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 Release: 3:00 p.m. CT, Tuesday, January 10, 2006)
JAMA NEWS RELEASES
EVEN WITHOUT COMMON CARDIOVASCULAR RISK FACTORS, OBESITY IN MIDDLE AGE LINKED TO HIGHER RISK OF HOSPITALIZATION AND DEATH IN OLDER AGE
ATHEROTHROMBOSIS PATIENTS WORLD-WIDE OFTEN HAVE UNDERTREATED, UNDERCONTROLLED CARDIOVASCULAR RISK FACTORS
MEDICATION PLUS BETA-BLOCKER HELPS PREVENT SHOCKS FROM IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
NEW STUDY FINDS OBESITY IN MID-LIFE IS INDEPENDENT RISK FACTOR FOR
HOSPITALIZATION OR DEATH IN OLDER AGE
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 middle-age obesity and subsequent health risks. The release will be fed Tuesday, January 10, 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).
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 10, 2006
Media Advisory: To contact Lijing L. Yan, Ph.D., M.P.H., call Elizabeth Crown at 312-503-8928.
EVEN WITHOUT COMMON CARDIOVASCULAR RISK FACTORS, OBESITY IN MIDDLE AGE LINKED TO HIGHER RISK OF HOSPITALIZATION AND DEATH IN OLDER AGE
CHICAGO—Middle-age individuals without high blood pressure or high cholesterol levels but who are obese have an increased risk in older age for hospitalization or death from coronary heart disease, cardiovascular disease, or diabetes, compared to individuals of normal weight, according to a study in the January 11 issue of JAMA.
Obesity adversely affects a large array of health outcomes, including coronary heart disease (CHD), other cardiovascular disease (CVD), and diabetes mellitus, according to background information in the article. Obesity is also associated with established cardiovascular risk factors, particularly diabetes and elevated levels of blood pressure and serum cholesterol. However, controversies persist as to whether excess weight has additional impact on CVD outcomes beyond its effects on established risk factors. Direct evidence on this issue is limited. In clinical settings, patients sometimes ask if they still need to control their weight if their blood pressure and cholesterol levels are not high. Therefore, in light of the worsening obesity epidemic, further research is warranted to examine whether obesity carries additional risks in the absence or presence of other major risk factors.
Lijing L. Yan, Ph.D., M.P.H., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues examined the relationship of body mass index (BMI) earlier in life with illness and death outcomes in older age, i.e., 65 years and older, among individuals without and with other major risk factors at baseline. The Chicago Heart Association Detection Project in Industry study included 17,643 men and women aged 31 through 64 years, who were free of CHD, diabetes, or major electrocardiographic abnormalities at baseline (1967-1973). Cardiovascular risk was classified as low: systolic blood pressure 120 or less and diastolic blood pressure 80 mm Hg or less, serum total cholesterol level less than 200 mg/dL, and not currently smoking; moderate risk: nonsmoking and systolic blood pressure 121-139 mm Hg, diastolic blood pressure 81-89 mm Hg, and/or total cholesterol level 200-239 mg/dL; or having any 1, any 2, or all 3 of the following risk factors: blood pressure 140 or greater/90 mm Hg, total cholesterol level 240 mg/dL or greater, and current cigarette smoking. Body mass index was classified as normal weight (18.5-24.9), overweight (25.0-29.9), or obese (30 or greater). Average follow-up was 32 years.
In multivariable analyses that included adjustment for systolic blood pressure and total cholesterol level, the researchers found that the risk for CHD death for obese participants, compared with those of normal weight in the same risk category, was 43 percent higher for the low risk group and nearly 2.1 times higher for the moderate risk group. Compared to those of normal weight, obese individuals in the low risk group had a 4.2 times higher risk for CHD hospitalization; for the moderate risk obese group, the risk of CHD hospitalization was twice as high. Results were similar for other risk groups and for cardiovascular disease, but stronger for diabetes (low risk, 11 times increased risk for death and 7.8 times increased risk for hospitalization).
"In this predominantly white cohort who survived to age 65 years and older, persons who were overweight, and particularly those who were obese earlier in life (aged 31-64 years), had significantly higher risks of hospitalization and mortality in older age compared with persons of normal weight with similar other cardiovascular risk factors at baseline. Elevated risk was present for individuals both with and without other major cardiovascular risk factors (smoking, high blood pressure, and/or serum total cholesterol level) in young adulthood and middle age," the authors write. "In general, relationships were qualitatively consistent for both sexes for both hospitalization for and mortality from CHD, CVD, and diabetes in older age."
"Convincing evidence from our findings and other studies provides strong support for population-wide, multifaceted, primary prevention starting at young age of all major risk factors, including overweight and obesity, as a key element for the national effort to continue the progress already achieved toward ending the epidemic of CHD and CVD. The success of smoking cessation campaigns and national blood pressure and cholesterol programs can be used as models to combat and reverse the worsening obesity epidemic. The real challenge is to apply the extensive knowledge already gained in the practice of medical care and public health for the benefit of individuals and society," the researchers conclude.
(JAMA. 2006;295:190-198. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Funding for this study was provided by grants from the National Heart, Lung, and Blood Institute.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 10, 2006
Media Advisory: To contact Deepak L. Bhatt, M.D., call Michelle Bolek at 216-444-0333.
ATHEROTHROMBOSIS PATIENTS WORLD-WIDE OFTEN HAVE UNDERTREATED, UNDERCONTROLLED CARDIOVASCULAR RISK FACTORS
CHICAGO—A large international study demonstrates that patients world-wide with atherothrombosis (coronary artery disease, cerebrovascular disease, peripheral arterial disease) often have cardiovascular risk factors such as obesity and hypertension that are undertreated and undercontrolled, according to a report in the January 11 issue of JAMA.
Atherothrombosis is the leading cause of cardiovascular illness and death around the globe, according to background information in the article. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis. The Reduction of Atherothrombosis for Continued Health (REACH) Registry was designed to provide these data from the most geographically and ethnically diverse population yet surveyed.
Deepak L. Bhatt, M.D., of the Cleveland Clinic Foundation, and colleagues analyzed data from the REACH Registry to determine the prevalence and treatment of atherosclerosis risk factors. The Registry included 67,888 patients aged 45 years or older from 5,473 physician practices in 44 countries who had either established arterial disease (coronary artery disease [CAD], n = 40,258; cerebrovascular disease, n = 18,843; peripheral arterial disease, n = 8,273) or 3 or more risk factors for atherothrombosis (n = 12,389) between 2003 and 2004.
The researchers found that atherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8 percent), hypercholesterolemia (72.4 percent), and diabetes (44.3 percent). The prevalence of overweight (39.8 percent), obesity (26.6 percent), and morbid obesity (3.6 percent) were similar in most geographic locales, but was highest in North America (overweight: 37.1 percent, obese: 36.5 percent, and morbidly obese: 5.8 percent). Patients were generally undertreated with statins (69.4 percent overall), antiplatelet agents (78.6 percent overall), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4 percent). Undertreated hypertension (50.0 percent with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9 percent), and impaired fasting glucose (36.5 percent in those not known to be diabetic) were common.
"The REACH Registry demonstrates a substantial gap between recommendations in guidelines and actual clinical practice in the care of patients with or at risk for atherothrombosis," the authors write. "A pattern of underutilization of established medical therapies and lifestyle interventions is seen in the REACH Registry throughout all geographic regions studied, among different physician specialties, and across disease subtypes. Despite an overwhelming amount of data in support of statins and antiplatelet therapy, these classes of medicines are not being prescribed at optimal rates. A substantial proportion of patients receiving statins are not meeting established targets that are recommended in guidelines for cholesterol reduction, and newer data suggest even more aggressive targets. Only a minority of patients were at target goals for blood pressure, glucose, cholesterol, body weight, and nonuse of tobacco."
"These data demonstrate a strikingly elevated degree of obesity internationally as a critical cardiovascular risk factor," the researchers write. "The percentages of overweight and obese patients support efforts at targeting this risk factor in patients along the atherothrombotic continuum of risk. The follow-up phase of the REACH Registry will allow measurement of the cardiovascular ischemic event rates of this population as well as an assessment of how these various risk factors affect the rate of subsequent morbidity and mortality and cardiovascular outcomes in a geographically diverse population."
(JAMA. 2006;295:180-189. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo). For the financial disclosures of the authors, 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 10, 2006
Media Advisory: To contact Stuart J. Connolly, M.D., call Veronica McGuire at 905-525-9140, ext. 22169. To contact editorial author Richard L. Page, M.D., call Clare Hagerty at 206-685-1323.
MEDICATION PLUS BETA-BLOCKER HELPS PREVENT SHOCKS FROM IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
CHICAGO—Use of the medication amiodarone in combination with a beta-blocker is effective in preventing shocks that can occur from an implantable cardioverter defibrillator, according to a study in the January 11 issue of JAMA.
The implantable cardioverter defibrillator (ICD) reduces death in patients at risk for sustained ventricular arrhythmia, primarily by delivering high voltage shocks that terminate potentially fatal ventricular arrhythmias, according to background information in the article. ICD shocks are painful and patients may receive multiple ICD shocks. Such experiences are unpleasant and may lead to premature ICD battery depletion and continue to present a problem in the treatment of patients with ICD.
Antiarrhythmic drugs such as amiodarone and sotalol have the potential for reducing both appropriate and inappropriate shocks, but their relative efficacy to prevent shocks compared with standard therapy with a beta-blocker is unknown. Amiodarone has multiple effects on the heart; however, despite decades of use, it has never been compared with beta-blockers in a randomized controlled study. Sotalol is a beta-blocker with properties that are thought to help prevent ICD shocks, although previous studies have shown mixed results with this medication.
Stuart J. Connolly, M.D., of McMaster University, Hamilton, Ontario, Canada, and colleagues compared amiodarone plus a beta-blocker, sotalol alone, or standard beta-blocker therapy alone for prevention of ICD shocks in the OPTIC study. The randomized controlled trial included 412 patients from 39 out-patient ICD clinical centers located in Canada, Germany, United States, England, Sweden, and Austria, and was conducted from January 13, 2001, to September 28, 2004. Patients were eligible if they had received an ICD within 21 days for inducible or spontaneously occurring ventricular tachycardia (VT – a rapid, abnormal heart rhythm) or ventricular fibrillation (VF). Patients were randomized to treatment for 1 year of amiodarone plus beta-blocker, sotalol alone, or beta-blocker alone.
A significant reduction (56 percent) was observed in the risk of a shock when the 274 patients randomized to either of the 2 active treatment groups, sotalol or amiodarone plus beta-blocker, were compared with the 138 patients randomized to beta-blocker alone. Amiodarone plus beta-blocker significantly reduced (73 percent) the risk of shock compared with beta-blocker alone and sotalol (57 percent reduction). There was a non-significant trend for sotalol to reduce the risk of shock compared with beta-blocker alone.
In patients randomized to beta-blocker alone, the annual risk of any shock was 38.5 percent. The annual risk of an appropriate shock (for VT or VF) was 22.0 percent and the annual risk of an inappropriate shock (mostly for supraventricular arrhythmia) was 15.4 percent. Both types of shock were significantly reduced by amiodarone plus beta-blocker but not significantly reduced by sotalol. Adverse pulmonary and thyroid events, and symptomatic bradycardia (abnormally slow heartbeat) were more common among patients receiving amiodarone.
"Should amiodarone or sotalol be administered immediately after ICD implantation or some time before a first shock occurs? By delaying therapy, one reduces the risk of drug-related adverse effects; however, this needs to be balanced against the adverse experience of receiving shock therapy. Fourteen patients (10 percent) receiving beta-blocker alone experienced their first shock as multiple (2 shocks or more within 24 hours). On the other hand, a majority of patients did not have a shock in the year of follow-up in this OPTIC trial. Therapeutic decisions should be individualized, taking into account possible improvements in quality of life and small but increased risks of drug-related adverse effects," the authors conclude.
(JAMA. 2006;295:165-171. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by St. Jude Medical, Sylmar, Calif. Co-authors Connolly, Dorian, and Hohnloser have received research grants from St. Jude Medical. As a St. Jude Medical employee, co-author Dr. Fain is a stockholder in the company. None of the other authors reported disclosures.
EDITORIAL: ANTIARRHYTHMIC DRUGS FOR ALL PATIENTS WITH AN ICD?
In an accompanying editorial, Richard L. Page, M.D., of the University of Washington School of Medicine, Seattle, comments on the study by Connolly and colleagues.
"Based on the study by Connolly et al and taken in context with previous studies, should cardiologists advocate empirical antiarrhythmic therapy for patients receiving an ICD? Importantly, the OPTIC study applies primarily to ICDs placed as secondary prevention, in which sustained ventricular arrhythmias have been observed clinically. There are less data to support the use of antiarrhythmic agents in patients with prophylactic or primary prevention ICD therapy and this group appears to have less frequent need for such therapy; thus, empirical antiarrhythmic therapy cannot be recommended for this setting. For patients who receive an ICD for secondary prevention, one could argue for empirical initiation of amiodarone or sotalol. As per the OPTIC study, such therapy would reduce the absolute risk of shock by 28 percent or 14 percent, respectively, and as such would provide a substantial benefit in comfort and possibly quality of life."
(JAMA. 2006;295:211-213. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Page has previously served as consultant to Astra Zeneca, GlaxoSmithKline, Cardiome, Reliant Pharmaceuticals, Forrest Research, and Procter & Gamble Pharmaceuticals. He is now a consultant to Berlex Laboratories, Alza (a subsidiary of Johnson & Johnson), and Sanofi Synthelabo.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
NEW STUDY FINDS OBESITY IN MID-LIFE IS INDEPENDENT RISK FACTOR FOR
HOSPITALIZATION OR DEATH IN OLDER AGE
VIDEO:
B-ROLL
Dr. Kushner with patient in hospital room
AUDIO:
DR. ROBERT KUSHNER IS AN OBESITY SPECIALIST. HE’S HEARD THIS QUESTION FROM SOME OF HIS PATIENTS:
VIDEO:
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@ :06
Super: Robert Kushner, M.D.
Obesity specialist
Runs :07
AUDIO:
“If everything is okay regarding my blood sugar, my cholesterol, and my blood pressure, does my weight really make a difference?”
VIDEO:
B-ROLL
GFX/JAMA Cover
AUDIO:
A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, HAS AN ANSWER TO THAT QUESTION.
VIDEO:
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@ :18
Super: Lijing Yan, Ph.D., M.P.H.
Northwestern University/Peking University
Runs :17
AUDIO:
“Even for those who didn’t have high blood pressure, high cholesterol or diabetes, but who were overweight or obese in middle age, they were at much higher risk of being hospitalized for heart disease or diabetes or even dying from it in older age.”
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Dr. Yan and colleague at desk/computer
Overweight men and women walking on city sidewalk
Staff in hospital hallway
AUDIO:
DR. LIJING (lee-jing) YAN OF NORTHWESTERN UNIVERSITY AND PEKING UNIVERSITY WAS PART OF A TEAM OF RESEARCHERS. THEY STUDIED THE HEALTH HISTORIES OF MORE THAN 17-THOUSAND CHICAGOANS, WHOSE HEALTH HAD BEEN TRACKED FOR ABOUT THIRTY YEARS. THEY FOUND A CONNECTION BETWEEN OVERWEIGHT AND OBESITY IN MIDDLE AGE, AND HOSPITALIZATION AND DEATH AFTER AGE 65.
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Lijing Yan, Ph.D., M.P.H.
Northwestern University/Peking University
Runs :10
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“Our study is one more reason for people to pay more attention to their weight, even for those who think they’re okay, their blood pressure and cholesterol are not high and they’re not diabetic.”
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Normal weight people walking on sidewalk Obese woman
Dr. Kushner with patient in hospital room
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WEIGHT, OBESE PEOPLE’S RISK FOR HOSPITALIZATION LATER IN LIFE FROM HEART DISEASE WAS UP TO FOUR TIMES GREATER. THEIR RISK OF DEATH FROM DIABETES WAS UP TO ELEVEN TIMES GREATER. DR. KUSHNER PUTS IT THIS WAY.
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Robert Kushner, M.D.
Obesity specialist
Runs :11
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“Every pound that you put on really does rob you later on in life of health, as well as chances are you’re going to be hospitalized more and perhaps even dying sooner."
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Heavy couple walking on sidewalk
Slender elderly couple walking on sidewalk
AUDIO:
SO FOR PEOPLE IN MIDDLE AGE, WATCHING YOUR WEIGHT NOW CAN MEAN A HEALTHIER YOU THIRTY YEARS FROM NOW. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
