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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, May 6, 2008)
JAMA NEWS RELEASES
SUPPLEMENTATION WITH FOLIC ACID, B VITAMINS NOT ASSOCIATED WITH REDUCED RISK OF CARDIOVASCULAR EVENTS IN HIGH-RISK WOMEN
MUCH OF THE INCREASED RISK OF DEATH FROM SMOKING REDUCED WITHIN SEVERAL YEARS AFTER QUITTING
USE OF CORTICOSTEROIDS IS NOT ASSOCIATED WITH REDUCED RISK OF DEATH FOR CHILDREN WITH BACTERIAL MENINGITIS
INCIDENCE OF GROUP B STREP HAS DECREASED AMONG NEWBORNS, BUT HAS INCREASED AMONG ADULTS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
WOMEN WHO QUIT SMOKING CAN DECREASE THEIR RISK OF CERTAIN FATAL DISEASES WITHIN JUST FIVE YEARS
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TV Note: This week's JAMA Video News Report is on the change in risk of death from various causes after quitting smoking. The report will be fed Tuesday, May 6, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, May 6, 2008
Media Advisory: To contact co-author JoAnn E. Manson, M.D., Dr.P.H., call Lori Shanks at 617-534-1604. To contact editorial author Eva Lonn, M.D., M.Sc., F.R.C.P.C., call Veronica McGuire at 905-525-9140, ext. 22169.
SUPPLEMENTATION WITH FOLIC ACID, B VITAMINS NOT ASSOCIATED WITH REDUCED RISK OF CARDIOVASCULAR EVENTS IN HIGH-RISK WOMEN
CHICAGO—Women at high-risk of cardiovascular disease who took a daily supplement of folic acid and vitamin B6 and B12 for seven years did not have an overall reduced rate of cardiovascular events, despite a significant lowering of homocysteine levels, according to a study in the May 7 issue of JAMA.
“Homocysteine [an amino acid produced by the body] levels have been directly associated with cardiovascular risk in observational studies; and daily supplementation with folic acid, vitamin B6, vitamin B12, or a combination have been shown to reduce homocysteine levels to varying degrees in intervention studies,” the authors write. Observational data suggest cardiovascular benefits from B-vitamin supplementation may be greater among women, yet women have been underrepresented in published randomized trials. “Given the paucity of data on women and the known influences of estrogen on homocysteine levels, adequately powered randomized trials of homocysteine lowering in women are still needed.”
Christine M. Albert, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues tested whether a combination of folic acid, vitamin B6 and vitamin B12 would reduce total cardiovascular events among women at high risk for the development of cardiovascular disease (CVD) over 7 years of follow-up. Within an ongoing randomized trial of antioxidant vitamins, 5,442 women who were U.S. health professionals age 42 years or older, with either a history of CVD or three or more coronary risk factors, were enrolled in a randomized trial to receive a combination pill containing folic acid (2.5 mg), vitamin B6 (50 mg), and vitamin B12 (1 mg) or a matching placebo.
During the 7.3 years of follow-up, 796 participants (14.6 percent) experienced a confirmed CVD event included in the primary end point (heart attack, stroke, coronary revascularization, or CVD death), with some individuals experiencing more than one event. There was no difference in the cumulative incidence of the primary combined end point in the active vs. placebo treatment groups at any time during study follow-up. A total of 406 women (14.9 percent) in the active treatment group and 390 (14.3 percent) in the placebo group experienced at least one cardiovascular event included in the primary end point.
When analyzed separately, there were no significant differences for each of the components of the primary outcome including heart attack, stroke, and CVD death, between the active treatment and placebo groups. Also, the risk of death from any cause was similar between the active and placebo treatment groups.
The researchers also found that the average plasma homocysteine level was 18.5 percent lower in the active group than that observed in the placebo group.
“Our results are consistent with prior randomized trials performed primarily among men with established vascular disease and do not support the use of folic acid and B vitamin supplements as preventive interventions for CVD in these high-risk fortified populations,” the authors write.
(JAMA. 2008;299[17]:2027-2036. Available pre-embargo to the media 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: HOMOCYSTEINE-LOWERING B VITAMIN THERAPY IN CARDIOVASCULAR PREVENTION—WRONG AGAIN?
In an accompanying editorial, Eva Lonn, M.D., M.Sc., F.R.C.P.C., of McMaster University, Hamilton, Ontario, Canada, comments on the findings of Albert and colleagues.
“...B vitamin supplements cannot currently be recommended for the prevention of CVD events (with the exception of rare genetic disorders) and there is no role for routine screening for elevated homocysteine levels. However, ongoing clinical research should provide further evidence on whether there may be any role for homocysteine-lowering B vitamin supplements in CVD prevention and for the overall importance of homocysteine as a CV risk factor.”
(JAMA. 2008;299[17]:2086-2087. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, May 6, 2008
Media Advisory: To contact Stacey A. Kenfield, Sc.D., call Todd Datz at 617-432-3952.
MUCH OF THE INCREASED RISK OF DEATH FROM SMOKING REDUCED WITHIN SEVERAL YEARS AFTER QUITTING
CHICAGO—Women who quit smoking significantly reduce their risk of death from coronary heart disease within 5 years and have about a 20 percent lower risk of death from smoking-related cancers within that time period, according to a study in the May 7 issue of JAMA.
“Tobacco use remains the leading preventable cause of death in the United States. Globally, approximately 5 million premature deaths were attributable to smoking in 2000. The World Health Organization projects by 2030 that tobacco-attributable deaths will annually account for 3 million deaths in industrialized countries and 7 million in developing countries,” the authors write. They add that the rate of mortality risk reduction after quitting compared with continuing to smoke is uncertain.
Stacey A. Kenfield, Sc.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between cigarette smoking and smoking cessation on total and cause-specific mortality in women by analyzing data from the Nurses’ Health Study, an observational study of 104,519 female participants, with follow-up from 1980 to 2004. A total of 12,483 deaths occurred in this group, 4,485 (35.9 percent) among never smokers, 3,602 (28.9 percent) among current smokers, and 4,396 (35.2 percent) among past smokers.
The researchers found a significant 13 percent reduction in the risk of all-cause mortality within the first 5 years of quitting smoking compared with continuing to smoke, and the excess risk decreased to the level of a never smoker 20 years after quitting, with some causes taking more or less time. “Significant trends were observed with increasing years since quitting for all major cause-specific outcomes. A more rapid decline in risk after quitting smoking compared with continuing to smoke was observed in the first 5 years for vascular diseases compared with other causes.”
“Much of the reduction in the excess risk for these causes of death were realized within the first 5 years for coronary heart disease and cerebrovascular disease. Sixty-one percent of the full potential benefit of quitting in regard to coronary heart disease mortality and 42 percent of the full potential benefit of quitting in regard to cerebrovascular mortality was realized within the first 5 years of quitting smoking, when comparing hazard ratios for recent quitters of less than 5 years with long-term quitters of 20 years or greater. For death due to respiratory disease, an 18 percent reduction in risk of death was observed 5 to 10 years after quitting smoking, with the risk reaching that of a never smoker’s risk after 20 years.”
For lung cancer mortality, a significant 21 percent reduction in risk was observed within the first 5 years compared with continuing smokers, but the excess risk did not disappear for 30 years. Past smokers with 20 to less than 30 years of cessation had an 87 percent reduction in risk of lung cancer mortality compared with current smokers. When including the other smoking-related cancers, the excess risk approached a never smoker’s risk more than 20 years after quitting smoking.
Significant trends were observed for earlier age at initiation of smoking for total mortality, respiratory disease mortality, and all smoking-related cancer mortality. The data also suggested that smoking is associated with an increased risk of colorectal cancer mortality but not ovarian cancer mortality. The researchers also found that approximately 64 percent of deaths among current smokers and 28 percent of deaths among former smokers were attributable to cigarette smoking.
“Early age at initiation is associated with an increased mortality risk so implementing and maintaining school tobacco prevention programs, in addition to enforcing youth access laws, are key preventive strategies. Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs,” the authors conclude.
(JAMA. 2008;299[17]:2037-2047. Available pre-embargo to the media 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, May 6, 2008
Media Advisory: To contact corresponding author Samir S. Shah, M.D., M.S.C.E., call Rachel Salis-Silverman at 267-426-6063.
USE OF CORTICOSTEROIDS IS NOT ASSOCIATED WITH REDUCED RISK OF DEATH FOR CHILDREN WITH BACTERIAL MENINGITIS
CHICAGO—Use of corticosteroids in addition to other treatment for children with bacterial meningitis is not associated with a decreased risk of death or shorter hospital stay, according to a study in the May 7 issue of JAMA.
In adults, the use of corticosteroids (synthetic steroids used to reduce inflammation) in addition to primary therapy for bacterial meningitis reduces mortality, although in children the potential benefit of steroids remains unclear, with studies yielding mixed results, according to background information in the article.
Jillian Mongelluzzo, B.A., of the Children’s Hospital of Philadelphia, and colleagues conducted a study to determine the effect of adjuvant (supplemental) corticosteroid therapy on death and length of hospitalization in children with bacterial meningitis. The study included 2,780 children treated for bacterial meningitis, with data from the Pediatric Health Information System, a database containing information from 27 tertiary care children’s hospitals located in 18 U.S. states and the District of Columbia. The median (midpoint) age was 9 months; 57 percent of the patients were males. Streptococcus pneumoniae was the most commonly identified cause of meningitis. Adjuvant corticosteroids were administered to 248 children (8.9 percent).
The overall rate of death was 4.2 percent; the cumulative rates of death were 2.2 percent and 3.1 percent at 7 days and 28 days, respectively, after admission. There were 15 deaths (6.0 percent) in children who received corticosteroids and 102 deaths (4.0 percent) in children who did not receive corticosteroids. Additional analysis indicated the difference in time to death between the two groups was not statistically significant, and that adjuvant corticosteroids were not associated with reducing the risk of death in any age category.
The overall median length of stay was 11 days, with the median length of stay for children who received corticosteroids being 12 days, and the median length of stay for the children who did not receive corticosteroids being 10 days. The unadjusted difference in time to hospital discharge was not statistically significant. Length of hospital stay, analyzed as time to hospital discharge, was not associated with the administration of adjuvant corticosteroids for any age group.
“Our study results of no difference in mortality in children who received or did not receive corticosteroid therapy may differ from results of studies of adults for several reasons. First, adults may have different predisposing factors for meningitis or a different inflammatory response, either of which may alter the course of disease compared with children. Second, the case fatality rate in pneumococcal meningitis in children is lower in comparison with the case fatality rate in adults with pneumococcal meningitis (4.2 percent vs. 34 percent, respectively). Our study could have been underpowered to determine a difference in mortality when case fatality rates are low in children with bacterial meningitis,” the authors write.
“...adjuvant corticosteroid use in the treatment of bacterial meningitis appears to be increasing. A randomized trial is warranted to explore the possible benefit of adjuvant corticosteroid therapy on both morbidity and mortality in children with bacterial meningitis before such corticosteroid use becomes routine,” the researchers conclude.
(JAMA. 2008;299[17]:2048-2055. Available pre-embargo to the media 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, May 6, 2008
Media Advisory: To contact Christina R. Phares, Ph.D., call Curtis Allen at 404-639-3286.
INCIDENCE OF GROUP B STREP HAS DECREASED AMONG NEWBORNS, BUT HAS INCREASED AMONG ADULTS
CHICAGO—A major cause of infections, group B streptococcus disease declined about 25 percent among infants younger than 7 days from 1999 to 2005, but increased nearly 50 percent among persons 15 to 64 years old, according to a study in the May 7 issue of JAMA.
In the 1970s, group B streptococcus emerged as the leading cause of sepsis and meningitis in the first week of life. Subsequent prevention strategies resulted in substantial declines in disease in infants younger than 7 days (also known as early-onset disease). Guidelines for prevention of this disease near the time of birth were revised in 2002. Disease trends following the release of these guidelines have not yet been well studied.
In addition to illness in the first week of life, group B streptococcus also causes invasive disease in older infants, pregnant women, children and young adults with underlying medical conditions and older adults. “The epidemiology of group B streptococcal disease is dynamic, and continued surveillance to monitor trends across age groups is necessary. For example, an increase in disease incidence among nonpregnant adults has been documented in past decades, but whether that trend has continued is unknown,” the authors write. In the United States in 2005, group B streptococcus caused an estimated 21,500 cases of invasive disease and 1,700 deaths, according to information in the article.
Christina R. Phares, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues evaluated trends and characteristics over a recent period among cases of laboratory-confirmed invasive group B streptococcal disease identified by population-based surveillance in 10 states participating in the Active Bacterial Core surveillance/Emerging Infections Program Network.
From 1999 through 2005, surveillance identified 14,573 cases of invasive group B streptococcal disease, of which 1,232 were early-onset disease. Disease incidence decreased 27 percent after the 2002 release of revised early onset disease prevention guidelines, from 0.47 per 1,000 live births in 1999-2001 to 0.34 per 1,000 live births in 2003-2005. Incidence remained stable among infants age 7 to 89 days and pregnant women.
Group B strep incidence increased 48 percent for those age 15 to 64 years, while those 65 years or older experienced a 20 percent increase. Among persons age 15 through 64 years, incidence increased from 3.4 per 100,000 population in 1999 to 5.0 per 100,000 in 2005; among those 65 years or older, incidence increased from 21.5 per 100,000 to 26.0 per 100,000. These values translate to a 32 percent increase in the overall incidence of adult disease, which reached 7.9 per 100,000 in 2005. The proportion with known outcome who died was highest in the oldest age groups.
All 4,882 isolates tested were susceptible to the antibiotics penicillin, ampicillin, and vancomycin, but 32 percent and 15 percent were resistant to erythromycin and clindamycin, respectively.
“...maternal group B streptococcus vaccination trials should be a public health priority, followed by expanded vaccine development to target disease among elderly and younger adults with chronic underlying conditions,” the authors conclude.
(JAMA. 2008;299[17]:2056-2065. Available pre-embargo to the media 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.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
WOMEN WHO QUIT SMOKING CAN DECREASE THEIR RISK OF CERTAIN FATAL DISEASES WITHIN JUST FIVE YEARS
INTRO:
When it comes to your health the hazards of smoking are quite clear and if you ever questioned the benefits of quitting smoking a new study may change your thinking. The study reveals that women, some who have smoked for decades, can significantly decrease their risk of certain fatal diseases within just five years after quitting. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
SOT/FULL
Liz Riley
Former Smoker
Runs: 03
AUDIO:
“I feared for my own health.”
VIDEO:
B-ROLL
Walking to desk
At desk
Women smoking
Cigarettes tight
AUDIO:
LIZ RILEY STARTED SMOKING WHEN SHE WAS FIFTEEN YEARS OLD. LIKE MANY WOMEN SHE DIDN’T EXPECT IT TO TURN INTO A THIRTY YEAR HABIT BUT IT DID.
VIDEO:
SOT/FULL
Super @ :13
Liz Riley
Former Smoker
Runs: 06
AUDIO:
“I smoked for thirty years and I knew that I if I continued to smoke that I probably would die.”
VIDEO:
B-ROLL
Women walking on street
Lady smoking
Doctor walking into office
Doctor at desk
AUDIO:
A RECENT STUDY ANALYZES JUST HOW QUICKLY WOMEN CAN DECREASE THEIR RISK OF SERIOUS HEALTH PROBLEMS BY DECIDING TO STOP SMOKING. DOCTOR STACEY KENFIELD WITH HARVARD SCHOOL OF PUBLIC HEALTH EXPLAINS SHE AND HER COLLEAGUES FOUND FOR CERTAIN DISEASES IT DOESN’T TAKE LONG.
VIDEO:
SOT/FULL
Super @:36
Stacey Kenfield, Sc.D
Harvard School of Public Health
Runs: 09
AUDIO:
“There’s such a great decline in risk for some diseases that women who are contemplating whether or not to quit really see a benefit quickly with smoking cessation.”
VIDEO:
B-ROLL
Women on street
Woman smoking
Lady lights cigarette
Flicks ash in tray
AUDIO:
RESEARCHERS STUDIED ABOUT ONE HUNDRED THOUSAND WOMEN FROM 1980 THROUGH 2004 AND COMPARED MORTALITY RATES FOR VARIOUS DISEASES AMONG CURRENT AND FORMER SMOKERS TO THOSE WHO HAD NEVER SMOKED AT ALL. THEY FOUND THE RISK OF DYING DECREASED SIGNIFICANTLY ONCE WOMEN IN THE STUDY STOPPED SMOKING.
VIDEO:
SOT/FULL
Stacey Kenfield, Sc.D.
Harvard School of Public Health
Runs: 13
AUDIO:
“Within the first five years of quitting smoking we saw a twenty-one percent reduction in the risk of dying of lung cancer and a fifty percent reduction in the risk of dying of cardiovascular disease specifically coronary heart disease.”
VIDEO:
Graphic – smoking video background –
Within 20 years
Risk drops
Comparable to non-smoker
GFX/ JAMA COVER
AUDIO:
AND WITHIN TWENTY YEARS AFTER QUITTING SMOKING SOME WOMEN’S RISK OF DYING FROM CARDIOVASCULAR DISEASE DROPS EVEN FURTHER COMPARABLE TO THE LEVEL OF A NON-SMOKER. THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Stacey Kenfield, Sc.D.
Harvard School of Public Health
Runs: 06
AUDIO:
“Once you remove the carcinogens from tobacco smoke from your body your body is able to repair itself.”
VIDEO:
B-ROLL
Liz walking across street
AUDIO:
LIZ RILEY SAYS THAT’S WHAT SHE EXPERIENCED. SHE WAS FINALLY ABLE TO QUIT SMOKING IN 2002 WITH THE HELP OF AN ADDICTION COUNSELOR.
VIDEO:
SOT/FULL
Liz Riley
Former Smoker
Runs: 10
AUDIO:
“Immediately I noticed the effects even within the first few days I noticed that I could breathe better.”
VIDEO:
B-ROLL
Lady smokes
Puts cigarette out
AUDIO:
LIZ HAS PEACE OF MIND KNOWING HER DECISION MAY LIKELY HAVE PROLONGED HER LIFE. RESEARCHERS HOPE THE FINDINGS PROMPT OTHER WOMEN TO STOP SMOKING AS SOON AS POSSIBLE. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers found that sixty-four percent of deaths among current smokers are attributable to their own smoking. In the United States tobacco use remains the most common preventable cause of death. The study was conducted using questionnaire data from The Nurses’ Health Study which began in 1976. For more information about this study you can log on to www.jama.com.
