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, December 10, 2007)
CALCIUM IN CORONARY ARTERIES MAY BE ASSOCIATED WITH INCREASED RISK FOR HEART DISEASE IN OTHERWISE LOW-RISK WOMEN
MOST ADULTS WITH CONDITIONS THAT INCREASE CARDIOVASCULAR DISEASE RISK HAVE HIGH BLOOD PRESSURE
MEDITERRANEAN DIET AND PHYSICAL ACTIVITY EACH ASSOCIATED WITH LOWER DEATH RATE OVER FIVE YEARS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 10, 2007)
HIGH BLOOD PRESSURE ASSOCIATED WITH RISK FOR MILD COGNITIVE IMPAIRMENT
COMBINATION THERAPY INCLUDING ANTIBIOTICS MAY BE BENEFICIAL FOR MULTIPLE SCLEROSIS
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 10, 2007)
EDITORIAL: BETTER SCIENCE, MORE RIGOROUS STUDIES CHARACTERIZE FIELD OF OPHTHALMIC PLASTIC SURGERY
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 10, 2007
Media Advisory: To contact Susan G. Lakoski, M.D., M.S., call Jim Steele at 336-716-3487. To contact corresponding editorialist Christopher J. O’Donnell, M.D., M.P.H., call the NHLBI Communications Office at 301-496-4236.
CALCIUM IN CORONARY ARTERIES MAY BE ASSOCIATED WITH INCREASED RISK FOR HEART DISEASE IN OTHERWISE LOW-RISK WOMEN
CHICAGO—About 5 percent of women considered low-risk for heart disease by current classification standards have evidence of advanced coronary artery calcium and may be at increased risk for cardiovascular events, according to a report in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The Framingham risk score—which includes such factors as age, cholesterol and blood pressure levels, smoking habits and diabetes—is a standard approach for assessing an individual’s risk of developing coronary heart disease in the next 10 years, according to background information in the article. Americans are considered low-risk if they have an estimated risk of less than 10 percent in 10 years, and high risk is 20 percent or greater in 10 years. Approximately 95 percent of U.S. women younger than 70 are considered low-risk and therefore do not qualify for aggressive management of risk factors. “Nevertheless, most women will ultimately die of heart disease, suggesting that the Framingham risk score alone does not adequately stratify women in ways that would be useful for targeted preventive interventions,” the authors write.
Susan G. Lakoski, M.D., M.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues assessed 3,601 women age 45 to 84 when the study began, in 2000. Computed tomographic (CT) scans of the chest were used to determine scores for coronary artery calcium. High scores indicate a significant amount of calcium deposits, which has previously been associated with heart disease risk but is not included in the Framingham risk score. Medical history, measurements and laboratory tests were also taken at the beginning of the study, and participants were interviewed by telephone every nine to 12 months about subsequent cardiovascular diagnoses and hospital admissions.
A total of 2,684 (90 percent) of the women were considered low-risk based on the Framingham risk score. About one-third (32 percent) of them had detectable calcium in their coronary arteries. Over an average of 3.75 years, 24 of the low-risk women had heart events (such as heart attack and heart pain)—a 0.9 percent risk—and 34 (a 1.3 percent risk) had a cardiovascular disease event, including heart events, stroke or death.
“Compared with women with no detectable coronary artery calcium, low-risk women with a coronary artery calcium score greater than zero were at increased risk for coronary heart disease and cardiovascular disease events,” the authors write. In addition, almost 5 percent of the low-risk women had advanced coronary artery calcium, defined as a score of 300 or greater. These women had a 6.7 percent risk of a heart event and 8.6 percent risk of a cardiovascular event over the 3.75-year follow-up.
“These data shed new light on cardiovascular disease risk and the modalities to evaluate and treat middle-aged and older women,” the authors write. “This study also provides novel data in support of the 2007 guidelines on cardiovascular disease prevention in women, suggesting that women with coronary artery calcium are at potentially higher risk than a Framingham risk score classification would suggest.” Studies with longer-follow up periods will be required to determine which low-risk women should be screened for coronary artery calcium or treated more aggressively for heart disease risk factors, they conclude.
(Arch Intern Med. 2007;167(22):2437-2442. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This research was supported by contracts and 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.
EDITORIAL: ONE-SIZE-FITS-ALL NOT THE BEST APPROACH TO ASSESSING CARDIOVASCULAR RISK
Tools like CT scanning for coronary artery calcium may allow physicians to more accurately define personal risk for cardiovascular disease, but the risks and benefits of such tests should be periodically reviewed, write Sarah Rosner Preis, Sc.D., M.P.H., and Christopher J. O’Donnell, M.D., M.P.H., of the National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Mass., in an accompanying editorial.
“We have entered an exciting new era that holds the promise of improving the prediction and prevention of coronary heart disease using cardiac CT as well as other subclinical disease imaging tests, biomarker measurements and genetic and genomic testing,” they write. “Clinicians and policy makers alike will benefit from continued assessment of these modalities, conducted in large, ethnically diverse, observational cohorts of men and women. Such outcome studies should include a periodic re-evaluation of our definition of normal vs. abnormal as we strive for personalized, safe and cost-effective approaches.”
(Arch Intern Med. 2007;167(22):2399-2401. 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, December 10, 2007
Media Advisory: To contact Nathan D. Wong, Ph.D., call Tom Vasich at 949-824-6455. To contact editorialist Theodore A. Kotchen, M.D., call Toranj Marphetia at 414-456-4700.
MOST ADULTS WITH CONDITIONS THAT INCREASE CARDIOVASCULAR DISEASE RISK HAVE HIGH BLOOD PRESSURE
CHICAGO—Nearly three-fourths of American adults with conditions such as coronary heart disease, stroke, diabetes or others that raise their risk for cardiovascular complications also have hypertension (high blood pressure), according to a report in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Although 75 percent of these individuals are being treated for hypertension, only one-third to one-half are reaching blood pressure goals.
Blood pressure control remains a problem in the United States and around the world, according to background information in the article. “Recent estimates indicate little change in the prevalence of hypertension, and, although there seem to be some recent improvements in treatment and control rates, hypertension in many persons remains inadequately controlled,” the authors write.
Nathan D. Wong, Ph.D., of the University of California, Irvine, and colleagues analyzed data from adults participating in the National Health and Nutrition Examination Survey, a nationally representative survey conducted by the Centers for Disease Control and Prevention. In 2003 and 2004, 4,646 adults provided demographic and socioeconomic information and underwent laboratory and physiological testing (including blood pressure measurements).
A total of 1,671 (31.4 percent) of the participants had hypertension, defined as a systolic (top number) blood pressure of at least 140 milligrams of mercury (130 milligrams of mercury in those with diabetes or chronic kidney disease) or a diastolic (bottom number) blood pressure of at least 90 milligrams of mercury (80 milligrams of mercury in those with diabetes or chronic kidney disease), or as reporting use of a blood pressure–lowering medication. The condition was more common in older and black adults. A total of 68.5 percent of those with hypertension were being treated and 52.9 percent of those had their hypertension under control.
Overall, 23.1 percent of individuals without conditions that increase cardiovascular risk such as diabetes, heart failure and stroke had hypertension, while those with such diseases had rates of hypertension ranging from 51.8 percent to 81.8 percent. Specifically, high blood pressure was found in:
- 51.8 of patients with dyslipidemia (cholesterol disorders that include high cholesterol)
- 61.5 percent of those with the metabolic syndrome, a combination of disorders that may include obesity, dyslipidemia and resistance to the effects of the hormone insulin
- 76.8 percent of those with diabetes
- 81.8 percent of those with chronic kidney disease
- 69.5 percent of those with stroke
- 71.4 percent of those with congestive heart failure, which occurs when the heart can’t pump enough blood to the rest of the body
- 73.7 percent of those with peripheral artery disease, or narrowed veins or arteries
- 73 percent of those with coronary artery disease
- 76.9 percent of those with two or more of these diseases
Among individuals with these conditions, 75 percent or more were being treated for hypertension, but only one-third to one-half of those in treatment reached goal levels for blood pressure (140/90 milligrams of mercury for most patients, or 130/80 milligrams of mercury for patients with diabetes or chronic kidney disease). “Moreover, given recently released recommendations to reduce the blood pressure goal to less than 130/80 milligrams of mercury for persons with coronary artery disease and other high-risk conditions, our hypertension control rates would be even lower and a greater distance from the goal for these persons if the new criteria are applied,” the authors write.
“Nearly three-fourths of adults with cardiovascular comorbidities have hypertension,” they conclude. “Poor control rates of systolic hypertension remain a principal problem that further compromises their already high cardiovascular disease risk.”
(Arch Intern Med. 2007;167(22):2431-2436. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a contract from Bristol-Myers Squibb to the University of California, Irvine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: RESEARCH MUST EXAMINE REASONS FOR SLOW TRANSLATION OF GUIDELINES INTO CLINICAL PRACTICE
Several potential explanations exist for the gap between recommended treatment goals—such as target blood pressure ranges—and clinical practice, writes Theodore A. Kotchen, M.D., of the Medical College of Wisconsin, Milwaukee, in an accompanying editorial.
“These reasons may include the complexity or difficulty of achieving the recommended guidelines, patient or physician behavior and/or deficiencies in the system of health care,” Dr. Kotchen writes. “Developing effective strategies to address the slow pace of dissemination into health care will require a better understanding of the potential barriers.”
(Arch Intern Med. 2007;167(22):2394-2395. 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, December 10, 2007
Media Advisory: To contact Panagiota N. Mitrou, Ph.D., e-mail: pm277{at}medschl.cam.ac.uk. To contact Michael F. Leitzmann, M.D., Dr.P.H., call NCI Press Officers at 301-496-6641.
MEDITERRANEAN DIET AND PHYSICAL ACTIVITY EACH ASSOCIATED WITH LOWER DEATH RATE OVER FIVE YEARS
CHICAGO—Eating a Mediterranean diet and following national recommendations for physical activity are each associated with a reduced risk of death over a five-year period, according to two reports in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Both studies use data from the National Institutes of Health-AARP Diet and Health Study, which began when questionnaires were returned from 566,407 AARP members age 50 to 71 in six states between 1995 and 1996.
In one study, Panagiota N. Mitrou, Ph.D., then of the National Cancer Institute, Bethesda, Md., and now of the University of Cambridge, England, and colleagues used a nine-point scale to assess conformity with the Mediterranean diet in 380,296 of the participants (214,284 men and 166,012 women) with no history of chronic disease. Components of the diet included vegetables, legumes, fruits, nuts, whole grains, fish, ratio of monounsaturated fats, alcohol and meat. During five years of follow-up, 12,105 participants died, including 5,985 from cancer and 3,451 from cardiovascular disease. Those with higher Mediterranean diet scores were less likely to die of any cause or of cancer or heart disease.
In another study, Michael F. Leitzmann, M.D., Dr.P.H., also of the National Cancer Institute, and colleagues analyzed the results of two questionnaires on physical activity from 252,925 of the participants (142,828 men and 110,097 women). Of those, 7,900 died during follow-up. Compared with being inactive, individuals who performed the amount of moderate physical activity recommended in national guidelines (at least 30 minutes most days of the week) were 27 percent less likely to die and those who achieved the goal for vigorous physical activity (at least 20 minutes three times per week) were 32 percent less likely to die. Smaller amounts of physical activity also appeared to be associated with a 19 percent reduced risk of death.
(Arch Intern Med. 2007;167(22):2461-2468 and 2453-2460. 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, December 10, 2007
Media Advisory: To contact corresponding author José A. Luchsinger, M.D., M.P.H., call Elizabeth A. Streich at 212-305-6535.
HIGH BLOOD PRESSURE ASSOCIATED WITH RISK FOR MILD COGNITIVE IMPAIRMENT
CHICAGO—High blood pressure appears to be associated with an increased risk for mild cognitive impairment, a condition that involves difficulties with thinking and learning, according to a report in the December issue of Archives of Neurology, one of the JAMA/Archives journals.
“Mild cognitive impairment has attracted increasing interest during the past years, particularly as a means of identifying the early stages of Alzheimer’s disease as a target for treatment and prevention,” the authors write as background information in the article. About 9.9 of every 1,000 elderly individuals without dementia develop mild cognitive impairment yearly. Of those, 10 percent to 12 percent progress to Alzheimer’s disease each year, compared with 1 percent to 2 percent of the general population.
Christiane Reitz, M.D., Ph.D., and colleagues at the Columbia University Medical Center, New York, followed 918 Medicare recipients age 65 and older (average age 76.3) without mild cognitive impairment beginning in 1992 through 1994. All participants underwent an initial interview and physical examination, along with tests of cognitive function, and then were examined again approximately every 18 months for an average of 4.7 years. Individuals with mild cognitive impairment had low cognitive scores and a memory complaint, but could still perform daily activities and did not receive a dementia diagnosis.
Over the follow-up period, 334 individuals developed mild cognitive impairment. This included 160 cases of amnestic mild cognitive impairment, which involves low scores on memory portions of the neuropsychological tests, and 174 cases of non-amnestic mild cognitive impairment. Hypertension (high blood pressure) was associated with an increased risk of all types of mild cognitive impairment that was mostly driven by an increased risk of non-amnestic mild cognitive impairment; hypertension was not associated with amnestic mild cognitive impairment, nor with the change over time in memory and language abilities.
“The mechanisms by which blood pressure affects the risk of cognitive impairment or dementia remain unclear,” the authors write. “Hypertension may cause cognitive impairment through cerebrovascular disease. Hypertension is a risk factor for subcortical white matter lesions found commonly in Alzheimer’s disease. Hypertension may also contribute to a blood-brain barrier dysfunction, which has been suggested to be involved in the cause of Alzheimer’s disease. Other possible explanations for the association are shared risk factors,” including the formation of cell-damaging compounds known as free radicals.
“Our findings support the hypothesis that hypertension increases the risk of incident mild cognitive impairment, especially non-amnestic mild cognitive impairment,” the authors conclude. “Preventing and treating hypertension may have an important impact in lowering the risk of cognitive impairment.”
(Arch Neurol. 2007;64(12):1734-1740.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institutes of Health; the Charles S. Robertson Memorial Gift for Research in Alzheimer’s Disease; and the Blanchette Hooker Rockefeller 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, December 10, 2007
Media Advisory: To contact Alireza Minagar, M.D., call Elaine King at 318-675-5408.
COMBINATION THERAPY INCLUDING ANTIBIOTICS MAY BE BENEFICIAL FOR MULTIPLE SCLEROSIS
CHICAGO—A preliminary study suggests that combining a medication currently used to treat multiple sclerosis with an antibiotic may slow the progress of the disease, according to an article posted online today that will appear in the February 2008 print issue of Archives of Neurology, one of the JAMA/Archives journals.
“Multiple sclerosis (MS) is an immune-mediated disorder that affects genetically susceptible individuals after exposure to certain, as yet unidentified environmental antigens,” or disease-causing agents, the authors write as background information in the article. The development of MS involves inflammation that destroys parts of the brain along with progressive degeneration of brain tissue. The most common type is relapsing-remitting MS, in which patients experience attacks of symptoms such as muscle weakness and spasms followed by periods of symptom-free remission. Many patients with relapsing-remitting MS who take interferon, a medication that boosts the immune system and fights viruses, still experience relapses and may continue to develop new areas of damaged brain tissue (lesions) visible on magnetic resonance imaging (MRI).
Alireza Minagar, M.D., of Louisiana State University Health Sciences Center, Shreveport, and colleagues conducted a single-center trial involving 15 patients (average age 44.5) with relapsing-remitting MS who had been taking interferon for at least six months and were experiencing symptoms and developing new brain lesions. For four months, participants took 100 milligrams daily of the antibiotic doxycycline in addition to continuing interferon therapy. They underwent monthly neurological examinations, MRI to detect brain lesions and blood work to monitor safety.
After four months, the combination treatment resulted in fewer lesions visible on MRI—60 percent of the patients had more than a one-fourth reduction in the number of lesions from the beginning of the study. The patients also had reduced average scores on a scale designed to assess disability levels. Only one patient relapsed; adverse effects were mild and included only known effects of the two drugs individually rather than new effects associated with combining the medications.
Antibiotics in the tetracycline family, including doxycycline, may be effective against MS and other inflammatory diseases by inhibiting the action of enzymes that destroy certain nervous system cells, protecting the brain and increasing the effectiveness of the immune system, the authors note.
“There is growing interest in combination therapy in patients with MS to stabilize the clinical course, reduce the rate of clinical relapses and decelerate the progressive course of the underlying pathologic mechanism,” they write. “Overall, data from this cohort suggest that the treatment combination of oral doxycycline and interferon beta-1a may be safe and effective in some patients with MS; however, further controlled clinical trials are warranted to demonstrate safety and efficacy in a larger patient population.”
(Arch Neurol. 2008;65(2):(doi:10.1001/archneurol.2007.41).
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Authors Dr. Minagar and Dr. Alexander have received independent medical grants from Bayer Pharmaceuticals and EMD Serono. This work was supported by an independent medical grant from Biogen Idec Inc. 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, December 10, 2007
Media Advisory: For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EDITORIAL: BETTER SCIENCE, MORE RIGOROUS STUDIES CHARACTERIZE FIELD OF OPHTHALMIC PLASTIC SURGERY
Advances realized by collaboration between specialties highlighted in Archives of Ophthalmology, Archives of Facial Plastic Surgery joint theme issue
CHICAGO—Collaboration between the fields of ophthalmology and facial plastic surgery has led to fresh approaches to clinical problems, according to an editorial in the December issue of the journal Archives of Ophthalmology, a theme issue on orbital and ophthalmic plastic surgery. The November/December issue of Archives of Facial Plastic Surgery was a paired theme issue on the same topic, writes Robert A. Goldberg, M.D., of the Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles.
Articles in this issue of Archives of Ophthalmology exemplify collaborative discovery as well as the specialty’s emphasis on well-designed clinical studies, and include papers regarding:
- new technology in the diagnosis and classification of periocular lymphoma, a cancerous tumor on the eyelid, eyeball or surrounding tissue
- anatomy of the tear ducts
- more precise measurements during eyelid surgery
- cerebrospinal fluid leaks during ophthalmic plastic surgery
- dynamic magnetic resonance angiography of eye lesions
“Ophthalmic plastic surgery as a discipline is fortunate to have passionate, innovative and dedicated practitioners and teachers who drive the field forward,” Dr. Goldberg writes. “I hope the collection of articles in this issue of the Archives captures some of their work at the cutting edge of our specialty.”
(Arch Ophthalmol. 2007;125(12):1708-1709. 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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