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, November 4, 2008)
JAMA NEWS RELEASES
EXTENDED-TREATMENT WITH COMBINATION MEDICATION FOR OPIOID-ADDICTED YOUTHS SHOWS BENEFIT
FOLIC ACID, B VITAMINS DO NOT APPEAR TO AFFECT CANCER RISK
RISK OF SUDDEN CARDIAC DEATH APPEARS INCREASED WITHIN 30 DAYS OF HEART ATTACK
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS HIGH-DOSE INTAKE OF THREE B VITAMINS DOES NOT REDUCE WOMEN'S RISK OF DEVELOPING CANCER
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 4, 2008
Media Advisory: To contact George Woody, M.D., call Kim Guenther at 215-662-6183. To contact editorial author David A. Fiellin, M.D., call Karen Peart at 203-432-1326.
EXTENDED-TREATMENT WITH COMBINATION MEDICATION FOR OPIOID-ADDICTED YOUTHS SHOWS BENEFIT
CHICAGO—Adolescents addicted to opioids who received continuing treatment with the combination medication buprenorphine-naloxone had lower rates of testing positive or reporting use of opioids compared to youths who went through a short-term detoxification program using the same medication, according to a study in the November 5 issue of JAMA.
Recent data suggest that abuse of opioids, including heroin and prescription pain-relief drugs, is increasing among adolescents, according to background information in the article. "The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months. Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist [a drug that mimics the action of a naturally occurring substance] medication," the authors write.
George Woody, M.D., of the University of Pennsylvania, Philadelphia, and colleagues conducted a study comparing outcomes of treating opioid addiction among adolescents with extended treatment using buprenorphine-naloxone vs. short-term detoxification. Buprenorphine is an oral medication that acts by relieving the symptoms of opiate withdrawal. Naloxone is a drug that prevents or reverses the effects of opioids if it is injected. The study included 152 patients, age 15 to 21 years. Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg. per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg. per day and then tapered to day 14. All were offered weekly individual and group counseling.
The researchers found that overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12. At week 4, 61 percent of detox patients had positive results vs. 26 percent of the 12-week buprenorphine-naloxone patients. At week 8, 54 percent of detox patients had positive results vs. 23 percent of 12-week buprenorphine-naloxone patients. At week 12, 51 percent of detox patients had positive results vs. 43 percent of buprenorphine-naloxone patients, who by that time had been tapered off their medication.
By week 12, 20.5 percent of detox patients remained in treatment vs. 70 percent of 12-week buprenorphine-naloxone patients. During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less use of opioids, cocaine and marijuana, less injecting, and less need for additional addiction treatment. High levels of opioid use occurred in both groups at follow-up.
"Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group," the authors write.
"Because much opioid addiction treatment has shifted from inpatient to outpatient where buprenorphine-naloxone can be administered, having it available in primary care, family practice, and adolescent programs has the potential to expand the treatment options currently available to opioid-addicted youth and significantly improve outcomes. Other effective medications, or longer and more intensive psychosocial treatments, may have similarly positive results. Studies are needed to explore these possibilities and to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence."
(JAMA. 2008;300[17]:2003-2011. 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: TREATMENT OF ADOLESCENT OPIOID DEPENDENCE—NO QUICK FIX
In an accompanying editorial, David A. Fiellin, M.D., of the Yale University School of Medicine, New Haven, Conn., writes that there is a need for more evidence regarding effective opioid-addiction treatments.
"The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling; close monitoring for relapse; and, in some cases, naltrexone should be offered following buprenorphine tapers. From a research perspective, additional efforts are needed to provide a stronger evidence base from which to make recommendations for adolescents who use opioids. There is limited research on prevention of opioid experimentation and effective strategies to identify experimentation and intercede to disrupt the transition from opioid use to abuse and dependence."
(JAMA. 2008;300[17]:2057-2057. 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, November 4, 2008
Media Advisory: To contact Shumin M. Zhang, M.D., Sc.D., call Lori Shanks at 617-534-1604.
FOLIC ACID, B VITAMINS DO NOT APPEAR TO AFFECT CANCER RISK
CHICAGO—A daily supplementation combination that included folic acid and vitamin B6 and B12 had no significant effect on the overall risk of cancer, including breast cancer, among women at high risk of cardiovascular disease, according to a study in the November 5 issue of JAMA.
Folate, vitamin B6, and vitamin B12 (water-soluble, essential B vitamins) are thought to play an important role in cancer prevention. "Background fortification of the food supply with folic acid (a synthetic form of folate), a policy that began in the United States in 1998 to reduce risk of neural tube defects, has improved folate status in the general population. Approximately one-third of U.S. adults currently take multivitamin supplements containing folic acid, vitamin B6, and vitamin B12," the authors write. Data from randomized trials of folic acid alone or in combination with B vitamins and cancer risk are limited, not entirely consistent, and one trial has even raised concerns about harmful effects.
Shumin M. Zhang, M.D., Sc.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a trial to evaluate the effect of combined folic acid, vitamin B6, and vitamin B12 treatment on cancer risk in women at high risk for cardiovascular disease. The Women's Antioxidant and Folic Acid Cardiovascular Study included 5,442 U.S. female health professionals age 42 years or older, with pre-existing cardiovascular disease or three or more coronary risk factors, who were randomly assigned to receive either a daily combination (n = 2,721) of folic acid (2.5 mg.), vitamin B6 (50 mg.), and vitamin B12 (1 mg.) or a matching placebo (n = 2,721). They were treated for 7.3 years, from April 1998 through July 2005.
"A total of 379 women developed invasive cancer (187 in the active treatment group and 192 in the placebo group)," the authors write. "Compared with placebo, women receiving the active treatment had similar risk of developing total invasive cancer, breast cancer, or any cancer death." There were no differences according to current use of multivitamin supplements, intakes of total folate, vitamin B6, and vitamin B12, or history of cancer at baseline. Lack of effect for total invasive cancer did not vary over time.
Age significantly modified the effect of combined B vitamin treatment on risk of total invasive cancer and breast cancer. A significantly reduced risk was observed for total invasive cancer and breast cancer among women age 65 years or older at study entry, but no reductions in risk were observed among younger women (40-54 years or 55-64 years).
"If the finding is real and substantiated, the results may have public health significance because the incidence rates of cancer are high in elderly persons. The finding is biologically plausible because elderly individuals have increased requirements for these B vitamins," the authors write.
"In conclusion, treatment with combined folic acid, vitamin B6, and vitamin B12 provided neither beneficial nor harmful effects on overall risk of total cancer, breast cancer, or deaths from cancer among women at high risk for CVD."
(JAMA. 2008;300[17]:2012-2021. 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, November 4, 2008
Media Advisory: To contact corresponding author Véronique L. Roger, M.D., M.P.H., call Traci Klein at 507-284-5005.
RISK OF SUDDEN CARDIAC DEATH APPEARS INCREASED WITHIN 30 DAYS OF HEART ATTACK
CHICAGO—The risk of sudden cardiac death following a heart attack has declined significantly in the past 30 years, although patients appear to be at elevated risk for sudden cardiac death for the first month after having a heart attack, after which time their risk decreases unless they develop heart failure, according to a study in the November 5 issue of JAMA.
"Sudden cardiac death is a devastating complication of myocardial infarction [heart attack]," the authors write as background information in the article. Determining which patients are at risk for this complication remains challenging, they note. Currently, risk prediction approaches are based on characteristics assessed shortly after heart attack—a strategy that may be insufficient. Other factors that occur in the days to weeks following heart attack, such as heart failure or recurrent ischemia (which may cause chest pain from narrowed or blocked coronary arteries), may be associated with risk of sudden cardiac death.
A. Selcuk Adabag, M.D., M.S., of Veterans Affairs Medical Center, Minneapolis, and colleagues at Mayo Clinic, Rochester, Minn., studied 2,997 residents (average age 67, 59 percent men) who had a heart attack in Olmsted County, Minn., between 1979 and 2005. Patients were followed through medical records for a median (midpoint) of 4.7 years, through Feb. 29, 2008.
During this time, 1,160 patients died, including 282 (24 percent) from sudden cardiac death. The 30-day cumulative incidence of sudden cardiac death was 1.2 percent, which is four times higher than expected. For each following year, however, the rate of sudden cardiac death was constant at 1.2 percent per year—lower than the rate among the general population. The cumulative five-year incidence of sudden cardiac death among heart attack patients was 6.9 percent.
A total of 842 patients developed recurrent ischemia, 365 developed heart failure and 873 developed both. Recurrent ischemia was not associated with sudden cardiac death. However, compared with patients who did not experience heart failure during follow-up, those who did had a 2.5 percent higher risk of sudden cardiac death within 30 days of heart attack and in each year thereafter.
"The risk of sudden cardiac death has declined significantly over time for myocardial infarctions that occurred between 1997 and 2005 compared with between 1979 and 1987," the authors write—a decline of more than 40 percent over the past 25 years. This decline predates the widespread use of defibrillators but coincides with other drastic changes in therapy for heart attacks, including secondary prevention and reperfusion therapy, which re-opens blocked arteries.
"In the community, the risk of sudden cardiac death is the highest during the first month after myocardial infarction when it markedly exceeds the rate in the general population," the authors conclude. "Among 30-day survivors, the risk of sudden cardiac death declines rapidly but it is markedly increased by the occurrence of heart failure during follow-up. This underscores the importance of continued surveillance of patients after myocardial infarction and the dynamic nature of risk stratification."
(JAMA. 2008;300[17]:2022-2029. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Public Health Service and grants from the National Institutes of Health. Dr. Adabag is supported, in part, by a VA Clinical Science R&D Service Grant. Co-author Dr. Roger is an established investigator of the American Heart Association. 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.
JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS HIGH-DOSE INTAKE OF THREE B VITAMINS DOES NOT REDUCE WOMEN'S RISK OF DEVELOPING CANCER
INTRO:
Approximately one-third of U.S. adults take multivitamin supplements containing three B vitamins — B6, B12, and Folic Acid. But do large, daily doses of those vitamins help reduce cancer risk in women? We now have results of a study which explored that very question. Alissa Krinsky explains in this week's JAMA Report.
VIDEO:
B-ROLL
Vitamin Bottles
B6 vitamin bottle
B12 vitamin bottle
Folic Acid vitamin bottle
AUDIO:
MILLIONS OF AMERICANS TAKE MULTIVITAMINS THAT CONTAIN MEMBERS OF THE B VITAMIN FAMILY AS PART OF A BALANCED DIET. B6 HELPS MAINTAIN HEALTHY IMMUNE FUNCTION - AND B12 IS IMPORTANT FOR THE BRAIN AND NERVOUS SYSTEM. ANOTHER B VITAMIN IS FOLIC ACID, COMMONLY TAKEN BY PREGNANT WOMEN TO PREVENT BIRTH DEFECTS.
VIDEO:
SOT/FULL
Super @ :20
JoAnn Manson, M.D.
Brigham and Women's Hospital
Runs :09
AUDIO:
"It's very important that women, before pregnancy even — before conception, have adequate intake of folic acid and throughout pregnancy."
VIDEO:
B-ROLL
Vitamin Bottles
Doctors walk into room together
AUDIO:
BUT WITH ALL THEIR HEALTH BENEFITS, DOES TAKING SUPPLEMENTS OF THESE THREE VITAMINS HELP PREVENT CANCER IN WOMEN? DOCTOR JOANN MANSON AND LEAD RESEARCHER DOCTOR SHUMIN ZHANG (Shoo-meen jong), OF BOSTON'S BRIGHAM AND WOMEN'S HOSPITAL - AND THEIR COLLEAGUES - DECIDED TO EXPLORE THAT VERY QUESTION.
VIDEO:
SOT/FULL
JoAnn Manson, M.D.
Brigham and Women's Hospital
Runs :12
AUDIO:
"We were interested in the effect of the folic acid and B vitamins on cancer in general, total cancer, as well as specifically the risk of breast cancer and colorectal cancer."
VIDEO:
B-ROLL
GXF/JAMA COVER
GFX:
B Vitamin Study
- Seven Years
- More Than 5,000 Women
- Age 40 and Over
- Large Doses of B6, B12, Folic Acid
- Largest B Vitamin Study of Women
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. IT FOLLOWED, OVER SEVEN YEARS, MORE THAN FIVE THOUSAND WOMEN - AGE FORTY AND OVER - WHO TOOK LARGE DOSES OF THE THREE VITAMINS. TO DATE, IT'S THE LARGEST B VITAMIN STUDY OF WOMEN.
VIDEO:
SOT/FULL
Spuper @ 1:13
Shumin Zhang, M.D.
Brigham and Women's Hospital
Runs :04
AUDIO:
"Women has been underrepresented in previous B vitamin trials."
VIDEO:
BROLL
Vitamin B12 Bottle
AUDIO:
BUT THIS B—VITAMIN STUDY SHOWED NO EVIDENCE OF REDUCING CANCER RISK.
VIDEO:
SOT/FULL
JoAnn Manson, M.D.
Brigham and Women's Hospital
Runs :18
AUDIO:
"It was surprising that there was no evidence of any cancer benefit because some previous studies had suggested that at least a diet that is high in Folate and B vitamins might be protective against cancer."
VIDEO:
BROLL
Researchers reviewing study documents
AUDIO:
SO ALTHOUGH THE VITAMINS PROVIDE OTHER HEALTH BENEFITS, THE SEARCH CONTINUES FOR WAYS TO REDUCE CANCER RISK. ALISSA KRINSKY, THE JAMA REPORT.
TAG:
The study had a dual purpose: all of the women who were participants either had cardiovascular disease or had at least three coronary risk factors. In a set of study results previously released, it was found that the three B vitamins also had no beneficial effect on cardiovascular disease. For more information about this study you can log on to www.jama.com.
