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, June 11, 2007)
DIABETES ASSOCIATED WITH DECREASES IN LIFE EXPECTANCY AND NUMBER OF YEARS FREE OF HEART DISEASE
STUDIES IDENTIFY INTERACTIONS BETWEEN HEART DISEASE, KIDNEY DISEASE
SURVEY: MOST PATIENTS WANT TO SHAKE HANDS WITH THEIR PHYSICIANS
ADDRESSING MULTIPLE UNHEALTHY BEHAVIORS AT ONCE MAY BE MORE EFFECTIVE THAN SEQUENTIAL APPROACH
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 11, 2007)
BLOOD PRESSURE DROP DURING BYPASS SURGERY ASSOCIATED WITH INCREASED RISK OF COGNITIVE DECLINE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 11, 2007)
HIGH ARTERIAL PULSE PRESSURE ASSOCIATED WITH HIGH-TENSION OPEN-ANGLE GLAUCOMA
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 11, 2007
Media Advisory: To contact Oscar H. Franco, M.D., D.Sc., Ph.D., e-mail oscar.franco{at}unilever.com
DIABETES ASSOCIATED WITH DECREASES IN LIFE EXPECTANCY AND NUMBER OF YEARS FREE OF HEART DISEASE
CHICAGO—Men and women with diabetes at age 50 and older appear not to live as long overall, or have as many years without cardiovascular disease, than individuals without diabetes, according to a report in the June 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The benefit is greater in those who had not previously been getting the daily recommended amount of calcium.
“Globalization of the Western lifestyle led to diabetes mellitus being a major and progressive health care problem worldwide,” the authors write as background information in the article. By 2000, more than 171 million individuals had diabetes—a number that is expected to double in 25 years. Research has shown that individuals with diabetes have an increased risk of illness and death, including double the risk of cardiovascular disease.
Oscar H. Franco, M.D., D.Sc., Ph.D., of University Medical Center Rotterdam, the Netherlands, and Unilever Corporate Research, Sharnbrook, England, and colleagues used data from the Framingham Heart Study, a group of 5,209 men and women age 28 to 62 years recruited between 1948 and 1951 and followed for more than 46 years. The researchers selected three follow-up periods of 12 years each that began in 1956 to 1958, 1969 to 1973, and 1985 to 1989. Participants were followed during each of the three periods until they developed cardiovascular disease or died, and their diabetes status was measured again at the beginning of each interval.
“Women with diabetes had more than double the risk of developing cardiovascular disease and, among those already with cardiovascular disease, mortality compared with non-diabetic women,” the authors write. “Diabetic men, compared with non-diabetic men, had more than double the risk of developing cardiovascular disease and a 1.7 times higher risk of dying once cardiovascular disease was present.” Among those age 50 and older, diabetic men lived an average of 7.5 years less than men without diabetes, and diabetes reduced women’s life expectancy by an average of 8.2 years. Life expectancy free of cardiovascular disease was reduced by 7.8 years in men and 8.4 years in women with diabetes.
“Having diabetes at age 50 years and older represents not only a significant increase in the risk of developing cardiovascular disease and mortality but also an important decrease in life expectancy and life expectancy free of cardiovascular disease,” the authors write. “These findings underscore the importance of diabetes prevention for the promotion of healthy aging. Toward this end, it is essential to implement global strategies to change the current ‘Western’ lifestyle and to promote the adoption of physical activity and healthy diets.”
“Prevention of diabetes is a fundamental task facing today’s society, with the aim to achieve populations living longer and healthier lives,” they conclude.
(Arch Intern Med. 2007;167:1145-1151. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Co-authors Dr. Franco, Dr. Mackenbach and Dr. Nusselder were partly funded by the Netherlands Organization for Scientific Research. Dr. Hu is a recipient of an American Heart Association Established Investigator 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, June 11, 2007
Media Advisory: To contact Peter A. McCullough, M.D., M.P.H., call Ilene Wolff at 248-551-0740. To contact corresponding author Daniel E. Weiner, M.D., M.S., call Catherine Bromberg at 617-636-0200. To contact corresponding editorialist Thomas D. DuBose Jr., M.D., call Bonnie Davis at 336-716-4977..
STUDIES IDENTIFY INTERACTIONS BETWEEN HEART DISEASE, KIDNEY DISEASE
CHICAGO— Anemia and other conditions related to chronic kidney disease are independently associated with the risk of cardiovascular disease; conversely, heart disease is associated with a decline in kidney function and the development of kidney disease, according to two reports in the June 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Chronic kidney disease is becoming increasingly prevalent in the United States and worldwide, according to background information in the articles. Chronic kidney disease is associated with a wide variety of complications, including anemia (low red blood cell count, or red blood cells that are deficient in oxygen-transporting hemoglobin), nerve pain, bone disease, death and cardiovascular disease. Most patients with chronic kidney disease die of complications from heart disease rather than of kidney failure.
In one study, Peter A. McCullough, M.D., M.P.H., of William Beaumont Hospital, Royal Oak, Mich., and colleagues assessed a group of 37,153 individuals who were screened for kidney disease through a community-based program between 2000 and 2003. The participants (average age of 52.9 years) all reported a personal or family history of diabetes, hypertension or kidney disease on a screening survey. Patients had their blood pressure measured and provided blood and urine samples, which were processed to assess three markers of chronic kidney disease:
- estimated glomerular filtration rates (eGFR), or the rate at which kidneys filter blood, calculated based on levels of the waste product creatinine in the blood
- anemia, determined by blood hemoglobin levels
- and microalbuminuria, or slightly high levels (20 milligrams per liter or more) of the protein albumin in the urine
Of the participants who were followed for a maximum of 47.5 months, 5,504 (14.8 percent) had eGFR values of less than 60 milliliters per minute per 1.73 square meters, which were considered abnormal and signs of declining kidney function. In addition, 4,588 (13.1 percent) had anemia; and 15,959 (49.5 percent) had microalbuminuria. A total of 1,835 (4.9 percent) had a history of heart attack, 1,336 (3.6 percent) had a history of stroke and 2,897 (7.8 percent) had a self-reported history of heart attack or stroke.
Each of the three variables—anemia, microalbuminuria and low eGFR—was associated with cardiovascular disease. More than one-fourth of the patients who had all three kidney disease measures had cardiovascular disease, and their survival rates over the course of the study were lower by approximately 93 percent than those of any other group.
“These data suggest that screening for cardiovascular disease would be of high yield among patients with these risk markers but who do not report any history of cardiovascular disease symptoms,” the authors conclude.
In a related study, Essam F. Elsayed, M.D., of Tufts–New England Medical Center, Boston, and colleagues evaluated a total of 13,826 individuals (average age 57.6) who had participated in one of two large cardiovascular health studies. Participants were recruited to the studies between 1987 and 1990 and followed up at approximately three-year intervals for an average of 9.3 years. At the beginning of the study and at each subsequent visit, blood creatinine levels were measured and used to track the decline in kidney function and the development of kidney disease both directly and by calculating eGFR. History of cardiovascular disease, as well as medication use, lifestyle characteristics, and other variables also were collected at the initial assessment.
At the beginning of the studies, 1,787 (12.9 percent) of the participants had cardiovascular disease. As measured by creatinine levels, 520 individuals (3.8 percent) experienced a decline in kidney function—including 128 (7.2 percent) of those with cardiovascular disease and 392 (3.3 percent) of those without cardiovascular disease—and 314 (2.3 percent) developed kidney disease. The presence of cardiovascular disease at the beginning of the study was associated with a decline in kidney function and the development of kidney disease as measured by both creatinine levels and eGFR.
“Our study demonstrates that cardiovascular disease is associated with subsequent kidney function decline and development of kidney disease,” the authors conclude. “This study identifies a population that may benefit from (1) increased cardiovascular disease risk factor surveillance and intervention, (2) heightened awareness of the risk factors associated with kidney disease, and (3) greater attention to and treatment for sequelae of kidney disease.”
“Because these patients are mainly under the care of primary care physicians and cardiologists, it is important to draw attention to the increased risk of kidney disease in this population, with goals of preventing further progression, managing sequelae of kidney disease as they arise and adequately preparing individuals for kidney failure with timely nephrology referrals. Only with recognition of risk factors for kidney disease can this happen.”
(Arch Intern Med. 2007;167:1122-1129, 1130-1136. 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.
EDITORIAL: FOCUSED APPROACH WILL REDUCE HEART AND KIDNEY DISEASE RATES
The presence of cardiovascular disease should now be recognized as a risk factor for the development of kidney disease, and patients with both should be screened and treated accordingly, write Barry I. Freedman, M.D., and Thomas D. DuBose Jr., M.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., in an accompanying editorial.
These two reports “address the interactive effects of kidney disease and cardiovascular disease risk in more than 50,000 subjects,” they write. “These studies provide novel insights into the relationship between kidney disease and the vasculature.”
“The chances for reducing the current high rates of chronic kidney disease and cardiovascular disease will be maximized when primary care physicians, nephrologists and cardiologists work in partnership to reduce and treat modifiable vascular disease risk factors, including those that are a consequence of kidney disease,” Drs. Freedman and DuBose conclude. “In addition, the potential for achieving current treatment goals in individuals at risk for nephropathy and cardiovascular disease using a more focused approach promises greater reductions in future cardiovascular disease and end-stage renal disease events.”
(Arch Intern Med. 2007;167:1113-1115. 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, June 11, 2007
Media Advisory: To contact Gregory Makoul, Ph.D., call Marla Paul at 312-503-8928.
SURVEY: MOST PATIENTS WANT TO SHAKE HANDS WITH THEIR PHYSICIANS
CHICAGO—Most patients want physicians to shake their hands when they first meet, and about half want their first names used in greetings, according to a report in the June 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“The first few moments of a medical encounter are critical to establishing rapport, making the patient feel comfortable and setting the tone of the interview,” the authors write as background information in the article.
Gregory Makoul, Ph.D., and colleagues at Northwestern University Feinberg School of Medicine, Chicago, surveyed 415 adults in the United States between 2004 and 2005 regarding patient expectations and preferences for greetings by physicians. The authors also analyzed videotapes of 123 new patient visits in the offices of 19 different physicians in Chicago and Burlington, Vt.
The survey found that, among patients:
- 78.1 percent wanted physicians to shake their hands, while 18.1 percent did not
- 50.4 percent wanted their first names used during greetings, 17.3 percent preferred their last name and 23.6 percent favored the physician using both first and last names
- 56.4 percent wanted physicians to introduce themselves using first and last names, 32.5 percent expected physicians to use their last name, and 7.2 percent would like physicians to use their first name only
In the videotaped encounters, physicians and patients shook hands 82.9 percent of the time. In 62 (50.4 percent) of the visits, physicians did not mention patients’ names at all, and in 48 (39 percent) of the cases patients’ names were not mentioned by physicians or patients. Physicians used their first and last names when introducing themselves 58.5 percent of the time, and did not introduce themselves at all in 14 visits (11.4 percent).
“Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior,” the authors conclude. “Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients’ first and last names and introduce themselves using their own first and last names.”
(Arch Intern Med. 2007;167:1172-1176. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by the American Board of Medical Specialties Research and Education Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 11, 2007
Media Advisory: To contact Gregory Makoul, Ph.D., call Marla Paul at 312-503-8928.
ADDRESSING MULTIPLE UNHEALTHY BEHAVIORS AT ONCE MAY BE MORE EFFECTIVE THAN SEQUENTIAL APPROACH
CHICAGO—Physicians trying to help patients change more than one behavioral risk factor may have more success approaching several topics at once rather than addressing them separately over time, according to a report in the June 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
David J. Hyman, M.D., M.P.H., of Baylor College of Medicine, Houston, and colleagues randomly assigned 289 African-American patients who had hypertension and were smokers to one of three groups that encouraged them to stop smoking, reduce their sodium intake to less than 100 milliequivalents per liter per day, and increase physical activity by at least 10,000 pedometer steps per week.
The first group received one in-clinic counseling session on all three behaviors every six months, plus motivational telephone calls for 18 months; the second group followed a similar protocol, but addressed a different behavior every six months; and the third group received usual care, consisting of a one-time referral to existing group classes. After six, 12 and 18 months, urine and blood samples were obtained, blood pressure was taken and behavioral changes were assessed.
A total of 230 participants completed the full study. “At 18 months, only 6.5 percent in the simultaneous arm, 5.2 percent in the sequential arm and 6.5 percent in the usual-care arm met the primary end point,” or changing two of the three behaviors, the authors write. “However, results for single behavioral goals consistently favored the simultaneous group.”
For example, after six months, 29.6 percent in the simultaneous, 16.5 percent in the sequential and 13.4 percent in the usual-care groups had reached the urine sodium goal. After 18 months, 20.3 percent in the simultaneous, 16.9 percent in the sequential and 10.1 percent in the usual-care groups tested negative for urine cotinine, which the body produces when it metabolizes nicotine, indicating they had stopped smoking.
“Long-term multiple behavior change is difficult in primary care,” the authors conclude. “This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach.”
(Arch Intern Med. 2007;167:1152-1158. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 11, 2007
Media Advisory: To contact Rebecca F. Gottesman, M.D., call Eric A. Vohr at 410-955-8665.
BLOOD PRESSURE DROP DURING BYPASS SURGERY ASSOCIATED WITH INCREASED RISK OF COGNITIVE DECLINE
CHICAGO—Patients whose mean arterial blood pressure drops during bypass surgery may be at risk for early difficulties in thinking, learning and memory, according to an article posted online today that will appear in the August 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.
“Many patients who undergo a coronary artery bypass graft (CABG) operation have pre-existing vascular disease, and a subset have pre-existing cognitive dysfunction,” the authors write as background information in the article. “Although recent prospective controlled trials have suggested that CABG may not cause long-term cognitive dysfunction, there may be a subset of patients who experience short-term cognitive problems.”
Rebecca F. Gottesman, M.D., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues assessed 15 patients age 57 to 81 years undergoing CABG operations who were believed to be at high risk for having a stroke following surgery. All 15 patients were given cognitive (thinking, learning and memory) tests before and three to five days after surgery. Their blood pressure was taken before and during the operation and the mean arterial blood pressure (MAP) was measured. The MAP is calculated as the diastolic (bottom number) blood pressure plus one-third times the difference between the systolic (top number) blood pressure and the diastolic blood pressure and provides an estimate of the pressure that perfuses the various organs in the body. Thirteen of the patients also underwent magnetic resonance imaging (MRI) of the brain following surgery.
All of the participants had a decrease in MAP during surgery compared with their MAP before surgery. Those whose MAP decreased by 27 millimeters of mercury or more had an average decrease in score on the Mini-Mental State Examination, one of the cognitive tests, of 1.4 points (out of a maximum of 30 points). After one individual was excluded from the analysis, those who had a MAP decrease of less than 27 millimeters of mercury increased their scores by an average of one point. Individuals with high MAP before surgery also were more likely to have a decreased cognitive score.
Six of the 13 individuals who underwent MRI had findings in the brain consistent with acute stroke. Because the number of participants was small, it was difficult to analyze this information, the authors note. However, patients with a drop in MAP greater than 27 millimeters of mercury were 2.7 times as likely to have such a lesion as those whose MAP decreased by a smaller amount.
“Our preliminary data from a small group of subjects suggest that a substantial decrease in MAP from a patient’s baseline may be a risk factor for short-term cognitive dysfunction,” the authors conclude. “This may be in part because of an increased risk for radiographic stroke. Future prospective studies are needed to further define the relationship between change in blood pressure and postoperative stroke as well as change in blood pressure and postoperative cognitive performance.”
(Arch Neurol. 2007;64(8):(doi:10.1001/archneur.64.8.noc70028).
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by GlaxoSmithKline. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 11, 2007
Media Advisory: To contact corresponding author Paulus T. V. M. de Jong, M.D., Ph.D., e-mail p.dejong{at}nin.knaw.nl.
HIGH ARTERIAL PULSE PRESSURE ASSOCIATED WITH HIGH-TENSION OPEN-ANGLE GLAUCOMA
CHICAGO— Individuals with a high pulse pressure (the difference between the systolic [top number] and diastolic [bottom number] blood pressure), appear to have an increased risk for high-tension open-angle glaucoma, according to a report in the June issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Researchers have previously examined the role of vascular factors in the development of open-angle glaucoma, an eye disease often associated with increased intra-ocular pressure and that involves loss of certain retinal cells and atrophy of the optic nerve, according to background information in the article. “Still, the relations between risk factors such as systemic hypertension [high blood pressure], systolic or diastolic blood pressures or perfusion pressures and open-angle glaucoma remain controversial,” the authors write.
Caroline A. A. Hulsman, M.D., Ph.D., and colleagues at the Academic Medical Center, Amsterdam, and Erasmus Medical Center, Rotterdam, the Netherlands, analyzed data from 5,317 individuals, 215 of whom had definite or probable open-angle glaucoma and 5,102 of whom did not have the condition. At the beginning of the study, between 1990 and 1993, participants received eye examinations and their blood pressure was measured. During the third phase of the study, between 1997 and 1999, arterial stiffness (a change in artery structure associated with an increased risk of cardiovascular disease) was also measured. Based on their intraocular pressure (pressure within the eye), individuals with glaucoma were classified into high-tension open-angle glaucoma (pressure greater than 21 millimeters of mercury) and normal-tension open-angle glaucoma (pressure of 21 millimeters of mercury or less).
“We found that high-tension open-angle glaucoma was associated with high pulse pressure, possibly with increased carotid arterial stiffness and, only in persons treated for systemic hypertension, with low diastolic perfusion pressure,” the authors write. “In these persons, normal-tension open-angle glaucoma was associated with high diastolic blood pressure, whereas the association between normal-tension open-angle glaucoma and low diastolic perfusion pressure was inverted.”
“Although our findings of high-tension open-angle glaucoma and normal-tension open-angle glaucoma need to be confirmed in other population-based studies and the numbers of cases are low, we conclude that the mechanisms involved in the etiology of high-tension open-angle glaucoma may be different from those in normal-tension open-angle glaucoma,” they write.
(Arch Ophthalmol. 2007;125:805-812. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the articles 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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