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, April 28, 2008)
DIABETES DRUGS MAY BE RELATED TO FRACTURE RISK
OSTEOPOROSIS DRUG MAY BE ASSOCIATED WITH IRREGULAR HEARTBEAT
HORMONE THERAPY IN POSTMENOPAUSAL WOMEN ASSOCIATED WITH INCREASED RISK OF STROKE
INCREASED PHYSICAL ACTIVITY RELATED TO LOWER HEART DISEASE RISK AMONG WOMEN WITH HIGH BODY MASS INDEX
THYROTROPIN LEVELS MAY BE ASSOCIATED WITH CORONARY HEART DISEASE MORTALITY IN WOMEN
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 28, 2008
Media Advisory: To contact corresponding author Christoph R. Meier, Ph.D., e-mail: meierch{at}uhbs.ch.
DIABETES DRUGS MAY BE RELATED TO FRACTURE RISK
CHICAGO—A widely used class of diabetes medications appears to be associated with an increased risk for fractures, according to a report in the April 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“The insulin-sensitizing thiazolidinediones are a relatively new and effective class of oral antidiabetic agents that have gained wide use in clinical conditions characterized by insulin resistance,” the authors write as background information in the article. Two drugs in this category, pioglitazone and rosiglitazone, account for 21 percent of oral diabetes medications prescribed in the United States and 5 percent of those in Europe. Recent studies have suggested that these therapies may have unfavorable effects on bone, resulting in slower bone formation and faster bone loss.
Christian Meier, M.D., of University Hospital Basel, Basel, Switzerland, and colleagues studied 1,020 patients with diabetes who had fractures diagnosed at British general practitioners’ offices between 1994 and 2005. For each of those patients, up to four control patients with diabetes who were the same age and sex and had the same physician but did not have fractures were selected, for a total of 3,728 matched controls.
After adjusting for other risk factors, individuals who were currently taking rosiglitazone and pioglitazone had approximately double or triple the odds of hip and other non-spine fractures than those who did not take these drugs. The odds for fracture were increased among patients who took the drugs for approximately 12 to 18 months and the risk was highest for those with two or more years of therapy.
“This analysis provides further evidence of a possible association between long-term use of thiazolidinediones and fractures, particularly of the hip and wrist, in patients with diabetes mellitus,” the authors conclude. “No such effect was seen for other antidiabetic drugs in this study population. These findings, although they are consistent with recently reported data from a randomized trial, are based on relatively few thiazolidinedione-exposed patients and need to be confirmed by additional observational studies and by controlled clinical trials.”
(Arch Intern Med. 2008;168[8]:820-825. 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, April 28, 2008
Media Advisory: To contact Susan R. Heckbert, M.D., Ph.D., call Rebecca Hughes at 206-287-2055. To contact corresponding editorialist Jane A. Cauley, Dr.P.H., call Clare Collins at 412-624-2607.
OSTEOPOROSIS DRUG MAY BE ASSOCIATED WITH IRREGULAR HEARTBEAT
CHICAGO—Alendronate, a medication used to prevent fractures in women with osteoporosis, may be associated with an increased risk of atrial fibrillation, a type of abnormal heart rhythm, according to a report in the April 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Other recent studies have reported atrial fibrillation as an unexpected adverse effect of bisphosphonates, a class of drugs that includes alendronate and other medications that affect the body’s calcium levels, according to background information in the article. Atrial fibrillation occurs when the atria, the smaller upper chambers of the heart, begin to beat irregularly and rapidly.
Susan R. Heckbert, M.D., Ph.D., of the University of Washington and Group Health, Seattle, and colleagues studied 719 women with confirmed atrial fibrillation that began between 2001 and 2004 and 966 control women who were the same age but did not have atrial fibrillation.
More patients with atrial fibrillation than control patients had ever used alendronate (47 or 6.5 percent vs. 40 or 4.1 percent). After adjusting for other risk factors, having taken alendronate was associated with a higher risk of atrial fibrillation compared with never having taken any bisphosphonate. The researchers estimate that approximately 3 percent of new atrial fibrillation cases in this population may be attributed to alendronate use.
Bisphosphonates may disrupt the function of regulatory proteins, trigger inflammation and cause small decreases in blood calcium and phosphate levels, any of which could affect the chambers of the heart known as atria and therefore alter the heartbeat, the authors note. “More information is needed about whether bisphosphonates could have effects on atrial tissue in the long term through these or other mechanisms that favor the initiation or persistence of atrial fibrillation,” they write.
“In conclusion, all drugs have benefits and adverse effects,” the authors continue. “When new information becomes available about a previously unrecognized benefit or adverse effect, physicians and patients must reweigh the current knowledge about benefits and risks in making treatment decisions for each patient. The benefits of fracture prevention in patients at high risk for fracture will generally outweigh the possible risks of atrial fibrillation. However, it is important to carefully weigh the benefits against the possible risk of atrial fibrillation in women who have only modestly increased fracture risk and in women who have risk factors for atrial fibrillation, such as diabetes mellitus, coronary disease or heart failure.”
(Arch Intern Med. 2008;168[8]:826-831. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Heart, Lung and Blood Institute. Co-author Dr. Cummings has received research support from Amgen, Novartis, Lilly, Pfizer and Zelos and consulting fees and honoraria from Amgen, Novartis, Lilly, Zelos, Merck and P&G-Aventis. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: RISKS AND BENEFITS OF MEDICATIONS MUST BE BALANCED
“The decision to treat an individual patient with a given medication for a specific condition should be made with consideration of the risks associated with no treatment and of the benefits, risks and adverse effects of each therapy,” write Jane A. Cauley, Dr.P.H., and Kristine E. Ensrud, M.D., M.P.H, of the University of Pittsburgh, in an accompanying editorial.
“It is often overwhelming for patients to fully understand the overall risks and benefits associated with different therapies,” they continue. “Some researchers have suggested that a more quantitative presentation of risks and benefits in terms of absolute risk reduction, relative risk reduction or the numbers needed to treat will improve patient understanding and facilitate shared decisions.
“Future research should evaluate the effectiveness of such strategies in presenting risks and benefits of therapies on patient understanding, compliance and risk of health outcomes,” they conclude.
(Arch Intern Med. 2008;168[8]:793-795. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. Cauley has received research support from Merck & Co., Eli Lilly & Co., Pfizer Pharmaceuticals and Novartis Pharmaceuticals; has received consulting fees from Eli Lilly & Co. and Novartis Pharmaceuticals; and is on the speaker’s bureau for Merck & Co. Inc. 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, April 28, 2008
Media Advisory: To contact co-author JoAnn E. Manson, M.D., call Jessica Podlaski at BWH at 617-534-1603.
HORMONE THERAPY IN POSTMENOPAUSAL WOMEN ASSOCIATED WITH INCREASED RISK OF STROKE
CHICAGO—Postmenopausal women taking hormone therapy appear to have an increased risk of stroke regardless of when they started treatment, according to a report in the April 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“Many controversies remain regarding the risks and benefits of postmenopausal hormone therapy,” according to background information in the article. There have been previous studies analyzing the risk of stroke with use of hormone therapy, but these did not determine stroke risk for younger women taking hormone therapy near the onset of menopause.
Francine Grodstein, Sc.D., and colleagues, at Brigham and Women’s Hospital and Harvard Medical School, Boston, evaluated stroke risk associated with hormone therapy in 121,700 women (age 30 to 55 at the beginning of the study) who participated in the Nurses’ Health Study from 1976 to 2004. There were 360 cases of stroke among women who had never used hormones and 414 cases of stroke among women who were currently using hormones.
Compared to women who had never used hormones, women currently taking hormone therapy had an increased risk for stroke (39 percent for those taking estrogen and 27 percent for those taking estrogen with progestin). “This increased risk was observed for women initiating hormone therapy at young ages or near menopause and at older ages or more than 10 years after menopause,” the authors write. Taking hormone therapy for less than five years at younger ages was not linked to a clear increase in stroke, possibly due to the small number of cases.
“The incidence of stroke was relatively low in younger women, and the attributable risk in women aged 50 through 54 years indicated approximately an additional two cases of stroke per 10,000 women per year taking hormones,” the authors write. There was also a strong relationship found between dose of estrogen and stroke, with larger doses increasing the risk.
“In summary, our findings in the Nurses’ Health Study indicate that hormone therapy is associated with an increased risk of stroke, regardless of the hormone regime or the timing of hormone therapy initiation,” the authors conclude. “However, in younger women, who are at lower absolute risk of stroke, the attributable risk of stroke owing to hormone use is modest, and our data suggest that risk might be further minimized by lower doses and shorter duration of treatment.”
(Arch Intern Med. 2008;168[8]:861-866. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The work in this article was supported by grants from the National Institutes of Health. 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, April 28, 2008
Media Advisory: To contact Amy R. Weinstein, M.D., M.P.H., call Bonnie Prescott at 617-667-7306.
INCREASED PHYSICAL ACTIVITY RELATED TO LOWER HEART DISEASE RISK AMONG WOMEN WITH HIGH BODY MASS INDEX
CHICAGO—The risk of heart disease in women associated with being overweight or obese is reduced but not eliminated by higher levels of physical activity, according to a report in the April 28 issue of the JAMA/Archives journals.
Both obesity and physical inactivity are modifiable risk factors for coronary heart disease, according to background information in the article. “Obesity is recognized as a major public health issue owing to its dramatically rising prevalence and deleterious impact on many chronic diseases, including coronary heart disease,” the authors write. “In addition, the majority of Americans are inactive and not meeting the Surgeon General’s goal for adequate physical activity.”
Amy R. Weinstein, M.D., M.P.H., of Beth Israel Deaconess Medical Center, Boston, and colleagues studied the interaction between these two risk factors in 38,987 women who were participants in the recently completed Women’s Health Study. At the beginning of the study in 1992, the women reported their height and weight (used to calculate their body mass index or BMI), the average time per week spent performing physical activities, other health habits and medical history. They were then followed for an average of 10.9 years and completed regular follow-up questionnaires about heart events and risk factors.
At the beginning of the study, 34 percent of women were considered physically active based on the Surgeon General’s guidelines, 31 percent were overweight and 18 percent were obese. During the follow-up period, 948 women developed coronary heart disease. Both BMI and physical activity were individually associated with the risk of heart disease. Risk was lowest for women of normal weight who were active, slightly higher for women of normal weight who were inactive, higher still for women who were overweight or obese and active, and highest for women who were overweight or obese and inactive.
Fat cells or adipocytes release chemicals that may have adverse effects on the heart by accelerating the hardening of the arteries and increasing inflammation, clotting and dysfunction of the blood vessels, the authors note. Physical activity, on the other hand, improves blood vessel function and reduces the risk for blood clots. “We postulate that the beneficial effect of physical activity may directly reduce and combat the ill effect of the prothrombotic factors released by adipocytes,” the authors write.
However, physical activity did not eliminate the negative effects of being overweight. “Even high quantities of physical activity are unlikely to fully reverse the risk of coronary heart disease in overweight and obese women without concurrent weight loss,” the authors conclude. “Regardless of body weight, these data highlight the importance of counseling all women to participate in increasing amounts of regular physical activity and maintaining a healthy weight to reduce the risk of coronary heart disease.”
(Arch Intern Med. 2008;168[8]:884-890. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported by research grants from the National Institutes of Health, Bethesda, Md. 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, April 28, 2008
Media Advisory: To contact Bjørn O. Åsvold, M.D., bjorn.o.asvold{at}ntnu.no.
THYROTROPIN LEVELS MAY BE ASSOCIATED WITH CORONARY HEART DISEASE MORTALITY IN WOMEN
CHICAGO—Women with increasing levels of thyrotropin within the normal range appear to have a higher risk of fatal coronary heart disease, according to a report in the April 28 issue of the JAMA/Archives journals.
Thyrotropin, a hormone produced by the pituitary gland, is released into the blood and acts on the thyroid gland to stimulate its growth and function, according to background information in the article. “Emerging evidence indicates that levels of thyrotropin within the reference [normal] range are positively and linearly associated with systolic [top number] and diastolic [bottom number] blood pressure, body mass index and serum lipid concentrations with adverse effects on cardiovascular health.”
Bjørn O. Åsvold, M.D., of the Norwegian University of Science and Technology, Trondheim, Norway, and colleagues studied the association between thyrotropin levels and fatal heart disease in 17,311 women and 8,002 men without known thyroid disease, cardiovascular disease or diabetes at the beginning of the study.
During follow-up, 228 women (1.3 percent) and 182 men (2.3 percent) had died of coronary heart disease. “Of these, 192 women and 164 men had thyrotropin levels within the clinical reference range of 0.5 milli-international units per liter to 3.5 milli-international units per liter,” the authors write. “Overall, thyrotropin levels within the reference range were positively associated with coronary heart disease mortality; the trend was statistically significant in women but not in men.”
“This study shows that coronary heart disease mortality increases in women with increasing levels of thyrotropin within the reference range,” the authors conclude. “These results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal coronary heart disease.”
(Arch Intern Med. 2008;168[8]:855-860. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Norwegian University of Science and Technology and by the Central Norway Regional Health Authority. 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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