. 2006;166:1915-1922. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The CARDIA Study is supported by contracts from the National Heart, Lung and Blood Institute. 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, September 25, 2006
Media Advisory: To contact Eddie Hulten, M.D., M.P.H., call Walter Reed Army Medical Center public affairs at 202-782-7177.
EARLY STATIN THERAPY FOR PATIENTS WHO HAVE HAD ACUTE CORONARY SYNDROMES REDUCES DEATH, CARDIOVASCULAR EVENTS
CHICAGO—Early, intensive therapy with statin medications reduces death and cardiovascular events for patients who have had heart attacks or other acute heart events, according to an analysis of previous studies published in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Statins, commonly taken to lower cholesterol levels, have clearly been shown to benefit patients with cardiovascular disease, according to background information in the article. However, it is less clear whether these drugs provide a short-term benefit when given immediately to patients hospitalized for acute coronary syndrome, the group of heart disorders associated with myocardial ischemia (a lack of blood flow to the heart). In addition to reducing cholesterol, statins may stabilize the amount of plaque build-up in arteries, reduce inflammation, prevent blood clotting, reduce blood pressure and improve the functioning of blood vessels, all of which could improve outcomes for patients with acute coronary syndrome.
Eddie Hulten, M.D., M.P.H., and colleagues at Walter Reed Army Medical Center, Washington, D.C., and Uniformed Services University of the Health Sciences, Bethesda, Md., analyzed the results of 13 previous clinical trials of early, intensive statin therapy (begun within 14 days of hospitalization for acute coronary syndrome) involving 17,963 adults with acute coronary syndrome. The studies compared intensive (high-dose) statins with low-dose statins, placebo for four months followed by a lower dose of statins, placebo alone or usual care per the treating physicians’ discretion. The participants had an average age of 60 and 76 percent were male.
“This systematic review provides evidence that early, intensive therapy with statins is associated with a reduction of adverse cardiovascular outcomes, particularly cardiovascular death, unstable angina and revascularization when prescribed within 14 days of hospitalization for acute coronary syndrome,” the authors write. “These benefits took more than four months to begin to accrue and were sustained for two years. During these two years, there was slightly less than a 20 percent reduction in the risk of experiencing an adverse coronary event.” These results could not be explained by statins’ cholesterol-lowering effects.
Overall, statins were about as safe and tolerable as the control treatments. Of the 17,963 patients, three developed a dangerous breakdown of muscle fibers, known as rhabdomyolysis; some studies showed a slightly higher risk of hepatitis among individuals taking statins. “Use of intensive statin therapy is often avoided by clinicians owing to fear of increased adverse events due to the higher statin dose or, in patients with only mild elevations in LDL-C [bad cholesterol] level, of driving LDL-C level below a theoretical safe value,” the authors continue. “Our study showed that intensive statin therapy and controls experienced comparable rates of hepatitis, myositis and rhabdomyolysis. Serious adverse events were rare.”
The statin regimen with the most evidence of effectiveness is an 80-milligram dose of atorvastatin, begun within 14 days of hospitalization for acute coronary syndrome, they conclude.
(Arch Intern Med. 2006;166:1814-1821. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: 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, September 25, 2006
Media Advisory: To contact Derjung M. Tarn, M.D., Ph.D., call Enrique Rivero at 310-794-2273.
PHYSICIANS OFTEN DO NOT COMMUNICATE IMPORTANT MEDICATION INFORMATION
CHICAGO—Physicians prescribing new medication often do not communicate to patients important details, such as potential side effects, how long or how often to take the drug or the specific name of the medication, according to an article in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Almost half of all Americans take at least one prescription drug, and half of older adults take three or more, according to background information in the article. Taking medications properly is essential in ensuring their effectiveness. However, patients often do not adhere to prescribed therapies, which can lead to worsening disease, failure of the treatment, adverse effects, drug overdose, unnecessary hospitalization and higher health care costs. “Patients who report better general physician communication, better explanations about how to take their medications and more medication information are more adherent,” the authors write. “One-on-one educational interventions can improve patient adherence and health outcomes.”
Derjung M. Tarn, M.D., Ph.D., of the David Geffen School of Medicine, University of California, Los Angeles, and colleagues assessed communication by physicians prescribing new medications in 185 outpatient visits with 44 physicians in 1999. Patients were called one to two days prior to their appointments at one of two health care systems in Sacramento, Calif. Their encounters with the physicians were then audiotaped and transcribed, and physicians identified those at which new medications were prescribed. The researchers coded the transcripts for the type of communication that occurred, based on five key recommended elements: the name of the medication, the purpose or justification for taking it, the duration of use, adverse effects and the number of tablets or sprays plus the frequency or timing of ingestion.
A total of 243 new medications were prescribed at visits monitored during the study, including 46 cardiovascular medications; 42 ear, nose and throat preparations; 35 analgesics (pain-relieving drugs); 35 antibiotics; 21 dermatologic creams; 21 psychiatric medications; and 11 pulmonary medications. Overall, physicians communicated an average of 3.1 of the five essential elements, indicating that 62 percent of the necessary information was conveyed. Physicians used the specific name for 74 percent of new prescriptions, explained the purpose for 87 percent and discussed adverse effects for 35 percent. Thirty-four percent of the encounters included instructions on how long to take the drug, 55 percent on the number of tablets to take and 58 percent on the frequency or timing of dosing.
“This study demonstrates spotty physician counseling about new medication prescriptions,” the authors write. “Although physicians educated patients more about psychiatric and analgesic medications, the overall quality of communication was poor even for these medication types and could contribute to patient misunderstandings about how and why to take their new medications. Physicians conveyed full medication dosing directions for less than 60 percent of all medications and informed patients about duration of intake and adverse effects or adverse events only approximately one-third of the time.”
Patients receiving incomplete instructions may be less likely to take their medication properly, in part because they do not understand how to do so, they conclude. However, patients often get medication information from pharmacists and other sources, and there may be trade-offs involved to asking physicians to provide more detailed communication. “More research is needed to investigate how much time physicians spend educating patients about new medications and whether better communication is associated with more appropriate patient medication use and health outcomes,” they write.
(Arch Intern Med. 2006;166:1855-1862. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: 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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