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, August 19, 2008)
JAMA NEWS RELEASES
B VITAMINS AND FOLIC ACID NOT EFFECTIVE FOR REDUCING RISK OF DEATH OR MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY ARTERY DISEASE
ARSENIC EXPOSURE MAY BE ASSOCIATED WITH TYPE 2 DIABETES
STUDY EXAMINES TESTING MODEL TO PREDICT AND DIAGNOSE NEW CASES OF DEMENTIA
SILVER-COATED ENDOTRACHEAL TUBES APPEAR TO REDUCE RISK OF PNEUMONIA ASSOCIATED WITH VENTILATOR USE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MORTALITY AND CARDIOVASCULAR EVENTS IN PATIENTS TREATED WITH HOMOCYSTEINE-LOWERING B VITAMINS AFTER CORONARY ANGIOGRAPHY: A RANDOMIZED CONTROLLED TRIAL
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TV Note: This week’s JAMA Report video is on the effect of B vitamins and folic acid in reducing the risk of cardiovascular events or death in patients with coronary artery disease. The report will be fed Tuesday, August 19, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 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, August 19, 2008
Media Advisory: To contact Marta Ebbing, M.D., e-mail: marta.ebbing{at}helse-bergen.no.
B VITAMINS AND FOLIC ACID NOT EFFECTIVE FOR REDUCING RISK OF DEATH OR MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY ARTERY DISEASE
CHICAGO— In a large clinical trial involving patients with coronary artery disease, use of B vitamins was not effective for preventing death or cardiovascular events, according to a study published in the August 20 issue of JAMA.
Observational studies have demonstrated that the concentration of total homocysteine in blood is associated with risk of coronary artery disease and stroke," the authors provide as background information. Plasma total homocysteine levels can be lowered by oral administration of folic acid and vitamin B12. In this study, the authors’ objective was "to evaluate the effects of homocysteine-lowering treatment with folic acid plus vitamin B12 on mortality and cardiovascular events."
Marta Ebbing, M.D. of Haukeland University Hospital, Bergen, Norway and colleagues, conducted a randomized controlled study with 3,096 patients in two Norwegian hospitals between 1999 – 2006. Patients were randomly assigned to one of four groups receiving a daily oral dose of one of the following treatments: folic acid, 0.8mg, plus vitamin B12 , 0.4mg, plus vitamin B6 , 40mg (n= 772); folic acid plus vitamin B12 (n = 772); vitamin B6 alone (n = 772); or placebo (n = 780). Patients were scheduled for follow-up visits with an interview, clinical examination, and blood sampling at one month, one year, and at a final study visit. The main outcome measure (primary end point) was a composite of all-cause death, nonfatal acute myocardial infarction (heart attack), acute hospitalization for unstable angina pectoris, and nonfatal thromboembolic stroke.
The study was stopped early because of concerns among the participants about preliminary results from another similar Norwegian study suggesting no benefits from the treatment and an increased risk of cancer from the B vitamins.
"Mean (average) plasma total homocysteine concentration was reduced by 30 percent after 1 year of treatment in the groups receiving folic acid and vitamin B12," the authors report. "During a median (midpoint) 38 months of follow-up, the primary end point was experienced by a total of 422 participants (13.7 percent): 219 participants (14.2 percent) receiving folic acid/vitamin B12 vs. 203 (13.1 percent) not receiving such treatment and 200 participants (13.0 percent) receiving vitamin B6 vs. 222 (14.3 percent) not receiving vitamin B6."
"… we could not detect any preventive effect of intervention with folic acid plus vitamin B12 or with vitamin B6 on mortality or major cardiovascular events among patients with stable coronary artery disease undergoing intensive conventional treatment. We found a numerically lower incidence of stroke and higher incidence of cancer in the groups receiving folic acid, but these observations were not statistically significant," the authors conclude. "Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease."
(JAMA. 2008;300[7]:795-804. 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.
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, August 19, 2008
Media Advisory: To contact Ana Navas-Acien, M.D., Ph.D., call Natalie Wood-Wright at 410-614-6029. To contact corresponding editorialist Molly L. Kile, M.Sc., Sc.D., call Christina Roache at 617-432-6052.
ARSENIC EXPOSURE MAY BE ASSOCIATED WITH TYPE 2 DIABETES
CHICAGO—In a study involving a representative sample of U.S. adults, higher levels of arsenic in the urine appear to be associated with increased prevalence of type 2 diabetes, according to a report in the August 20 issue of JAMA.
Arsenic from inorganic sources is highly toxic and causes cancer in humans, according to background information in the article. Millions of individuals worldwide are exposed to drinking water contaminated with inorganic arsenic, including 13 million Americans whose public water supply contains more than the U.S. Environmental Protection Agency standard of 10 micrograms per liter. Exposure to high concentrations of the element in drinking water and in the workplace has been shown to be associated with diabetes risk factors, but little is known about the effect of lower levels on diabetes risk. In contrast, arsenobetaine—an organic arsenic compound derived eating seafood—is considered non-toxic.
Ana Navas-Acien, M.D., Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues studied 788 adults age 20 and older who had their urine tested for arsenic levels as part of the government-conducted 2003-2004 National Health and Nutrition Examination Survey (NHANES).
Overall, 7.7 percent of the participants had type 2 diabetes. After adjusting for diabetes risk factors and biomarkers of seafood intake, participants with type 2 diabetes had a 26 percent higher level of total arsenic in their urine than those without the disease. Levels of arsenobetaine and dimethylarsenate, a compound into which inorganic arsenic is metabolized before excretion, were similar between the two groups.
After the same adjustment for related factors, the researchers found that participants in the top one-fifth of total urine arsenic levels (16.5 micrograms per liter) had 3.6 times the odds of having type 2 diabetes as those in the lowest one-fifth (3.0 micrograms per liter), and those in the top one-fifth of dimethylarsenate levels (6.0 micrograms per liter) had 1.5 times the odds as those in the lowest one-fifth (2.0 micrograms per liter).
"The potential role of arsenic in diabetes development is supported by experimental and mechanistic evidence," the authors note. Insulin-sensitive cells that are exposed to insulin and sodium arsenite appear to take in less glucose than cells exposed only to insulin. Arsenic could also influence genetic factors that interfere with insulin sensitivity and other processes, or could contribute to oxygen-related cell damage, inflammation and cell death (which have also been related to diabetes).
"From a public health perspective, confirmation of a role for arsenic in diabetes development would add to the concerns posed by the carcinogenic, cardiovascular, developmental and reproductive effects of inorganic arsenic in drinking water, and could substantially modify risk assessment and risk-benefit analyses estimating the consequences of arsenic exposure," the authors conclude. "Given widespread exposure to inorganic arsenic from drinking water worldwide, elucidating the contribution of arsenic to the diabetes epidemic is a public health research priority with potential implications for the prevention and control of diabetes."
(JAMA. 2008;300[7]:814-822. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by a grant from the National Institute of Environmental Health Sciences in Urban Environmental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: LIMIT ARSENIC EXPOSURE WHILE RESEARCH CONTINUES
"Stemming the pandemic of type 2 diabetes is a public health priority and will require a multifaceted approach," write Molly L. Kile, M.S., Sc.D., and David C. Christiani, M.D., M.P.H., M.S., of the Harvard School of Public Health, Boston, in an accompanying editorial. "This must include improving the understanding of the etiology of diabetes and identifying modifiable factors that can be incorporated into prevention strategies."
"To date, this approach has focused on medication and lifestyle modification, but the role of environmental exposures must also be considered," they continue. "While many questions remain about the role of arsenic in diabetogenesis, they can only be answered by additional research."
"In the meantime, arsenic exposure from drinking water is a widespread environmental pollutant that affects millions of individuals around the world," Drs. Kile and Christiani conclude. "It is prudent to minimize arsenic exposure while its effect on metabolic diseases continues to be researched."
(JAMA. 2008;300[7]:845-846.. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by a grant from the National Institute of Environmental Health Sciences in Urban Environmental 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 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, August 19, 2008
Media Advisory: To contact Roee Holtzer, Ph.D., call Karen Gardner at 718-430-3101.
STUDY EXAMINES TESTING MODEL TO PREDICT AND DIAGNOSE NEW CASES OF DEMENTIA
CHICAGO—A preliminary report published in the August 20 issue of JAMA suggests that within-person variability on neuropsychological testing may be associated with development of dementia in older adults.
"Developing strategies to improve the prediction and diagnoses of dementia has paramount therapeutic and public health implications," the authors write. "When neuropsychological tests are used for diagnostic purposes, an individual’s level of performance on specific tests is measured against healthy normative samples to determine cognitive impairment. However, this approach does not take into account intra-individual variability in cognitive function." Intra-individual variability is inconsistency in cognitive performance within a person.
Roee Holtzer, Ph.D., and colleagues from the Albert Einstein College of Medicine, Yeshiva University, New York, evaluated 897 individuals, age 70 or older, who are part of The Einstein Aging Study, a longitudinal study of aging and dementia in Bronx County, New York. Participants had follow-up visits every 12 to 18 months, at which they underwent detailed neurological and neuropsychological evaluations. The researchers included tests for verbal IQ, attention/executive function, and memory. The study focused on whether within-person across-neuropsychological test variability predicts future dementia.
"Of the 897 participants, there were 61 cases of incident dementia (6.8 percent) … identified during the follow-up period (mean [average] 3.3 years)," the authors report. "On the basis of the consensus clinical diagnostic procedures, 47 participants developed incident dementia of the Alzheimer type and 18 participants developed incident vascular dementia. During the study, 128 individuals died, as expected for the age of this cohort. Of these, 18 had developed incident dementia."
"In summary, within-person across-neuropsychological test variability was associated with development of dementia independently of performance of the neuropsychological tests. This finding needs to be replicated in different populations before it is applied in a clinical setting," the authors conclude.
(JAMA. 2008;300[7]:823–830. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The Einstein Aging Study is supported by a National Institute on Aging grant. Dr. Holtzer is supported by the National Institute on Aging Paul B. Beeson Award. Co-author Dr. Verghese is supported by a National Institute on Aging grant. Please see the article for additional information, including other authors, author contributions and affiliations, 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, August 19, 2008
Media Advisory: To contact Marin H. Kollef, M.D., call Diane Duke Williams at 314-286-0111. To contact editorialist Jean Chastre, M.D., e-mail jean.chastre{at}psl.aphp.fr.
SILVER-COATED ENDOTRACHEAL TUBES APPEAR TO REDUCE RISK OF PNEUMONIA ASSOCIATED WITH VENTILATOR USE
CHICAGO—Among intensive care unit patients who require mechanical ventilation, use of a silver-coated endotracheal tube resulted in reduced incidence of pneumonia associated with ventilators, according to a report in the August 20 issue of JAMA.
Ventilator-associated pneumonia is associated with longer hospital stays, increased health care costs and infection with antibiotic-resistant pathogens, according to background information in the article. It is likely to develop when pathogenic bacteria colonize the aerodigestive tract or when patients breathe out contaminated secretions. "Prevention strategies often focus on modifiable risk factors for colonization and aspiration and can successfully reduce ventilator-associated pneumonia rates, but no single strategy completely eliminates ventilator-associated pneumonia," the authors write. "Adherence to prevention guidelines is variable due to costs and lack of education, resources and leadership."
Silver has displayed antimicrobial activity in the laboratory and has blocked the formation of harmful pathogens on ventilator tubes in animal models. Marin H. Kollef, M.D., of the Washington University School of Medicine, and colleagues in the NASCENT Investigation Group report on a randomized controlled trial involving patients at 54 centers expected to require mechanical ventilation for 24 hours or longer. Between 2002 and 2006, 2,003 patients were randomly assigned to undergo intubation with either a silver-coated tube or a similar tube that was not coated.
Of 1,509 patients who were intubated for 24 hours or longer, 4.8 percent of those with silver-coated tubes developed ventilator-associated pneumonia, compared with 7.5 percent of those with uncoated tubes—a 35.9 percent relative reduction in risk. Among 1,932 patients who were on ventilators for any length of time, the silver coating was associated with a 34.2 percent relative reduction in risk of developing pneumonia (3.8 percent of those with silver-coated tubes vs 5.8 percent with uncoated tubes).
In addition, the silver-coated tubes were associated with a delayed occurrence of ventilator-associated pneumonia. No differences were seen between the two groups in median (midpoint) duration of intubation, length of stay in the intensive care unit (ICU) or in the hospital, death rates or frequency and severity of adverse events.
"In conclusion, the results of this large, randomized, multicenter study demonstrated that the silver-coated endotracheal tube significantly reduced the incidence of microbiologically confirmed ventilator-associated pneumonia and had its greatest benefit during the peak time of ventilator-associated pneumonia occurrence, without any notable adverse events," the authors conclude. "The silver-coated endotracheal tube appears to offer a unique approach because it is the first intervention that becomes user-dependent after intubation, requiring no further action by the clinician."
(JAMA. 2008;300[7]:805-813. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study, including design, data collection, statistical analysis and manuscript preparation, was supported by a research grant from C. R. Bard Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: SILVER-COATED ENDOTRACHEAL TUBES NOT DEFINITIVE SOLUTION BUT COULD BENEFIT HIGH-RISK PATIENTS
"Based on the results of this trial, should clinicians reconsider guidelines for ventilator-associated pneumonia prevention and use a silver-coated endotracheal tube in all patients requiring intubation and mechanical ventilation in the ICU?" writes Jean Chastre, M.D., of the Groupe Hospitalier Pitie-Salpetriere, Paris, in an accompanying editorial.
"The answer is probably yes for the subset of patients at very high risk of developing early-onset ventilator-associated pneumonia, such as neurologically impaired patients or trauma patients, because the greatest effect of the intervention appeared to occur during the first 10 days of mechanical ventilation and was clinically relevant, with minimal effect on clinician workload," Dr. Chastre writes.
"Important uncertainties exist regarding the exact benefit of silver-coated endotracheal tubes," Dr. Chastre concludes. "Consequently, silver-coated tubes should not be viewed as the definitive answer for ventilator-associated pneumonia prevention, and, until additional data confirm the clinical effectiveness and cost benefit of these devices, their issue should be restricted to high-risk patients treated in ICUs with benchmark value-based infection rates that remain above institutional goals despite implementation of a comprehensive strategy of usual preventive measures to prevent ventilator-associated pneumonia."
(JAMA. 2008;300[7]:842-844. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Chastre reported receiving consulting and lecture fees from Pfizer, Brahms, Wyeth, Johnson & Johnson, Bayer-Nektar and Arpida. Please see the article for additional information, including other authors, author contributions and affiliations, 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
MORTALITY AND CARDIOVASCULAR EVENTS IN PATIENTS TREATED WITH HOMOCYSTEINE-LOWERING B VITAMINS AFTER CORONARY ANGIOGRAPHY: A RANDOMIZED CONTROLLED TRIAL
INTRO:
High levels of homocysteine in the blood have been associated with increased risk of coronary artery disease and stroke. Researchers in Norway studied whether using B vitamins such as folic acid and B twelve to lower homocysteine levels could help prevent cardiovascular events in patients. While homocysteine levels did improve, overall risk for patients did not. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Heart images / cath lab
Researchers looking at images
AUDIO:
CORONARY ARTERY DISEASE IS A MAJOR CAUSE OF ILLNESS AND DEATH. HIGH LEVELS OF AN AMINO ACID IN THE BLOOD CALLED HOMOCYSTEINE ARE OFTEN A RISK FACTOR. RESEARCHERS IN NORWAY WANTED TO SEE IF LOWERING THOSE LEVELS COULD IMPROVE A PATIENT’S HEALTH.
VIDEO:
SOT/FULL
Super @ :16
Marta Ebbing, M.D.
Haukeland University Hospital
Runs: 12
AUDIO:
"We could lower their homocysteine values and thus we thought also we could lower their risk for having further heart attacks and related disease."
VIDEO:
B-ROLL
Doctor walking
Two doctors look at heart
Tight heart images
Vitamin B study pills
Doctors in cath lab
Images on monitor
AUDIO:
DOCTOR MARTA EBBING WORKS IN THE DEPARTMENT OF HEART DISEASE AT HAUKELAND (how-ka-land) UNIVERSITY HOSPITAL IN NORWAY. SHE AND HER COLLEAGUES STUDIED MORE THAN THREE THOUSAND PATIENTS WITH CORONARY ARTERY DISEASE. SOME RECEIVED A DAILY DOSE OF VITAMIN B TWELVE, B SIX OR FOLIC ACID. OTHERS RECEIVED A PLACEBO. PATIENTS WERE FOLLOWED FOR ABOUT THREE YEARS. BLOOD SAMPLES ALLOWED RESEARCHERS TO MONITOR HOMOCYSTEINE LEVELS.
VIDEO:
SOT/FULL
Marta Ebbing, M.D.
Haukeland University Hospital
Runs: 06
AUDIO:
"Although we lowered homocysteine by almost one third it did not seem to have any beneficial effects."
VIDEO:
B-ROLL
GXF/JAMA COVER
Cath lab doctors working
Heart images on monitor
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. RESEARCHERS SAY NONE OF THE VARIOUS FORMS OF VITAMIN B LOOKED AT IN THE STUDY HELPED TO LOWER THE RISK OF HEART ATTACKS, STROKE OR DEATH.
VIDEO:
SOT/FULL
Super @ 1:07
Oyvind Bleie, M.D., Ph.D.
Haukeland University Hospital
Runs: 06
AUDIO:
"We couldn’t find any any statistical difference between the groups."
VIDEO:
SOT/FULL
Marta Ebbing, M.D.
Haukeland University Hospital
Runs: 13
AUDIO:
"Our findings might imply that homocysteine does not change the course of coronary artery disease but is just a risk marker of increased risk in coronary artery disease patients."
VIDEO:
B-ROLL
Cath lab
Single pill in hand
Vitamin B study pills
AUDIO:
RESEARCHERS SAY THEIR FINDINGS ARE CONSISTENT WITH PREVIOUS STUDIES. HOWEVER THEY FEEL FURTHER CLINICAL TRIALS INVOLVING B VITAMINS ARE NECESSARY FOR A BETTER UNDERSTANDING OF HOW THEY MAY IMPACT PATIENT HEALTH. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
While researchers found patients with coronary artery disease did not benefit from B vitamins they also report that no increased adverse effects were observed in patients either. For more information about this study you can log on to www.jama.com.
