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, October 23, 2006)
HEALTHY MEN WHO DRINK MODERATELY HAVE REDUCED RISK OF HEART ATTACK
ELDERLY MEN WITH LOW TESTOSTERONE LEVELS MORE LIKELY TO FALL
ANXIETY DISORDERS LINKED TO PHYSICAL CONDITIONS
ADHERING TO CLINICAL GUIDELINES DECREASES BLOOD CLOTS IN THE ELDERLY
POLYCYSTIC OVARY SYNDROME MORE PREVALENT IN OVERWEIGHT WOMEN
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Save the Date: JAMA will present new research from its theme issue on men's health at a media briefing on Tuesday, November 14, at the Millennium Broadway Hotel in New York. Program and registration information will be provided in a future email.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 23, 2006
Media Advisory: To contact Kenneth J. Mukamal, M.D., M.P.H., M.A., call Bonnie Prescott at 617-667-7306.
HEALTHY MEN WHO DRINK MODERATELY HAVE REDUCED RISK OF HEART ATTACK
CHICAGO—For men with healthy lifestyle habits, drinking moderate amounts of alcohol may be associated with a lower risk of heart attack than drinking heavily or not drinking at all, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous studies have found that adults who drink moderate amounts of alcohol have a lower risk of myocardial infarction (heart attack) than those who do not drink at all, according to background information in the article. Researchers suspect this is due to increased levels of HDL or “good” cholesterol in the blood. Because there are many risks associated with heavy drinking, physicians do not typically recommend that patients begin drinking alcohol to reduce their heart disease risk—instead, they focus on other proven lifestyle interventions, including diet and exercise. However, these habits are not mutually exclusive, the authors write. “For individuals who exercise, abstain from smoking, maintain optimal weight and adhere to an appropriate diet, there may be few other standard lifestyle interventions to lower risk,” the authors write. “Whether alcohol intake is related to a lower risk for myocardial infarction in such individuals is unknown.”
Kenneth J. Mukamal, M.D., M.P.H., M.A., Beth Israel Deaconess Medical Center, Boston, and colleagues assessed the connection between drinking alcohol and heart attack in 8,867 healthy men who were part of the Health Professionals Follow-up Study, which began in 1986 and included 51,529 dentists, pharmacists, veterinarians and other health care professionals age 40 to 75. At the beginning of the study and at regular intervals afterward, the participants filled out questionnaires about their diets and medical conditions, reported the frequency with which they consumed particular substances and specified the types of alcohol they drank. All of the men in the current study had healthy lifestyles, defined as not smoking, having a body mass index (BMI) of less than 25, getting at least 30 minutes of exercise per day and eating a healthy diet, including large amounts of fruits, vegetables, fish and polyunsaturated fats and low amounts of trans-fats and red meat.
Between 1986 and 2002, 106 men had heart attacks. This included eight of the 1,282 who drank 15 to 29.9 grams of alcohol per day (about two drinks), nine of the 714 who drank 30 grams or more per day, 34 of the 2,252 who drank .1 to 4.9 drinks per day and 28 of the 1,889 who did not drink at all. Those who drank 15 to 29 grams per day had the lowest risk for heart attack and those who did not drink at all had the highest. The researchers also performed an analyses comparing those who drank 5 grams per day or more and those who drank less than 5 grams a day. For the latter, “we estimate that 25 percent of the incidence cases of myocardial infarction in this population were attributable to consuming less than 5 grams per day,” the authors write.
“There is a complicated mix of risks and benefits attributed to moderate drinking in observational studies, and the individual and societal complications of heavy drinking are well known,” the authors conclude. “It is easy to understand why clinical guidelines encourage physicians and patients to concentrate on seemingly more innocuous interventions, despite the relative paucity of effective, straightforward and generalizable methods for encouraging regular physical activity, weight reduction and abstinence from smoking in clinical practice. Our results suggest that moderate drinking could be viewed as a complement, rather than an alternative, to these other lifestyle interventions, a viewpoint espoused by some authors.”
(Arch Intern Med. 2006;166:2145-2150. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institutes of Health. Co-author Dr. Rimm has received honoraria for occasional speaking engagements at research conferences from industry-related organizations (Distilled Spirits Council and National Beer Wholesalers Association). 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, October 23, 2006
Media Advisory: To contact Eric Orwoll, M.D., call Jonathan Modie at 503-494-8231.
ELDERLY MEN WITH LOW TESTOSTERONE LEVELS MORE LIKELY TO FALL
CHICAGO—Low testosterone levels may be associated with a higher risk of falling in older men, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The level of testosterone in a man’s blood—including the amount that is bioavailable, or able to be used by the body—declines as he ages, according to background information in the article. Some researchers have speculated that this decline in sex hormone levels contributes to health conditions associated with aging; however, few studies support this notion. Muscle weakness and muscle loss are two adverse events that often occur with age and are known to increase the risk of falling among older adults.
Eric Orwoll, M.D., Oregon Health & Science University, Portland, and colleagues studied 2,587 men age 65 to 99 (average age 73) who enrolled in the Osteoporotic Fractures in Men (MrOS) Study between 2000 and 2002. At the beginning of the study, blood samples were taken and participants filled out questionnaires about their medical history, medications and lifestyle habits. The men completed several physical performance tests, including those assessing grip strength, leg power and balance. Every four months, they reported whether they had fallen and if so, how many times.
During the course of the study, which continued until March 2005, 56 percent of the men fell at least once. Those with lower bioavailable testosterone levels were significantly more likely to fall and to fall multiple times than those with higher levels—among the one-fourth of participants with the lowest testosterone levels, the risk for falling was 40 percent higher than among the one-fourth with the highest testosterone levels. The association was stronger in younger men (ages 65 to 69) and not apparent in men older than 80.
The association remained the same when the researchers factored in the scores on physical performance tests. “Bioavailable testosterone concentration is associated with measures of physical performance, but the association of testosterone level to the risk of falling is apparent regardless of physical performance,” the authors write. “Thus, the mechanisms by which testosterone level affects the propensity to fall may involve other pathways.” For example, low testosterone levels could impair vision, thinking processes or coordination, increasing the risk for falls.
“These findings strengthen the link between testosterone and the health of older men, suggesting that the effects of testosterone on fall risk may be via novel mechanisms and provide insight into how testosterone measurements might be useful for identifying men at higher risk for adverse events,” the authors conclude. “Moreover, these results provide additional justification for trials of testosterone supplementation in older men and should aid in the design of those studies.”
(Arch Intern Med. 2006;166:2124-2131. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The MrOS Study is supported by the National Institutes of Health. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, the National Institute for Dental and Craniofacial Research, the National Cancer Institute and the National Center for Research Resources. 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, October 23, 2006
Media Advisory: To contact Jitender Sareen, B.Sc., M.D., F.R.C.P.C., call Chris Rutkowski at 204-474-9514.
ANXIETY DISORDERS LINKED TO PHYSICAL CONDITIONS
CHICAGO—Anxiety disorders appear to be independently associated with several physical conditions, including thyroid disease, respiratory disease, arthritis and migraine headaches, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. This co-occurrence of disorders may significantly increase the risk of disability and negatively affect quality of life.
Although depression has long been linked to physical illness, evidence supporting an association between anxiety disorders and physical health problems is more recent, according to background information in the article. Anxiety disorders include panic disorder, agoraphobia (fear of being in a situation where panic or anxiety may occur and escape from the situation might be difficult), social phobia and obsessive-compulsive disorder. Studies have found that those with phobic (fearful) anxiety may be more likely to experience sudden cardiac death, and rates of anxiety disorders are higher than expected in patients with thyroid disease, cancer, hypertension and several other conditions.
Jitender Sareen, B.Sc., M.D., F.R.C.P.C., University of Manitoba, Winnipeg, Canada, and colleagues further explored the association between anxiety disorders and physical conditions in 4,181 adults who were part of the German Health Survey (GHS), conducted between 1997 and 1999. The survey assessed whether participants had any physical illnesses through a questionnaire asking about 44 particular conditions, a medical interview conducted by a primary care physician, blood pressure measurements and blood and urine samples. Psychiatric interviews were conducted by a psychologist or physician, who used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to detect anxiety disorders. A quality of life survey—which measured factors such as physical functioning, pain and general health—was also administered, and to determine disability levels participants reported how many days of the past 30 they were unable to perform their usual daily activities.
Among the 1,913 men and 2,268 women in the study, 429 (8.4 percent) had an anxiety disorder within the past month and 2,610 (60.8 percent) had a physical condition within the past month. Having an anxiety disorder was associated with having any type of physical condition, and specifically with respiratory diseases, gastrointestinal diseases, arthritis, allergies, thyroid diseases and migraine headaches. Most individuals with both an anxiety disorder and physical illness developed the anxiety disorder first, and tended to have a poorer quality of life than those with anxiety disorders or physical conditions alone. Those who had both types of disorders also were more likely to have one or more days of disability than those with physical illnesses alone.
“The mechanisms of association between anxiety disorders and physical conditions remain unknown, although several possibilities should be considered,” the authors write. For example, the presence of an illness may cause worry and anxiety that eventually becomes serious enough to qualify as an anxiety disorder, the presence of an anxiety disorders could trigger biological processes that contribute to illness or a third condition, such as a substance abuse disorder, could be linked to both.
“These findings extend previous work in clinical and community samples that noted an association between anxiety disorders and physical illnesses but also demonstrate the unique association of this comorbidity with poor quality of life and disability,” the authors write. “Although there have been increased efforts to recognize and treat depression in the medically ill, our findings underscore the need to create similar programs to recognize and treat anxiety disorders in the medically ill.”
(Arch Intern Med. 2006;166:2109-2116. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The GHS was supported by a grant from the German Federal Ministry of Research, Education and Science. Preparation of this article was supported by a Manitoba Health Research Council Award, by a U.S. National Institutes of Health grant and a Canada Research Chair award. 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, October 23, 2006
Media Advisory: To contact corresponding author Jose Labarere, M.D., e-mail JLabarere{at}chu-grenoble.fr.
ADHERING TO CLINICAL GUIDELINES DECREASES BLOOD CLOTS IN THE ELDERLY
CHICAGO—A multifaceted intervention designed to increase adherence with clinical guidelines for preventing deep-vein blood clots may decrease the rate of such blood clots among elderly patients, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Older adults and those in the hospital are at increased risk for deep vein thrombosis (DVT), a blood clot in the thigh or leg, according to background information in the article. Medications and compression stockings have been shown to reduce or prevent DVT in some patients. “However, several studies demonstrate a gap between scientific evidence and clinical practice in various settings, including post–acute care facilities,” the authors write. “These facilities are used to ensure the transition between short hospital stays and home when patients require specialized care or rehabilitation services.”
Elodie Sellier, M.D., Joseph Fourier University, Grenoble, France, and colleagues studied 1,373 patients age 65 or older (66.9 percent women) enrolled in 33 post–acute care facilities in France. The researchers evaluated patients for DVT before and after they implemented evidence-based guidelines for physicians and nurses at the facilities regarding prevention of DVT. The guidelines recommended that health care providers give prophylactic (preventive) medications to certain patients, such as those who recently had major surgery or who previously had DVT. Physical therapy, compression stockings and other non-drug preventive measures were recommended for other patients or in addition to medications in some cases. Educational sessions were held to communicate the guidelines; physicians and nurses were given posters and plastic cards as reminders. The researchers assessed 709 patients before and 664 patients following the implementation of the guidelines.
Before the guidelines were put in place, a blood clot was found in 91 (12.8 percent) of 709 patients. Following the intervention, clots were found in only 52 (7.8 percent) of 664 patients. The post-intervention participants were more likely to use compression stockings and less likely to take medications that were not recommended by the guidelines, especially if they were patients for whom drug therapy was not recommended under the guidelines.
“Changes in the prophylaxis means measured can only partly explain the decrease in the rate of DVT observed in our study. The most important change in prophylaxis consisted of an increased use of graduated compression stockings, while the change in pharmacologic prophylaxis use was modest and not statistically significant,” the authors write.
“These observations together suggest that our multifaceted intervention not only altered the use of measured prophylaxis means but also improved physician and nurse awareness of patients at risk for venous thromboembolism and eventually increased the use of additional prophylactic measures including early ambulation and physical therapy, which were addressed by our intervention but not investigated in our study,” they continue. Additional efforts should be undertaken to ensure that physicians and nurses comply with evidence-based guidelines for the prevention of DVT, they conclude.
(Arch Intern Med. 2006;166:2065-2071. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the French Ministry of Health and by a grant from the Egide Foundation, Paris. Co-authors Drs. Bosson and Sevestre served as consultants for Sanofi-Aventis France. 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, October 23, 2006
Media Advisory: To contact corresponding author Héctor F. Escobar-Morreale, M.D., Ph.D., e-mail hescobarm.hrc{at}salud.madrid.org.
POLYCYSTIC OVARY SYNDROME MORE PREVALENT IN OVERWEIGHT WOMEN
CHICAGO—Overweight and obese Spanish women appear five times as likely as lean women to have polycystic ovary syndrome, a condition that decreases fertility and contributes to other illnesses, according to an article in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Polycystic ovary syndrome occurs when the ovaries malfunction and levels of the sex hormone androgen are unusually high. Symptoms may include irregular or no menstrual periods, acne and excess hair growth. In addition to its implications for reproductive health, polycystic ovary syndrome is also associated with sleep apnea, poor quality of life and an increased risk for diabetes and cardiovascular disease, according to background information in the article. Although more than half of patients with polycystic ovary syndrome are obese, the prevalence of the condition in overweight or obese women is unknown.
Francisco Álvarez-Blasco, M.D., and colleagues at Hospital Universitario Ramón y Cajal, Madrid, Spain, evaluated 113 consecutive women who visited one hospital for weight loss treatment between May 2002 and December 2005. The women were diagnosed with polycystic ovary syndrome based on whether their ovaries were releasing eggs regularly, tests to assess the level of androgen in their blood and whether other diagnoses could be ruled out.
Of the 113 women, 32 (28.3 percent) were diagnosed with polycystic ovary syndrome, compared with the established rates of 6.5 percent among all women and 5.5 percent among lean women. “The prevalence of polycystic ovary syndrome was not statistically different when considering the degree of obesity, as classified according to the guidelines published by the National Institutes of Health,” the authors write. Patients with the syndrome tended to be younger and were more likely to also have insulin resistance, which occurs when the body has difficulty using the insulin it produces to turn glucose into energy.
“In summary, we report that the prevalence of polycystic ovary syndrome is markedly increased in unselected overweight and obese women seeking medical advice for weight loss, independent of the degree of obesity or the presence or absence of the metabolic syndrome and related disorders,” the authors continue. “We conclude that physicians treating overweight and obese patients should be aware of the high prevalence of polycystic ovary syndrome among these women and that screening for polycystic ovary syndrome, at least by obtaining a detailed menstrual history and a careful clinical evaluation of hyperandrogenic symptoms, should be conducted routinely to diagnose polycystic ovary syndrome and ameliorate the health burden distinctly associated with this prevalent disorder.”
(Arch Intern Med. 2006;166:2081-2086. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III. 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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