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, November 26, 2007)
PATIENT KNOWLEDGE OF HEART RISK PROFILE MAY HELP IMPROVE CHOLESTEROL MANAGEMENT
HIGH–GLYCEMIC INDEX CARBOHYDRATES ASSOCIATED WITH RISK FOR DEVELOPING TYPE 2 DIABETES IN WOMEN
UNDOCUMENTED LATINOS VISIT PHYSICIANS LESS OFTEN THAN U.S.-BORN COUNTERPARTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 26, 2007
Media Advisory: To contact Steven A. Grover, M.D., M.P.A., F.R.C.P.C., call Cynthia Lee at 514-398-6754. To contact corresponding editorialist Rod Jackson, M.B.Ch.B., Ph.D., e-mail: rt.jackson{at}auckland.ac.nz. To contact editorialist Charles B. Eaton, M.D., M.S., call Wendy Lawton at 401-837-6055.
PATIENT KNOWLEDGE OF HEART RISK PROFILE MAY HELP IMPROVE CHOLESTEROL MANAGEMENT
CHICAGO—Patients who discuss their coronary risk profiles with their physicians may respond better to treatment for cholesterol disorders, according to a report in the November 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Dyslipidemia, or cholesterol problems that may include combinations of high total cholesterol, high levels of low-density lipoprotein (LDL, or “bad” cholesterol) or low high-density lipoprotein (HDL, or “good” cholesterol), is a risk factor for cardiovascular disease. Treatment is most effective when targeted to high-risk individuals, according to background information in the article. However, these patients sometimes do not adhere to recommended lifestyle changes or pharmacotherapy. One study suggested that one-third of patients who stop taking lipid-lowering medications do so because they are not convinced they need treatment.
Steven A. Grover, M.D., M.P.A., F.R.C.P.C., of McGill University, Montreal, Quebec, Canada, and colleagues followed 3,053 patients undergoing treatment for dyslipidemia with lifestyle changes and statin medications when necessary. A group of 1,510 patients was randomly assigned to also receive a one-page computer printout of their probability for developing heart disease at the beginning of the study and at follow-up visits three, six, nine and 12 months later.
A total of 2,687 patients completed the 12-month study. After adjusting for beginning cholesterol levels, individuals who received their risk profile had small but significantly greater reductions in their LDL levels and their total cholesterol to HDL ratio. “Patients in the risk profile group were also more likely to reach lipid targets,” the authors write.
The risk profile included a summary of each individual’s cardiovascular age, calculated by subtracting the difference between life expectancy and the average life expectancy from the individual’s current age. “For example, a 50-year-old with a life expectancy of 25 more years (vs. 30 more years for the average Canadian) would be assigned a cardiovascular age of 55 years,” the authors write. “Individuals without cardiovascular disease were also given their cardiovascular age, their actual age and the resulting ‘age gap’ (cardiovascular age minus actual age). This variable seemed to modify the degree to which patients responded to the risk profile.” Patients with a larger gap between their cardiovascular and actual age had greater reductions in LDL cholesterol levels than those with a smaller gap or no gap.
Given the public health burden of cardiovascular disease, preventive steps must be taken, the authors note. “Communicating risk is consistent with many of the recommendations to improve adherence, including enhancing self-monitoring and using the support of family and friends,” the authors conclude. “Informing patients of their coronary risk may also increase the effectiveness of primary prevention by identifying individuals most likely to benefit from treatment while reassuring those at low risk. This information may also assist physicians in treatment selection while improving patient adherence.”
(Arch Intern Med. 2007;167(21):2296-2303. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by Pfizer Canada. Dr. Grover and co-authors Dr. Lowensteyn and Mr. Coupal have received research grants from Pfizer, Sanofi Aventis and AstraZeneca. Dr. Grover has received speaker honoraria from Pfizer, Sanofi Aventis and Orynx and has either been a consultant to or participated on an advisory board for AstraZeneca, Sanofi Aventis and Pfizer. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MANAGE CARDIOVASCULAR RISK, RATHER THAN RISK FACTORS
Understanding and treating patients’ overall cardiovascular risk may have advantages over focusing on individual risk factors such as high blood pressure and cholesterol, write Rod Jackson, M.B.Ch.B., Ph.D., and Sue Wells, M.B.Ch.B., M.P.H., of The University of Auckland, New Zealand, in an accompanying editorial.
“The distinction is far more than a subtle difference in wording; cardiovascular risk factors are individually poor predictors of a patient’s risk of a cardiovascular event, the only outcome that matters to patients,” they write. “For most patients, their actual blood cholesterol level or blood pressure becomes clinically meaningful only when considered in combination with other risk factors and when the cardiovascular risk is calculated.”
(Arch Intern Med. 2007;167(21):2286-2287. 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.
EDITORIAL: AGE CALCULATIONS AID PATIENT UNDERSTANDING
A patient-centered approach to cholesterol management that includes the concept of cardiovascular age appears effective, writes Charles B. Eaton, M.D., M.S., of the Warren Alpert School of Medicine at Brown University and Memorial Hospital of Rhode Island, Providence, in a second accompanying editorial.
“The results of this study are for the most part promising, but it should be pointed out that only 45 percent to 66 percent of these high-risk cardiovascular patients had reached their respective lipid targets after one year, and thus, a large treatment gap still persisted,” Dr. Eaton writes. “More research testing the systematic identification of high-risk patients (e.g., a dyslipidemia disease registry) combined with a calculated coronary risk strategy using the cardiovascular age paradigm seems to be warranted.”
(Arch Intern Med. 2007;167(21):2288. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 26, 2007
Media Advisory: To contact Supriya Krishnan, D.Sc., call Gina DiGravio at 617-638-8491. To contact corresponding author Xiao Ou Shu, M.D., Ph.D., call Craig Boerner at 615-343-7421.
HIGH–GLYCEMIC INDEX CARBOHYDRATES ASSOCIATED WITH RISK FOR DEVELOPING TYPE 2 DIABETES IN WOMEN
CHICAGO—Eating foods high on the glycemic index, which measures the effect of carbohydrates on blood glucose levels, may be associated with the risk for developing type 2 diabetes in Chinese women and in African-American women, according to two studies in the November 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, eating more cereal fiber may be associated with a reduced risk for type 2 diabetes in African-American women.
Researchers remain uncertain regarding exactly how diet, including carbohydrate intake, affects the development of type 2 diabetes, according to background information in the articles. Studies have revealed that the body absorbs carbohydrates from different foods at different rates. This leads to varying effects on levels of blood glucose and the hormone insulin, which converts glucose into energy. Foods high on the glycemic index, such as rice and other simple carbohydrates, cause a rapid spike and then a drop in blood glucose, whereas high-fiber foods tend to be lower on the glycemic index and have a more gradual effect. Some evidence has linked high–glycemic index foods with the risk of developing type 2 diabetes.
In one study, Supriya Krishnan, D.Sc., of Boston University School of Public Health, and colleagues examined data from 40,078 U.S. black women who filled out a food questionnaire in 1995. The glycemic index and glycemic load—a measure of the amount of carbohydrates from glucose—were calculated. Every two years through 2003, the women answered follow-up questionnaires about their weight, health and other factors.
During eight years of follow-up, 1,938 participants developed type 2 diabetes. Women who ate high–glycemic index foods or a diet with a high glycemic load had a higher risk for diabetes. However, women who ate more fiber from grains (cereal fiber) had a reduced risk; for women with a body mass index (BMI) of less than 25, women who ate about 8.3 grams of fiber per day were 59 percent less likely to develop diabetes than women who ate about 1.5 grams per day.
Because high–glycemic index foods increase blood glucose levels significantly, they increase the body’s demand for insulin, the authors note. This can contribute to problems with the pancreas (which produces insulin) that may eventually lead to diabetes. In addition, high–glycemic index foods can directly decrease the body’s response to insulin by increasing the production of fatty acids after meals.
“Our results indicate that black women can reduce their risk of diabetes by eating a diet that is high in cereal fiber,” the authors write. “Incorporating fiber sources into the diet is relatively easy: a simple change from white bread (two slices provides 1.2 grams of fiber) to whole wheat bread (two slices provides 3.8 grams of fiber) or substituting a cup of raisin bran (5 to 8 grams of fiber) or oatmeal (4 grams of fiber) for a cup of corn chex (0.5 grams of fiber) or rice chex (0.3 grams of fiber) will move a person from a low fiber intake category to a moderate intake category, with a corresponding 10 percent reduction in risk.”
In another study, Raquel Villegas, Ph.D., of Vanderbilt University Medical Center, Nashville, Tenn., and colleagues followed a group of 64,227 Chinese women for an average of five years. During in-person interviews conducted every two years between 2000 and 2004, the researchers collected data on dietary habits, physical activity and other health-related information.
During the study, 1,608 of the women developed diabetes. Women who consumed more carbohydrates overall were more likely to develop diabetes—when they were split into five groups based on carbohydrate intake, those in the group consuming the most (about 337.6 grams per day) had a 28 percent higher risk than those in the group consuming the least (about 263.5 grams per day). Women who ate diets with a higher glycemic index and who ate more staples such as bread, noodles and rice specifically also had an increased risk. Women who ate 300 grams or more of rice per day were 78 percent more likely to develop diabetes than those who ate less than 200 grams per day.
“Given that a large part of the world’s population consumes rice and carbohydrates as the mainstay of their diets, these prospective data linking intake of refined carbohydrates to increased risk of type 2 diabetes mellitus may have substantial implications for public health,” the authors conclude.
(Arch Intern Med. 2007;167(21):2304-2309, 2310-2316. 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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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 26, 2007
Media Advisory: To contact Alexander N. Ortega, Ph.D., call Sarah Anderson at 310-825-6381.
UNDOCUMENTED LATINOS VISIT PHYSICIANS LESS OFTEN THAN U.S.-BORN COUNTERPARTS
CHICAGO—Undocumented Mexicans and other undocumented Latinos report less use of health care and poorer experiences with the health care system compared with their counterparts who were born in the United States, according to a report in the November 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
An estimated 8.4 million of the 10.3 million undocumented individuals in the United States are Latino, including 5.9 million from Mexico, according to background information in the article. “One recurrent theme in the debate over immigration has been the use of public services, including health care,” the authors write. “Proponents of restrictive policies have argued that immigrants overuse services, placing an unreasonable burden on the public. Despite a scarcity of well-designed research into these questions regarding immigrants, use of resources continues to be a part of the public debate.”
Alexander N. Ortega, Ph.D., of the David Geffen School of Medicine, University of California, Los Angeles, and colleagues analyzed data from a 2003 telephone survey of 42,044 California residents designed to represent the state’s entire population. The researchers found that:
- a total of 1,317 participants were undocumented Mexicans; 2,851 were U.S.-born Mexicans, 271 were undocumented Latinos from other countries and 852 were other Latinos born in the United States
- undocumented Mexicans had 1.6 fewer physician visits in the past year than Mexicans born in the United States, while other undocumented Latinos had 2.1 fewer physician visits than their U.S.-born counterparts
- undocumented Mexicans were less likely to have a usual source of care and were more likely to report negative experiences than Mexicans born in the United States
- patterns of access to and use of health care services tended to improve when legal status changed from undocumented to green card or naturalized citizens
- undocumented Latinos reported less difficulty obtaining necessary health care than U.S.-born Latinos. This seemingly counterintuitive finding could have occurred because they are less likely to seek care than American-born Latinos or because the U.S. health care system compares favorably to the systems in their home countries, the authors note.
The results have implications for addressing health care disparities, they continue. “For example, worse health care experiences for undocumented Mexicans imply that efforts to improve processes of care need to address this specific vulnerable group,” the authors write. “Strategies to improve the delivery of health care services to legally authorized immigrants and U.S. citizens, to the exclusion of undocumented individuals, will likely miss an opportunity to influence health care for the individuals most affected by inequities in health care access.”
“Low rates of use of health care services by Mexican immigrants and similar trends among other Latinos do not support public concern about immigrants’ overuse of the health care system,” they conclude.
(Arch Intern Med. 2007;167(21):2354-2360. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Institute of Mental Health and by faculty start-up funding from the University of California, Los Angeles Chicano Studies Research Center. 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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