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, August 13, 2007)
ANTIOXIDANTS SHOW NO CLEAR BENEFIT AGAINST CARDIOVASCULAR EVENTS, DEATH IN HIGH-RISK WOMEN
STUDY, META-ANALYSIS EXAMINE FACTORS ASSOCIATED WITH DEATH FROM HEATSTROKE
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 13, 2007)
DNA VACCINE AGAINST MULTIPLE SCLEROSIS APPEARS SAFE, POTENTIALLY BENEFICIAL
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 13, 2007)
SMOKING MAY STRONGLY INCREASE LONG-TERM RISK OF EYE DISEASE
FLUCTUATING EYE PRESSURE ASSOCIATED WITH VISUAL FIELD DETERIORATION IN GLAUCOMA PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 13, 2007
Media Advisory: To contact Nancy R. Cook, Sc.D., call Lori J. Shanks at 617-534-1600.
ANTIOXIDANTS SHOW NO CLEAR BENEFIT AGAINST CARDIOVASCULAR EVENTS, DEATH IN HIGH-RISK WOMEN
CHICAGO—Vitamins C and E and beta carotene, either individually or in combination, do not appear to reduce the risk of cardiovascular events or death among women at high risk for heart disease, according to a report in the August 13/27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Oxidative damage—harm to cells caused by exposure to oxygen—may contribute to the development of cardiovascular disease, according to background information in the article. In addition, compounds known as free radicals may damage artery linings, encourage blood clots and alter the function of blood vessels. “Antioxidants scavenge free radicals and limit the damage they can cause,” the authors write. “Diets high in fruit and vegetable intake, and thus rich in such antioxidants, have been associated with reduced rates of coronary heart disease and stroke. Vitamins C and E and beta carotene are potential mediators of the apparent protective effect of a plant-based diet on cardiovascular disease.”
Nancy R. Cook, Sc.D., of Brigham & Women’s Hospital and Harvard Medical School, Boston, and colleagues tested the effects of these compounds in the Women’s Antioxidant Cardiovascular Study, which followed 8,171 women 40 years or older (average age 60.6) beginning in 1995 to 1996. The women, who either had a history of cardiovascular disease or three or more risk factors, were randomly assigned to take 500 milligrams of ascorbic acid (vitamin C) or placebo every day; 600 international units of vitamin E or placebo every other day; and 50 milligrams of beta carotene or placebo every other day. Participants were followed up for the occurrence of heart events (including stroke, heart attack and bypass surgery) or death through 2005.
During the average study period of 9.4 years, 1,450 women had one or more cardiovascular events, including 274 heart attacks, 298 strokes, 889 coronary revascularization procedures (bypass surgery or angioplasty) and 395 cardiovascular deaths (out of a total 995 deaths). “There was no overall effect of ascorbic acid, vitamin E or beta carotene on the primary combined end point or on the individual secondary outcomes of myocardial infarction, stroke, coronary revascularization or cardiovascular disease death,” the authors write. “There were no significant interactions between agents for the primary end point, but those randomized to both active ascorbic acid and vitamin E experienced fewer strokes.”
No additional adverse effects were observed for those taking active pills vs. placebo, with the exception of a small increase in reports of upset stomach among those taking active beta carotene.
“Overall, we found no benefit on the primary combined end point for any of the antioxidant agents tested, alone or in combination,” the authors conclude. “We also found no evidence for harm. While additional research into combinations of agents, particularly for stroke, may be of interest, widespread use of these individual agents for cardiovascular protection does not appear warranted.”
(Arch Intern Med. 2007;167(15):1610-1618. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by an investigator-initiated grant from the National Heart, Lung, and Blood Institute. Vitamin E and its placebo were supplied by Cognis Corporation (LaGrange, Ill.). All other agents and their placebos were supplied by BASF Corporation (Mount Olive, N.J.). Pill packaging was provided by Cognis and BASF. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 13, 2007
Media Advisory: To contact Laurent Argaud, M.D., Ph.D., e-mail laurent.argaud@chu-lyon.fr. To contact Abderrezak Bouchama, M.D., e-mail: abouchama{at}kfshrc.edu.sa.
STUDY, META-ANALYSIS EXAMINE FACTORS ASSOCIATED WITH DEATH FROM HEATSTROKE
CHICAGO— Individuals who live in a nursing home or take medication to lower blood pressure appear more likely to die during or following hospitalization for heatstroke, according to a study posted online today that will appear in a later print issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A meta-analysis of previous studies also published online today found that being confined to bed, not leaving home daily or being unable to care for oneself also are associated with death from heatstroke.
A severe heat wave struck Europe in 2003, with death toll estimates ranging from 22,000 to more than 70,000, according to background information in the articles. France alone had 14,800 deaths in a nine-day period, one-third of which were caused by heatstroke. “Heatstroke is the most severe heat-related illness and is defined by an elevated core body temperature above 40 degrees Celsius [104 degrees Fahrenheit], associated with central nervous system abnormalities,” the authors write. Unlike exertional heatstroke, which occurs during strenuous exercise, classic heatstroke results directly from exposure to high temperatures. During heat waves, most victims are found dead at home, and 60 percent of those who reach the hospital are likely to die.
Laurent Argaud, M.D., Ph.D., of Hospices Civils de Lyon and University Claude Bernard Lyon I, and colleagues evaluated survival rates and long-term outcomes of 83 patients hospitalized for heatstroke in Lyon, France, during the summer of 2003. Demographic, medical and functional data were collected when individuals entered the hospital, and they were assessed again after 28 days and one and two years.
Fifty-eight percent of patients died within 28 days. Patients who died:
- more often came from an institution for the elderly (24 of 48 non-survivors vs. seven of 35 survivors)
- were more likely to have used antihypertensive medications long-term (33 of 48 who died vs. 13 of 35 survivors)
- had a higher average body temperature on hospital admission (41.3 degrees Celsius/106.3 degrees Fahrenheit compared with 40.7 degrees Celsius/105.3 degrees Fahrenheit)
- had more respiratory, cardiovascular or kidney dysfunctions than survivors
- were more likely to come to the hospital in a coma (39 or 81 percent of non-survivors vs. eight or 23 percent of survivors) or to have anuria, the inability to form urine (19 vs. zero)
A total of 27 patients (33 percent) were alive after one year and 24 (29 percent) were alive after two years. “Functional outcome at one year revealed that six patients (22 percent), who lived at home before the heat wave, required care in institutions for elderly patients because of severe functional limitations,” the authors write. “Similarly, a dramatic alteration in functional status was recorded in most surviving patients.”
“Heatstroke is associated with poor outcomes in temperate urban areas,” the authors conclude. “This could be explained at least in part by our lack of experience. Western temperate countries need to be more prepared for future heat waves.”
In the meta-analysis, Abderrezak Bouchama, M.D., of the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, and colleagues identified six studies published through 2006 that included 1,065 heat wave–related deaths. All of the studies selected compared risk factors between those who died during heat waves and a control group of those who did not.
“Being confined to bed, not leaving home daily and being unable to care for oneself were associated with the highest risk of death during heat waves,” the authors write. “Pre-existing psychiatric illness tripled the risk of death, followed by cardiovascular and pulmonary illness. Working home air-conditioning, visiting cool environments and increasing social contact were strongly associated with better outcomes. Taking extra showers or baths and using fans were associated with a trend toward lower risk of death.”
Although further studies are needed to provide specific guidance on each intervention, such as fans and air-conditioning, these results “could help formulate recommendations for the prevention of heat wave–related mortality and morbidity,” the authors conclude.
(Arch Intern Med. 2007;167(20):(doi:10.1001/archinternmed.167.20.ioi70147 and doi:10.1001/archinternmed.167.20.ira70009). 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 13, 2007
To contact corresponding author Hideki Garren, M.D., Ph.D., call Mark W. Schwartz, Ph.D., or Fred Kurland at 650-320-2800.
DNA VACCINE AGAINST MULTIPLE SCLEROSIS APPEARS SAFE, POTENTIALLY BENEFICIAL
CHICAGO—A newly developed DNA vaccine appears safe and may produce beneficial changes in the brains and immune systems of individuals with multiple sclerosis, according to an article posted online today that will appear in the October 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.
In patients with multiple sclerosis (MS), the immune system attacks the myelin sheaths that protect nerve cells in the brain and spinal cord, according to background information in the article. The nerve cell’s axon, which transmits messages to other neurons, is eventually destroyed. The cause of MS is unknown, but evidence points to the involvement of immune cells and antibodies that recognize and attack specific substances in the myelin, such as myelin basic protein. Certain cytokines, small proteins produced by cells that trigger inflammation, also may play a role.
Amit Bar-Or, M.D., of the Montreal Neurological Institute and colleagues tested a DNA vaccine, BHT-3009, that encodes a full-length human myelin basic protein. Between 2004 and 2006, the researchers administered the vaccine to 30 patients with relapsing-remitting MS [characterized by symptomatic periods and periods of remission] or secondary progressive MS [when symptoms progressively worsen, but there still may be periods of remission]. After one, three, five and nine weeks, participants received intramuscular injections of placebo or BHT-3009 (in doses of .5 milligrams, 1.5 milligrams or 3 milligrams), with or without 80-milligram pills of atorvastatin calcium, a lipid-lowering drug previously shown to be effective in autoimmune conditions. After 13 weeks, participants who initially received placebo received four injections of BHT-3009.
Magnetic resonance imaging (MRI) and other safety evaluations were performed at the beginning of the study, and again after five, nine, 13, 26, 38 and 50 weeks. “BHT-3009 was safe and well tolerated, provided favorable trends on brain MRI and produced beneficial antigen-specific immune changes,” the authors write. These changes included a reduction in the number of cytokine-producing CD4+ T cells (a type of white blood cell) specifically targeting myelin proteins. This reduction was found in the blood as well as in the cerebrospinal fluid of three patients who voluntarily underwent lumbar puncture after completing the course of BHT-3009. Atorvastatin did not appear to provide additional benefit.
“There were no increases in clinical relapses, disability, drug-associated laboratory abnormalities, adverse events or the number and volume of contrast-enhancing [visible on MRI] lesions on brain MRI with BHT-3009 treatment compared with placebo,” the authors write. “In fact, there was a trend toward a decrease in the number and volume of contrast-enhancing lesions in the brain in patients treated with BHT-3009 compared with placebo.”
Based on these results, a phase 2b trial—a randomized clinical trial in approximately 290 patients—of BHT-3009 is already under way. “If successful in MS, antigen-specific DNA vaccines can be developed for prevention or treatment of related diseases, such as type 1 diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis and myasthenia gravis,” the authors conclude.
(Arch Neurol. 2007;64(10):(doi:10.1001/archneur.64.10.nct70002).
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The work described in this article was funded by Bayhill Therapeutics, Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 13, 2007
Media Advisory: To contact corresponding author Jie Jin Wang, M.Med., Ph.D., e-mail: jiejin_wang{at}wmi.usyd.edu.au.
SMOKING MAY STRONGLY INCREASE LONG-TERM RISK OF EYE DISEASE
CHICAGO—Current and past smokers appear to have a higher risk of developing late age-related macular degeneration than those who have never smoked, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Age-related macular degeneration (AMD) [a progressive eye disease that affects the central portion of the retina] is the leading cause of blindness in the Western world,” according to background information in the article. “In addition to smoking, AMD is postulated to share other risk factors with cardiovascular disease, such as elevated cholesterol level and hypertension. Smoking may also interact with AMD gene susceptibility and other environmental risk factors.”
Jennifer S. L. Tan, M.B.B.S., B.E., University of Sydney and Westmead Hospital, Sydney, Australia, and colleagues examined 2,454 Australians age 49 and older to study the association between smoking and the 10-year incidence of AMD, as well as the possible links between smoking and other common risk factors. The participants answered a food frequency questionnaire and had retinal photos taken at five-year and 10-year follow-up exams. An interviewer-administered questionnaire assessed participants’ smoking status. BMI and blood pressure were also measured.
Current smokers were found to be four times more likely to develop age-related macular degeneration and past smokers were three times as likely to have geographic atrophy, an advanced form of the disease, than those who had never smoked. “Joint exposure to current smoking and (1) the lowest level of high-density lipoprotein (HDL) [good] cholesterol, (2) the highest total to HDL cholesterol ratio, or (3) low fish consumption was associated with a higher risk of late AMD than the effect of any risk factor alone. However, interactions between smoking and HDL cholesterol level, ratio of total to HDL cholesterol and fish consumption were not statistically significant,” the authors write.
“In summary, the findings from this large population-based prospective study add evidence to a possible causal relationship between smoking and the long-term risk of late, but not early, AMD,” the authors conclude. “This supports speculation that AMD is a condition with multiple etiologic factors, and such joint effects contributing to the pathogenesis (origin and development) of AMD could mirror the pathogenesis of cardiovascular disease.”
(Arch Ophthalmol. 2007;125(8):1089-1095. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by grants from the Australian National Health and Medical Research Council. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 13, 2007
Media Advisory: To contact corresponding author Young Jae Hong, M.D., Ph.D, e-mail: yjhong0815{at}yumc.yonsei.ac.kr. To contact editorialist Joseph Caprioli, M.D., call Elaine Schmidt at 310-794-2272.
FLUCTUATING EYE PRESSURE ASSOCIATED WITH VISUAL FIELD DETERIORATION IN GLAUCOMA PATIENTS
CHICAGO—Fluctuations in eye pressure may be associated with a decreasing peripheral field of vision in patients with glaucoma, even if their eye pressure remains low overall, according to a report in the August issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Prevention of further visual field deterioration is a goal of glaucoma therapy,” the authors write as background information in the article. “Previous studies reported that lowering intraocular pressure (IOP) slowed the advancement of visual field damage in patients with glaucoma. However, even if the IOP can be substantially lowered, reduction of mean [average] and peak IOP does not always prevent progressive visual field deterioration.”
Samin Hong, M.D., and colleagues at the Yonsei University College of Medicine, Seoul, Korea, studied 408 eyes of patients (average age 66.5 years) who had undergone a triple procedure to treat glaucoma: phacoemulsification, that involves dissolving and removing the lens; posterior chamber intraocular lens implantation; and trabeculectomy, also known as filtration surgery. All patients had a low IOP after surgery (below 18 milligrams of mercury). Measurements of IOP and visual field were taken for an average of 9.2 years following surgery. Based on the standard deviation (difference from the average) in IOP, the eyes were split into two groups, one with greater fluctuation and one with less.
Throughout the follow-up period, the two groups had the same average IOP, and their visual fields were the same after three months. However, after the last follow-up examination—13 years later—the visual field was significantly worse in the group with greater fluctuation in IOP. The number of patients with progressive visual field loss was significantly larger in the group with more fluctuation.
“Our results suggest that glaucomatous visual field damage cannot be stabilized by only lowering the postoperative IOP but also requires reducing the long-term fluctuation of the post-operative IOP,” the authors conclude.
(Arch Ophthalmol. 2007;125(8):1010-1013. 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: PRESSURE MODULATION MAY HELP PRESERVE VISION
Fluctuations in IOP have been pinpointed as a potential cause for glaucoma and a factor in worsening the eye damage caused by the disease, writes Joseph Caprioli, M.D., of the Jules Stein Eye Institute, UCLA, in an accompanying editorial.
“Why should IOP fluctuation be damaging? Theories abound about the mechanisms of retinal ganglion cell damage in glaucoma, but no single cellular or molecular cause satisfactorily explains the condition in all patients,” Dr. Caprioli writes. “Long-term variability may disrupt homeostatic mechanisms. Irregular and large IOP fluctuations may cause a loading and unloading of stresses, and as opposed to conditions of static stress, the tissue is unable to compensate and damage occurs.”
“I would propose for your consideration ‘IOP modulation’ rather than ‘IOP reduction’ as appropriate treatment,” he concludes. “This would not only lead to robust IOP reduction in patients with advancing disease but also establish the goal of reducing IOP fluctuation, particularly in patients with disease progression even at lower pressures. Specific guidelines, however, must await a better understanding of the pathophysiologic consequences of IOP fluctuation in glaucoma.”
(Arch Ophthalmol. 2007;125(8):1124-1125. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including 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.
Go back to the top.
