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, February 11, 2008)
STUDIES IDENTIFY MODIFIABLE FACTORS ASSOCIATED WITH EXCEPTIONALLY LONG LIFE
AUTOPSY FINDINGS SUGGEST END OF DECLINE IN CORONARY DISEASE RATES
MOST WITH HIGH BLOOD PRESSURE DO NOT FOLLOW RECOMMENDED DIET
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 11, 2008)
LEARNING DISABILITIES ASSOCIATED WITH LANGUAGE PROBLEMS LATER IN LIFE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 11, 2008)
DONORS’ HEALTH ASSOCIATED WITH RISK OF INFECTION AMONG RECIPIENTS OF CORNEAL TRANSPLANT
OLDER WHITES MORE LIKELY TO HAVE SIGNS OF FUTURE EYE DISEASE THAN BLACKS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 11, 2008
Media Advisory: To contact Laurel B. Yates, M.D., M.P.H., call Jessica Podlaski at 617-534-1603. To contact Dellara F. Terry, M.D., M.P.H., call Allison Rubin at 617-638-8491. To contact editorialist William J. Hall, M.D., call Tom Rickey at 585-275-7954.
STUDIES IDENTIFY MODIFIABLE FACTORS ASSOCIATED WITH EXCEPTIONALLY LONG LIFE
CHICAGO—A healthy lifestyle during the early elderly years—including weight management, exercising regularly and not smoking—may be associated with a greater probability of living to age 90 in men, as well as good health and physical function, according to a report in the February 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A second article in the same issue finds that although some individuals survive to 100 years or beyond by avoiding chronic diseases, other centenarians live with such conditions for many years without becoming disabled.
Studies of twins have found that about one-fourth of the variation in human life span can be attributed to genetics, according to background information in the article. That leaves about 75 percent that could be attributed to modifiable risk factors.
Laurel B. Yates, M.D., M.P.H., of Brigham & Women’s Hospital, Boston, and colleagues studied a group of 2,357 men who were participants in the Physician’s Health Study. At the beginning of the study, in 1981 to 1984, the men (average age 72) provided information about demographic and health variables, including height, weight, blood pressure and cholesterol levels and how often they exercised. Twice during the first year and then once each following year through 2006, they completed a questionnaire asking about changes in habits, health status or ability to do daily tasks.
A total of 970 men (41 percent) lived to age 90 or older. Several modifiable biological and behavioral factors were associated with survival to this exceptional age. “Smoking, diabetes, obesity and hypertension significantly reduced the likelihood of a 90-year life span, while regular vigorous exercise substantially improved it,” the authors write. “Furthermore, men with a life span of 90 or more years also had better physical function, mental well-being, and self-perceived health in late life compared with men who died at a younger age. Adverse factors associated with reduced longevity—smoking, obesity and sedentary lifestyle—also were significantly associated with poorer functional status in elderly years.”
The researchers estimate that a 70-year-old man who did not smoke and had normal blood pressure and weight, no diabetes and exercised two to four times per week had a 54 percent probability of living to age 90. However, if he had adverse factors, his probability of living to age 90 was reduced to the following amount:
- Sedentary lifestyle, 44 percent
- Hypertension (high blood pressure), 36 percent
- Obesity, 26 percent
- Smoking, 22 percent
- Three factors, such as sedentary lifestyle, obesity and diabetes, 14 percent
- Five factors, 4 percent
“Although the impact of certain midlife mortality [death] risks in elderly years is controversial, our study suggests that many remain important, at least among men,” the authors conclude. “Thus, our results suggest that healthy lifestyle and risk management should be continued in elderly years to reduce mortality and disability.”
In the second study, Dellara F. Terry, M.D., M.P.H., of the Boston University School of Medicine and Boston Medical Center, and colleagues studied 523 women and 216 men age 97 or older. These centenarians completed questionnaires about their health history and functional ability by mail or telephone. Participants were split into groups based on sex and the age at which they developed diseases typically associated with aging: chronic obstructive pulmonary disease, dementia, diabetes, heart disease, hypertension, osteoporosis, Parkinson’s disease and stroke. Those who developed these conditions at age 85 or older were classified as delayers, whereas those who developed them at a younger age were termed survivors.
Of the participants, 32 percent were survivors and 68 percent were delayers—“thus, morbidity [illness] was not compressed toward the end of these exceptionally long life spans,” the authors write. “Yet, centenarians who had developed heart disease and/or hypertension before age 85 years and still survived to 100 years demonstrated similar levels of function (‘independent’ in the case of men and ‘requires minimal assistance’ in the case of women) as those who delayed morbidity until after age 85 years.”
Though fewer men than women survive to extremely old age, the male centenarians in this study appeared to have better mental and physical function than their female counterparts. “One explanation for this may be that men must be in excellent health and/or functionally independent to achieve such extreme old age,” the authors write. “Women on the other hand may be better physically and socially adept at living with chronic and often disabling health conditions.”
The results regarding the timing of illness in centenarians “may shed additional light on the various ways in which people can survive to extreme old age,” the authors conclude. “Determining the mechanisms that facilitate the delay or escape of disability in the face of clinically evident age- and mortality-associated morbidities merits further investigation.”
(Arch Intern Med. 2008;168[3]:284-290, 277-283. 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.
EDITORIAL: OLDEST AMERICANS MAY CHANGE FUTURE OF HEALTH CARE
The fastest-growing group of older Americans are those age 85 years and older, and these individuals will need regular medical care, writes William J. Hall, M.D., of the University of Rochester School of Medicine & Dentistry, New York, in an accompanying editorial.
“The challenge to current health care providers is to become adept at caring for present and future centenarians with only the beginnings of concrete evidence-based research,” Dr. Hall writes. “Our ability to adapt to this challenge may be a prime determinant in shaping the nature of primary care practice in this country.”
(Arch Intern Med. 2008;168[3]:262-263. 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, February 11, 2008
Media Advisory: To contact Cynthia L. Leibson, Ph.D., call Robert Nellis, Mayo Clinic, at 507-284-5005. To contact corresponding editorialist S. Jay Olshansky, Ph.D., call Chris Martin at 312-996-8277.
AUTOPSY FINDINGS SUGGEST END OF DECLINE IN CORONARY DISEASE RATES
CHICAGO—Autopsies of individuals in one Minnesota County suggest that the decades-long decline in the rate of coronary artery disease may have ended and possibly reversed after 2000, according to a report in the February 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“Over the past century, the rate of death due to heart disease in the United States rose until the mid 1960s when it began a steady decline, which continues today,” the authors write as background information in the article. These declines appear to be accompanied by reductions in the incidence and death rates of coronary artery disease, the most common form of heart disease, characterized by blockages in the vessels that supply blood to the heart. The gold standard for detecting trends in the prevalence of coronary artery disease among the general population has been gathering information from autopsies. However, autopsy rates must be high to ensure that findings accurately reflect the general population. The national autopsy rate has never been high and continues to decline, with a national average of only 8.3 percent in 2003.
Olmsted County, Minnesota, has traditionally had high autopsy rates across all age groups. Rates are especially high for non-elderly individuals who died of unnatural causes (such as accidents, homicides or suicides). Cynthia Leibson, Ph.D., and colleagues from Mayo Clinic, Rochester, Minn., and the University of British Columbia, Vancouver, Canada used data from death certificates and pathology reports to assess trends in coronary artery disease among Olmsted County residents age 16 through 64 who died of unnatural causes between 1981 and 2004.
A total of 3,237 Olmsted County residents in this age group died in those years, 515 of unnatural causes. Among those 515, 96 percent were autopsied and 82 percent (425) had grades assigned based on the amount of blockage in several coronary arteries, with grades ranging from zero (no blockage) to five (100 percent blocked).
“Over the full period (1981 to 2004), 8.2 percent of the 425 individuals had high-grade disease, and 83 percent had evidence of any disease,” the authors write. High-grade disease was defined as a grade of three or higher in the left main artery or a grade four or higher in any other single artery. Analyses adjusted to consider the individuals’ age and sex revealed declines over the entire period for high-grade disease, any disease and the average grade of disease. However, “declines in the grade of coronary disease ended after 1995 and possibly reversed after 2000.”
“Our finding that temporal declines in the grade of coronary artery disease at autopsy have ended, together with suggestive evidence that declines have recently reversed, provides some of the first data to support increasing concerns that declines in heart disease mortality may not continue,” the authors conclude. “The extent to which recent trends are attributable to the epidemics of obesity and diabetes mellitus awaits further investigation.”
(Arch Intern Med. 2008;168[3]:264-270. 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 and the A.J. and Sigismunda Palumbo Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: FINDINGS HIGHLIGHT IMPORTANCE OF EARLY PREVENTION
In the context of other recent studies about increasing rates of childhood obesity, “the study by Nemetz et al underscores the importance of focusing prevention efforts on lifestyle factors among younger generations, including continued efforts to decrease smoking and encouraging healthy diets and moderate physical activity, before clinical symptoms of coronary artery disease have an opportunity to be expressed,” write S. Jay Olshansky, Ph.D., and Victoria Persky, M.D., of the University of Illinois at Chicago, in an accompanying editorial.
“This limited examination of the autopsies of Olmsted County residents may be representative only of this unique segment of the American population, but the results are alarming enough to alert public health officials to begin monitoring younger cohorts for early signs of coronary artery disease with much greater vigilance,” they conclude.
(Arch Intern Med. 2008;168[3]:261. 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, February 11, 2008
Media Advisory: To contact Philip B. Mellen, M.D., M.S., call Amy Arrington at 601-268-5606.
MOST WITH HIGH BLOOD PRESSURE DO NOT FOLLOW RECOMMENDED DIET
CHICAGO—A relatively small proportion of individuals with hypertension (high blood pressure) eat diets that align with government guidelines for controlling the disease, according to a report in the February 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In fact, since the introduction of a diet shown to help reduce blood pressure, the dietary quality of those with hypertension has decreased.
Results of the Dietary Approaches to Stop Hypertension (DASH) trial, published in 1997, indicated that a diet high in fruits, vegetables and low-fat dairy products could significantly lower blood pressure, according to background information in the article. Subsequent studies found that this eating pattern complements other lifestyle changes, such as reducing sodium and losing weight, and can help lower cholesterol levels and prevent components of the metabolic syndrome. The DASH diet is recommended by the Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure for all patients with hypertension.
Philip B. Mellen, M.D., M.S., of the Hattiesburg Clinic, Hattiesburg, Miss., and colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES), conducted by the Centers for Disease Control and Prevention in 1988 to 1994 and 1999 to 2004. Men and women age 20 years and older were interviewed to obtain demographic and socioeconomic information and diet history; their blood pressure was measured, and they were asked if they had ever been diagnosed with hypertension. Using the DASH guidelines, the researchers identified goals for eight target nutrients: total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium and potassium. DASH scores ranging from zero to nine were calculated for individuals with and without hypertension from the surveys; those who scored a 4.5 or higher were considered to be following the diet.
Among individuals surveyed in 1999 to 2004, 4,386 (28 percent) had been diagnosed with hypertension. These individuals had an average DASH score of 2.92 (compared with 3.12 among those without high blood pressure), and only 19.4 percent followed the diet. Compared with those surveyed in 1988 to 1994, 7.3 percent fewer individuals with hypertension followed the DASH diet, reflecting fewer patients who consumed target levels of total fat, fiber and magnesium. DASH scores were lowest among young people, African-Americans and those with a body mass index of 30 or higher.
The findings suggest “that the diet of Americans with hypertension has not been greatly influenced by the results and recommendations emerging from the DASH trial and instead reflects secular trends in the dietary patterns of the overall population,” the authors write. “Moreover, the DASH score was lower in subgroups likely to receive the greatest benefit from the DASH diet—African Americans and obese individuals. As data continue to accrue on the optimal diet to reduce risk in patients with hypertension, it is imperative that national guideline recommendations be complimented by research and policy initiatives that seek to effectively implement this knowledge.”
(Arch Intern Med. 2008;168[3]:308-314. 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, February 11, 2008
Media Advisory: To contact Emily Rogalski, Ph.D., call Kim Waterman at 312-942-7820.
LEARNING DISABILITIES ASSOCIATED WITH LANGUAGE PROBLEMS LATER IN LIFE
CHICAGO—Individuals with a neurodegenerative condition affecting language appear more likely to have had a history of learning disabilities than those with other types of dementia or with no cognitive problems, according to a report in the February issue of Archives of Neurology, one of the JAMA/Archives journals.
The condition known as primary progressive aphasia causes individuals to lose language abilities as they age, even though their other brain functions appear unaffected for at least the first two years, according to background information in the article. “Although risk factors for Alzheimer’s disease have been well studied, much less is known about risk factors for primary progressive aphasia,” the authors write.
Emily Rogalski, Ph.D., then at Northwestern University and now at Rush University Medical Center, Chicago, and colleagues studied a group of 699 individuals—108 with primary progressive aphasia, 154 with Alzheimer’s disease, 84 with a related disorder known as frontotemporal dementia and 353 controls without dementia. When enrolling in the study, participants completed a detailed demographic and medical history interview that included two questions about whether they or immediate family members had a history of learning disabilities. A medical record review was conducted for the 23 individuals with primary progressive aphasia who reported either a personal or family history of learning disability.
Patients with primary progressive aphasia were more likely to have had learning disabilities or a close family member with learning disabilities than were those with other forms of dementia or without dementia. The review of patients with both aphasia and learning disabilities showed families with unusually high rates of learning problems, especially dyslexia. “For example, in three cases, nine of the 10 children of the probands [participants] were reported to have a history of specific learning disability in the area of language,” the authors write.
“In our clinical practice, we encounter many patients with primary progressive aphasia who report that spelling was never their ‘strong suit’ or that they could not learn new languages, but who would not have identified themselves as having a learning disability,” they continue. The findings may, therefore, underestimate the frequency of learning disabilities in patients and their families.
The association suggests that some individuals or families may have an underlying susceptibility to difficulties with the language network. “This relationship may exist in only a small subgroup of persons with dyslexia without necessarily implying that the entire population with dyslexia or their family members are at higher risk of primary progressive aphasia,” the authors conclude.
(Arch Neurol. 2008;65[2]:244-248.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the National Institute on Aging, by an Alzheimer’s Disease Core Center grant and by a grant from the National Institute on Deafness and Other Communication Disorders. 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, February 11, 2008
Media Advisory: To contact corresponding author Kirk R. Wilhelmus, M.D., Ph.D., call Glenna Picton at 713-798-7973. To contact editorialist Joel Sugar, M.D., call Jeanne Galatzer-Levy at 312-996-1583.
DONORS’ HEALTH ASSOCIATED WITH RISK OF INFECTION AMONG RECIPIENTS OF CORNEAL TRANSPLANTS
CHICAGO—Corneal grafts obtained from donors dying in the hospital or with cancer may be associated with an increased risk of infection for the recipient, according to a report in the February issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Infection is an uncommon but serious complication of corneal transplant,” the authors write as background information in the article. “Most infected eyes lose vision or become blind.” Various practices have been instituted to reduce the risk of infection, including refusing donors who have blood or other infections and retrieving and preserving tissue with antiseptic tools.
The Eye Bank Association of American monitors corneal transplants for infections that may be attributed to donor eye tissue. Sohela S. Hassan, Dr.P.H., of the Baylor College of Medicine, Houston, and colleagues used data from a surveillance registry to determine whether the donor’s health status was associated with risk of infection in the recipient. The researchers collected donor information for all cases of the eye infection endophthalmitis reported for transplants performed between 1994 and 2003. They then selected two controls for each case who had the same surgery date but did not develop an infection.
During the 10 years of the study, eye banks distributed 340,174 donor corneas in the United States and 109,009 internationally. A total of 162 cases of endophthalmitis were reported. The odds of infected recipients having received a cornea from a hospitalized donor were three times that of non-infected recipients. In addition, death of the donor from cancer was considerably more likely among the recipients who developed infections. The cause is unclear, but donors could acquire harmful microorganisms in the hospital and transmit them to the patients, the authors note.
The results provide evidence that the donor’s health before death may affect their eye tissue, but do not warrant excluding broad categories of donors, the authors note. “Blanket deferral from donation by hospitalized patients or those with cancer would be unreasonable as most corneas from these donors do not result in complications,” they write. “Rather, efforts are needed to determine what illnesses, interventions or other reasons might explain the pathway linking certain donors with recipient infection. We advocate judicious evaluation of decedents and encourage efficient recovery and delivery of donated tissues, but we also recognize an opportunity for better methods of microbiological assessment and control to reduce infections associated with corneal transplant.”
(Arch Ophthalmol. 2008;126[2]:235-239. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported under a Ruth L. Kirschstein National Research Service Award from the National Eye Institute, National Institutes of Health, Bethesda, Md., and by unrestricted grants from the Eye Bank Association of America, Washington, D.C., Research to Prevent Blindness, Inc., New York, and the Sid W. Richardson Foundation, Fort Worth, Tex. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: REPORTING SYSTEMS ENHANCE TRANSPLANT SAFETY
The results of the analysis support several changes in eye banking and also point to the necessity of reporting adverse events, writes Joel Sugar, M.D., of the University of Illinois at Chicago Eye Center, in an accompanying editorial.
“Certainly we should not eliminate the use of hospital-derived tissue because this is the most tissue available and the tissue is safe in the overwhelming majority of cases. Also, the number of patients with cancer is second only to the number with cardiac disease, making up 19.2 percent of donors in 2005,” Dr. Sugar writes. “Development of better methods of microbial assessment and prophylactic treatment of donor tissue would be worthwhile.”
“Most importantly, this study demonstrates the importance of having a national reporting system with an overview of adverse reactions related to donor tissue. Strict compliance with reporting will allow risk information to be acquired and will hopefully lead to even greater improvements in tissue safety for the future.”
(Arch Ophthalmol. 2008;126[2]:262. 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, February 11, 2008
Media Advisory: To contact Susan B. Bressler, M.D., call John Lazarou at 410-502-8902.
OLDER WHITES MORE LIKELY TO HAVE SIGNS OF FUTURE EYE DISEASE THAN BLACKS
CHICAGO—White individuals older than 65 are more likely than black individuals to have characteristics that indicate they will develop more advanced forms of the eye disease age-related macular degeneration (AMD), according to a report in the February issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
AMD is a leading cause of vision loss in the United States. Early symptoms include the appearance of drusen (large yellow or white spots in the retina), according to background information in the article. Previous studies have shown a potential difference in rates of AMD between black and white individuals.
Susan B. Bressler, M.D., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues analyzed the eyes of 2,520 individuals (average age 73.5 years) of whom 1,854 were white and 666 were black. Photographs of each eye were taken and assessed for several characteristics of AMD, including drusen and abnormal blood vessel growth.
Larger drusen, connected drusen, those covering a larger area and those closer to the center of the eye were more likely to be found in whites. White individuals were also more likely to already have advanced AMD (1.7 percent vs. 1.1 percent of blacks) and geographic atrophy, another form of AMD, (1.8 percent of whites vs. 0.3 percent of blacks).
“Such data strongly suggest that white individuals are more likely to progress to advanced vision-disabling AMD (certainly to geographic atrophy) than black individuals,” the authors conclude. The data also suggest that black individuals may have a mechanism for protection against AMD and other eye abnormalities. “The absence of racial differences in these early lesions in the pericentral (surrounding the center) area suggest that further research is warranted on factors that protect black individuals from lesions in the central zone or promote central lesions in white individuals.”
(Arch Ophthalmol. 2008;126[2]:241-245. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Research to Prevent Blindness through an Olga Keith Weiss Scholars Award (Dr. Bressler) and a senior scientist award (Dr. West); an unrestricted grant from Alcon Research Institute (Dr. West); and a grant from the National Institute on Aging. 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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