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, July 18, 2006)
JAMA NEWS RELEASES
MIGRAINES WITH AURA ASSOCIATED WITH INCREASED RISK FOR CARDIOVASCULAR DISEASE
USE OF COMBINATION ANTI-RETROVIRAL THERAPIES ASSOCIATED WITH REDUCED INFECTIONS IN HIV-INFECTED CHILDREN
GENETIC VARIATION LINKED TO AGE-RELATED MACULAR DEGENERATION
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
MIGRAINE ALONE IS NOT LINKED TO HEART ATTACK AND STROKE, BUT MIGRAINE WITH AURA IS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 18, 2006
Media Advisory: To contact Tobias Kurth, M.D., Sc.D., call Lori Shanks at 617-534-1604. To contact editorial co-author Richard B. Lipton, M.D., call Karen Gardner at 718-430-3101.
MIGRAINES WITH AURA ASSOCIATED WITH INCREASED RISK FOR CARDIOVASCULAR DISEASE
CHICAGO—Women age 45 years or older who experience migraines with aura (associated neurologic symptoms such as temporary visual disturbances) are at a higher risk for heart attack, ischemic stroke, angina and death due to ischemic cardiovascular disease compared to women who do not report a migraine history, according to a study in the July 19 issue of JAMA. In contrast, migraine without aura, the most common form of migraine, was not associated with increased risk of any cardiovascular event.
In the United States, the 1-year prevalence of migraine is approximately 18 percent in women and 6 percent in men; an estimated 28 million Americans have severe and disabling migraines, according to background information in the article. Migraine with aura has been previously linked with increased risk of ischemic stroke. Since some studies have suggested that migraine, particularly migraine with aura, is associated with an unfavorable cardiovascular risk profile, an association with other cardiovascular disease (CVD) is plausible but has not been firmly established.
Tobias Kurth, M.D., Sc.D., of Brigham and Women’s Hospital and the Harvard School of Public Health, Boston, and colleagues evaluated the association of migraine with or without aura and subsequent risk of overall and specific CVD. The study included 27,840 women, age 45 years or older, who were participating in the Women’s Health Study, were free of CVD and angina at study entry (1992-1995), and who had information on self-reported migraine and aura status and lipid measurements.
At baseline, 5,125 women (18.4 percent) reported a history of migraine; of the 3,610 with active migraine (migraine in the prior year), 1,434 (39.7 percent) indicated aura symptoms. During an average of 10 years of follow-up, 580 major CVD events occurred.
The researchers found that any history of migraine was associated with increased risk of major CVD. This increased risk differed according to aura status. Compared with no migraine history, women who reported active migraine with aura had a significantly increased risk of subsequent major cardiovascular events, ischemic stroke, heart attack, coronary revascularization, angina, and death due to ischemic CVD. These increased risks, which remained after adjusting for a large number of cardiovascular risk factors, ranged from a 1.7-fold increase for coronary revascularization to a 2.3-fold increase for ischemic cardiovascular disease death. In contrast, women who reported active migraine without aura did not have significantly increased risk for any ischemic vascular event.
“Since migraine without aura is far more common than migraine with aura, our data demonstrate no increased risk of CVD for the majority of migraine patients. Future research should focus on a better understanding of the relationship between migraine, aura status, and cardiovascular events,” the authors conclude.
(JAMA. 2006;296:283-291. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The study was supported by grants from the Donald W. Reynolds Foundation, Las Vegas, and the National Institutes of Health, Bethesda, Md.
EDITORIAL: MIGRAINE AND CARDIOVASCULAR DISEASE
In an accompanying editorial, Richard B. Lipton, M.D., and Marcelo E. Bigal, M.D., Ph.D., of the Albert Einstein College of Medicine, and the Montefiore Headache Center, Bronx, N.Y., comment on the study by Kurth et al.
“Why is there an association between migraine with aura and risk factors for CVD? One suggestion is that genetic polymorphisms may predispose to both cardiovascular risk factors and migraine with aura. A polymorphism in the methyltetrahydrofolate reductase gene (C677T) is associated with a moderately increased homocysteine level, which, in turn, is associated with risk of CVD. The same polymorphism is overexpressed in migraine with aura but not migraine without aura.”
“For patients with migraine with aura, clinicians should have heightened vigilance for modifiable cardiovascular risk factors, such as hypertension, hyperlipidemia [high cholesterol], and smoking. Ultimately, it will be important to determine whether migraine with aura is itself a modifiable risk factor for CVD. Future studies should investigate the possibility that preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with migraine with aura.”
(JAMA. 2006;296:332-333. Available pre-embargo to the media at www.jamamedia.org)
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, July 18, 2006
Media Advisory: To contact Philimon Gona, Ph.D., call 508-935-3432. To contact editorial co-author Joseph I. Harwell, M.D., call Wendy Lawton at 401-863-1862.
USE OF COMBINATION ANTI-RETROVIRAL THERAPIES ASSOCIATED WITH REDUCED INFECTIONS IN HIV-INFECTED CHILDREN
CHICAGO—Since the introduction of highly active antiretroviral therapies, there has been a substantial reduction of opportunistic infections and other infections in HIV-infected children, such as pneumonia and tuberculosis, according to a study in the July 19 issue of JAMA.
The human immunodeficiency virus (HIV) epidemic has spurred the development of new antiretroviral, immune, and vaccine-based therapies geared to block transmission, prevent disease progression, and prolong the survival of individuals who are HIV positive, according to background information in the article. Highly active antiretroviral therapy (HAART) has dramatically decreased rates of AIDS-related opportunistic infections (infections caused by an organism capable of causing disease in a host whose resistance is lowered, e.g., by other diseases or by drugs) and deaths in adults. Although HAART has dramatically decreased illness and death in HIV-infected infants, children, and adolescents in the United States, no studies comparing the incidence of opportunistic and other related infections before and during the HAART era have been conducted.
Philimon Gona, Ph.D., of the Harvard School of Public Health and Boston University, Boston, and colleagues estimated the rates for the first occurrence of 29 targeted opportunistic and other related infections between Jan. 1, 2001, and Dec. 31, 2004, in HIV-infected infants, children, and adolescents to compare the rates in the HAART era to those of the pre-HAART era. The study included 2,767 children enrolled between Sept. 15, 2000, and Dec. 31, 2004, with information entered in the database up to August 1, 2005, when data analysis was conducted. The pre-HAART era comparison population included 3,331 children enrolled in 13 Pediatric AIDS Clinical Trials Group (PACTG) protocols from October 1988 to August 1998.
Seventy-five percent of the children were enrolled in 2000 and 2001. Overall, 553 first episodes of a specific infection occurred among 395 (14 percent) of the study participants. The incidence rates (IRs) per 100 person-years for the 4 most common first-time infections were bacterial pneumonia (IR, 2.15), herpes zoster (IR, 1.11), dermatophyte infections (IR, 0.88), and oral candidiasis (IR, 0.93). Infection rates were significantly lower than those reported in the PACTG in the pre-HAART era: bacterial pneumonia (IR, 11.1), bacteremia (IR, 3.3), herpes zoster (IR, 2.9), oral candidiasis (IR, 1.2) and tuberculosis (IR, 0.2).
“Despite these current advances due to HAART, some HIV-infected children continue to develop opportunistic infections. Some children fail to respond to antiretroviral therapy as a result of viral resistance, poor adherence, or inability to tolerate complex treatment regimens. Furthermore, prophylactic [preventive] therapies are not fully effective and poor adherence can further reduce their efficacy. Drug interactions, complex dosing schedules, adverse effects, and high costs can further limit the efficacy of these therapies. Although these issues do present challenges, our findings demonstrate a substantial reduction in the incidence of several opportunistic infections in HIV-infected children since the introduction of HAART therapy,” the authors write.
(JAMA. 2006;296:292-300. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
EDITORIAL: ANTIRETROVIRAL THERAPY FOR CHILDREN — SUBSTANTIAL BENEFIT BUT LIMITED ACCESS
In an accompanying editorial, Joseph I. Harwell, M.D., of Brown Medical School, Providence, R.I., and Stephen K. Obaro, M.D., of Children’s Hospital of Pittsburgh, discuss the findings of the study by Gona and colleagues.
“Although significant advances have been made in the improvement of the quality of life for patients with HIV/AIDS, several important challenges remain. A cure for HIV infection remains elusive and following infection, chronic suppression of viral replication with preservation of immune function remains the goal. If in the best case scenario, a combination of HAART and specific opportunistic infection prophylaxis continues to prolong survival, patients must contend with the adverse effects of long-term treatment with these agents, most of which are new and have unknown long-term effects, particularly when administered to young children.”
“In the past 5 years, the debate has begun to shift from whether these treatments can be provided in developing countries to how these treatments can be provided. Through [various] programs … the issues of ‘how’ to provide treatment are gradually being addressed, but these efforts need to be increased substantially. For 2.3 million children living with HIV infection worldwide, the question is not whether or how but when they will receive (and, like their counterparts in the study by Gona et al, benefit from) the therapy that will allow them to reach adulthood.
(JAMA. 2006;296:330-331. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Harwell reports that he is a consultant to the Clinton Foundation Pediatric HIV/AIDS Initiative. Dr. Obaro reports no financial disclosures.
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, July 18, 2006
Media Advisory: To contact corresponding author Paulus T. V. M. de Jong, M.D., Ph.D., email: p.dejong{at}nin.knaw.nl.
GENETIC VARIATION LINKED TO AGE-RELATED MACULAR DEGENERATION
CHICAGO—The combination of a certain genetic variation, along with inflammatory factors and smoking, significantly increases the risk of the vision disorder age-related macular degeneration, according to a study in the July 19 issue of JAMA.
Age-related macular degeneration (AMD) is the most important cause of irreversible visual loss in the elderly of the Western world, according to background information in the article. It has long been recognized that hereditary factors play a role in AMD and there is increasing evidence that inflammation is an important disease mechanism. Recent case-control studies demonstrated an association between the complement factor H (CFH) gene, a regulator of the complement pathway, and AMD.
Dominiek D. G. Despriet, M.D., of the Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues hypothesized that the effect of this regulator gene may be particularly hazardous in persons in whom the complement cascade is activated. They assessed the association between the CFH gene and AMD and investigated the modifying effect of smoking, serum inflammatory markers, and genetic variation of C-reactive protein (CRP). The population-based study included 5,681 individuals age 55 years or older who were assessed for the gene mutation CFH Y402H. Information on smoking, serum inflammatory markers and CRP gene variation were assessed at baseline.
The frequency of CFH Y402H was 36.2 percent. At baseline, there were 2,062 persons (36.3 percent) with any type of AMD (prevalent cases), including 78 (1.4 percent) with late AMD. During an average follow-up of 8 years, 1,649 (35.5 percent) of 4,642 participants progressed to a higher stage of AMD (new cases), including 93 (5.6 percent) who developed late AMD.
The researchers found that the CFH gene was a major risk factor for AMD in the general population. The gene was implicated in all stages of AMD from early hallmarks such as drusen (material that builds up in the retina of the eye) to vision-disabling late AMD. The risks increased with each successive AMD stage, and homozygous individuals (i.e., with two identical gene copies of the CFH Y402H mutation at the corresponding site on a chromosome), had an 11 times higher risk to develop late AMD compared to noncarriers. Homozygous persons had a 48 percent cumulative risk of developing late AMD by age 95 years while this risk did not exceed 22 percent for noncarriers.
Factors that are known to activate the complement cascade modified the association between CFH and AMD: smoking further increased the risk of late AMD 34-fold; elevated serum CRP levels increased the risk 28-fold; and elevated sedimentation rates increased the risk 20-fold. The researchers also found a positive interaction between the CFH and the CRP gene for AMD, in particular with those forms of the gene predisposing for high serum CRP levels.
“These data suggest that CFH Y402H may be a causal factor in more than 50 percent of all AMD cases in the general population.”
“Genetic predisposition to a malfunctioning CFH can only be of importance when the complement system is switched on,” the authors write. “This is demonstrated by the significant interaction between chronic as well as acute inflammation and CFH Y402H.”
“The effect of CFH is significantly influenced by environmental and genetic factors that determine the inflammatory response and activate the complement pathway.”
(JAMA. 2006;296:301-309. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
MIGRAINE ALONE IS NOT LINKED TO HEART ATTACK AND STROKE, BUT MIGRAINE WITH AURA IS
VIDEO:
SOT/FULL
@ :01
Super: Shenika Walker
Migraine sufferer
Runs :04
AUDIO:
“They’re painful. Very, very, very painful.”
VIDEO:
B-ROLL
Leave her up through “she also”
Camera simulating dizziness
Camera simulating light flashes, loss of vision and spots
AUDIO:
SHE’S DESCRIBING HER MIGRAINE HEADACHES. SHE ALSO SUFFERS FROM AURA, WHICH MEANS DIZZINESS, LOSS OF VISION, FLASHES OR SPOTS OF LIGHT, THAT COME ON RIGHT BEFORE THE MIGRAINE.
VIDEO:
SOT/FULL
Shenika Walker
Migraine sufferer
Runs :03
AUDIO:
“I see spots when mine comes on.”
VIDEO:
B-ROLL
More “aura” video
GFX/JAMA COVER
Women walking on sidewalk
AUDIO:
THAT AURA MAY PUT HER AT INCREASED RISK FOR CARDIOVASCULAR DISEASE, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, WHICH COMPARED WOMEN WITH MIGRAINE AND AURA TO WOMEN WHO DON’T HAVE MIGRAINES.
VIDEO:
SOT/FULL
@ :29
Super: Tobias Kurth, M.D., Sc.D.
Brigham and Women’s Hospital
Runs :12
AUDIO:
“Women with migraine with aura were twice as likely to experience cardiovascular disease overall, and specific cardiovascular disease such as heart attack, stroke, chest pain or to die from cardiovascular disease.”
VIDEO:
B-ROLL
Dr. Kurth working at computer
Women walking on city sidewalk
AUDIO:
DR. TOBIAS (two-BEE-as) KURTH, OF BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON, IS ONE AUTHOR OF A TEN-YEAR STUDY OF MORE THAN TWENTY-SEVEN THOUSAND WOMEN. HE STRESSES THAT HIS STUDY REVEALS MORE GOOD NEWS THAN BAD, BECAUSE MOST WOMEN WITH MIGRAINES DO NOT HAVE AURA.
VIDEO:
SOT/FULL
Tobias Kurth, M.D., Sc.D.
Brigham and Women’s Hospital
Runs :08
AUDIO:
“We found that the most common form of migraine, migraine without aura, is not associated with cardiovascular disease.”
VIDEO:
B-ROLL
More women from sidewalk
AUDIO:
AND EVEN FOR WOMEN WITH AURA, THE RISK SOUNDS DRAMATIC, BUT IN REAL NUMBERS, IT’S PRETTY LOW.
VIDEO:
SOT/FULL
Tobias Kurth, M.D., Sc.D.
Brigham and Women’s Hospital
Runs :13
AUDIO:
“Absolute numbers mean only 18 additional cases per 10,000 women per year, so this is a rather low risk of experiencing cardiovascular disease if you have migraine with aura.”
VIDEO:
B-ROLL
Dr. Johnson at her desk
AUDIO:
STILL, CARDIOLOGIST DR. PAULA JOHNSON SAYS SHE’LL PAY MORE ATTENTION TO PATIENTS’ MIGRAINE HISTORY.
VIDEO:
SOT/FULL
@ 1:25
Super: Paula Johnson, M.D., M.P.H.
Cardiologist
Runs :09
AUDIO:
“And for those women who do have an aura, to make sure that they understand what the risk factors are for heart disease.”
VIDEO:
B-ROLL
Woman taking out cigarette from purse
More women walking on sidewalk
AUDIO:
RISK FACTORS LIKE SMOKING, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
