Archives News Releases - October 26, 2009

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, October 26, 2009)

Heart Attacks Become More Common But Less Often Fatal in Women

Fitness Levels Decline With Age, Especially After 45

Partners in Weight Loss Success May Help African-Americans Shed More Pounds

INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.

JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.

Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 26, 2009
Media Advisory: To contact Amytis Towfighi, M.D., call Leslie Ridgeway at 323-442-2823 or e-mail lridgewa{at}usc.edu, or call Meghan Lewit at 323-442-3941 or e-mail lewit{at}usc.edu. To contact Viola Vaccarino, M.D., Ph.D., call Jennifer Johnson at 404-727-5696 or e-mail jennifer.johnson{at}emory.edu. To contact corresponding editorial author Vera Regitz-Zagrosek, M.D., Ph.D., e-mail vera.regitz-zagrosek{at}charite.de.

Heart Attacks Become More Common But Less Often Fatal in Women

CHICAGO—Heart attacks appear to have become more common in middle-aged women over the past two decades, but all women and especially those younger than 55 have recently experienced a greater increase than men in their chances of survival following such a heart event, according to two reports in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Middle-aged women have historically had a lower overall risk of heart events and stroke than men of a similar age, according to background information in one of the articles. However, a recent report showing higher stroke rates among women than men in a sample representative of the U.S. population appeared to reveal a new phenomenon and raised the question of whether heart disease or heart attack were also becoming more prevalent among women.

Amytis Towfighi, M.D., of the University of Southern California, Los Angeles, and colleagues analyzed data from U.S. adults age 35 to 54 who participated in the National Health and Nutrition Examination Surveys (nationally representative surveys conducted by the government) during 1988 to 1994 (4,326 participants) and 1999 to 2004 (4,075 participants). The researchers assessed how often men and women had heart attacks and also compared their Framingham coronary risk score, a measurement of heart disease risk over 10 years that includes factors such as age, cholesterol levels, blood pressure and smoking history.

In both study periods, men age 35 to 54 years had more heart attacks than women in the same age group. However, the gap narrowed in more recent years as heart attacks decreased in prevalence among men and increased in prevalence among women (2.5 percent of men and 0.7 percent of women reported a history of heart attack in 1988-1994, whereas 2.2 percent of men and 1 percent of women did so in 1999-2004).

Between the two time periods, the average Framingham coronary risk score showed an improving trend among men but decreased among women. In male participants, total cholesterol levels remained stable, high-density lipoprotein (HDL or "good" cholesterol) levels and systolic (top number) blood pressure levels improved and smoking levels declined. The only risk factor that improved among women was HDL levels. Diabetes prevalence increased among both men and women, likely due to insulin resistance and the obesity epidemic in both sexes.

"Although men in their midlife years continue to have a higher prevalence of myocardial infarction and a higher 10-year risk of hard coronary heart disease than women of similar age, our study suggests that the risk is increasing in women, while decreasing in men," the authors write. "Therefore, intensification of efforts at screening for and treating vascular risk factors in women in their midlife years may be warranted."

In another report, Viola Vaccarino, M.D., Ph.D., of Emory University School of Medicine, Atlanta, and colleagues investigated trends in the rate of in-hospital deaths following heart attack from June 1, 1994, through Dec. 31, 2006. Data were collected from 916,380 patients through the National Registry of Myocardial Infarction.

In-hospital death rates decreased among all patients between 1994 and 2006, but decreased more markedly in women than in men. The reduced risk of death was largest in women younger than 55 years (a 52.9 percent reduction) and lowest in men of the same age (33.3 percent). The absolute decrease in the risk of death among patients younger than 55 was three times larger in women (2.7 percent) than men (0.9 percent).

"A large part (93 percent) of this sharper decrease in mortality of younger women compared with men in recent years was because the risk status of women on admission improved compared with that of men," the authors write. "Such improvement may be due to better recognition and management of coronary heart disease and its risk factors in women before the acute myocardial infarction event, as suggested by the narrowing sex difference in previous revascularization [surgical treatment for heart disease]."
(Arch Intern Med. 2009;169[19]:1762-1766 and 1767-1774. 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: Prevention Is Key for Women and Heart Disease

"Cardiovascular illnesses have been long neglected in their role as the primary cause of mortality in women, both by patients and physicians," write Sabine Oertelt-Prigione, M.D., and Vera Regitz-Zagrosek, M.D., Ph.D., of Charité Universitaetsmedizin, Berlin, in an accompanying editorial. "Men are still believed to be at greater risk for myocardial infarction and stroke and are thus more aggressively informed, counseled and treated for these diseases."

"The improvements described by Towfighi et al and Vaccarino et al are encouraging and indicate that we are on the right track. However, much needs to be done, especially in consideration of the increase in prevalence of risk factors as obesity and type 2 diabetes mellitus in the general population."

"As these studies show, increased and continuous vigorous attention to the prevention of cardiovascular risk factors-by healthy diet, regular physical activity and avoidance of smoke and smoking-is necessary for both men and women," they conclude.
(Arch Intern Med. 2009;169[19]:1740-1741. 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, October 26, 2009
Media Advisory: To contact Andrew S. Jackson, P.E.D., call Marisa Ramirez at 713-743-8152 or e-mail mrcannon{at}uh.edu.

Fitness Levels Decline With Age, Especially After 45
Exercising, maintaining a healthy weight and not smoking associated with better cardiovascular health

CHICAGO—Men and women become gradually less fit with age, with declines accelerating after age 45, according to a report in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, maintaining a healthy body mass index (BMI), not smoking and being physically active are associated with higher fitness levels throughout adult life.

"The U.S. population is aging and is becoming more obese and sedentary," the authors write as background information in the article. "It is well documented that the cardiorespiratory fitness of men and women declines with age and that body composition and habitual physical activity are related to cardiorespiratory fitness." Low fitness levels increase the risk of diseases and interfere with older adults' ability to function independently.

Andrew S. Jackson, P.E.D., of the University of Houston, and colleagues studied 3,429 women and 16,889 men age 20 to 96 who participated in the Aerobics Center Longitudinal Study (ACLS) between 1974 and 2006. During the study, participants completed between two and 33 health examinations that included counseling about diet, exercise and other lifestyle factors along with a treadmill exercise to assess fitness.

Statistical models showed that while fitness levels declined continuously over time, the decrease was not linear or steady-cardiorespiratory fitness declined more rapidly after age 45. The decline for men was greater than that for women.

The results also "showed that being active, keeping a normal BMI and not smoking were associated with substantially higher levels of cardiorespiratory fitness during the adult life span studied," the authors write. "Being inactive and having a high BMI were associated with a lower age at which an individual could be expected to reach threshold cardiorespiratory fitness levels associated with substantially higher health risks."

Given the high rates of obesity and low levels of physical activity previously observed in the general population, the results also suggest that more men and women will reach the fitness level designated by the Social Security Administration as representing disability at a younger age, the authors note. "These data indicate the need for physicians to recommend to their patients the necessity to maintain their weight, engage in regular aerobic exercise and abstain from smoking," they conclude.
(Arch Intern Med. 2009;169[19]:1781-1787. Available to the media pre-embargo at www.jamamedia.org)

Editor's Note: The ACLS 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.

Go back to the top.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 26, 2009
Media Advisory: To contact Shiriki K. Kumanyika, Ph.D., M.P.H., call Karen Kreeger at 215-349-5658 or 215-459-0544 (cell), or e-mail karen.kreeger{at}uphs.upenn.edu.

Partners in Weight Loss Success May Help African-Americans Shed More Pounds

CHICAGO—Enrolling in a weight loss program with a family member or friend appears to enhance weight loss among African Americans, but only if the involved partner attends sessions frequently or also loses weight, according to a report in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Obesity and its cardiovascular complications affect many African Americans, according to background information in the article. Standard behavioral treatments for obesity appear to be less successful in African Americans than in whites. Cultural modifications to these standard programs-such as the inclusion of family members and support networks-may enhance their effectiveness.

Shiriki K. Kumanyika, Ph.D., M.P.H., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, conducted a two-year trial of a culturally specific weight loss program among 344 African American men and women. The goal was to achieve and maintain a 5 percent to 10 percent weight loss. Components of the program included counseling that encouraged self-monitoring of food intake and physical activity, distribution of pedometers, group sessions involving weight and activity checks and skill building, and community-based field workshops such as cooking demonstrations and gym visits.

A total of 63 individuals enrolled in the program alone and 281 enrolled with a friend or family member (130 of whom were designated as the main, or index, participants and 151 as partners). Of the participants with partners, 65 (and 78 partners) were randomly assigned to a high-support group in which both individuals were expected to attend and participate fully in all treatment sessions. The remaining 65 (and 73 partners) were assigned to a low-support group, in which some portions of the program were restricted to the main participants. All participants' progress was measured at six, 12, 18 and 24 months.

After 24 months, main participants had lost an average of 2.4 kilograms (about 5.3 pounds). Participants in the two family groups initially had better attendance and greater weight loss than those in the individual group, but these changes were not statistically significant and decreased over time.

However, participants whose partners attended more personally tailored counseling sessions had lost more weight at six months in the high-support group and at six, 12 and 24 months in the low-support group. In addition, those in both family groups whose partner lost at least 5 percent of their body weight had greater weight loss at six months than those whose partner lost less than 5 percent (6.1 percent vs. 2.9 percent of body weight lost in the high-support group and 6.1 percent vs. 3.1 percent in the low-support group).

"We evaluated family and friend social support as a specific cultural adaptation strategy, which was added to an ethnic-specific program that was also adapted in other respects," the authors conclude. "Beneficial effects on weight loss were linked to actual rather than assigned partner participation and to partner success in losing weight. Further studies may elucidate ways to facilitate effective family or friend participation and to improve absolute weight losses."
(Arch Intern Med. 2009;169[19]:1795-1804. Available to the media pre-embargo at www.jamamedia.org)

Editor's Note: This study was funded by a grant from the National Heart, Lung, and Blood Institute. Laboratory analyses were provided through a General Clinical Research Center Grant from the National Institutes of Health/National Center for Research Resources. 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.

Go back to the top.


	Welcome \| My Account \| Access Rights \| Sign In October 26, 2009 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, October 26, 2009) Heart Attacks Become More Common But Less Often Fatal in Women Fitness Levels Decline With Age, Especially After 45 Partners in Weight Loss Success May Help African-Americans Shed More Pounds INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 26, 2009 Media Advisory: To contact Amytis Towfighi, M.D., call Leslie Ridgeway at 323-442-2823 or e-mail lridgewa{at}usc.edu, or call Meghan Lewit at 323-442-3941 or e-mail lewit{at}usc.edu. To contact Viola Vaccarino, M.D., Ph.D., call Jennifer Johnson at 404-727-5696 or e-mail jennifer.johnson{at}emory.edu. To contact corresponding editorial author Vera Regitz-Zagrosek, M.D., Ph.D., e-mail vera.regitz-zagrosek{at}charite.de. Heart Attacks Become More Common But Less Often Fatal in Women CHICAGO—Heart attacks appear to have become more common in middle-aged women over the past two decades, but all women and especially those younger than 55 have recently experienced a greater increase than men in their chances of survival following such a heart event, according to two reports in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Middle-aged women have historically had a lower overall risk of heart events and stroke than men of a similar age, according to background information in one of the articles. However, a recent report showing higher stroke rates among women than men in a sample representative of the U.S. population appeared to reveal a new phenomenon and raised the question of whether heart disease or heart attack were also becoming more prevalent among women. Amytis Towfighi, M.D., of the University of Southern California, Los Angeles, and colleagues analyzed data from U.S. adults age 35 to 54 who participated in the National Health and Nutrition Examination Surveys (nationally representative surveys conducted by the government) during 1988 to 1994 (4,326 participants) and 1999 to 2004 (4,075 participants). The researchers assessed how often men and women had heart attacks and also compared their Framingham coronary risk score, a measurement of heart disease risk over 10 years that includes factors such as age, cholesterol levels, blood pressure and smoking history. In both study periods, men age 35 to 54 years had more heart attacks than women in the same age group. However, the gap narrowed in more recent years as heart attacks decreased in prevalence among men and increased in prevalence among women (2.5 percent of men and 0.7 percent of women reported a history of heart attack in 1988-1994, whereas 2.2 percent of men and 1 percent of women did so in 1999-2004). Between the two time periods, the average Framingham coronary risk score showed an improving trend among men but decreased among women. In male participants, total cholesterol levels remained stable, high-density lipoprotein (HDL or "good" cholesterol) levels and systolic (top number) blood pressure levels improved and smoking levels declined. The only risk factor that improved among women was HDL levels. Diabetes prevalence increased among both men and women, likely due to insulin resistance and the obesity epidemic in both sexes. "Although men in their midlife years continue to have a higher prevalence of myocardial infarction and a higher 10-year risk of hard coronary heart disease than women of similar age, our study suggests that the risk is increasing in women, while decreasing in men," the authors write. "Therefore, intensification of efforts at screening for and treating vascular risk factors in women in their midlife years may be warranted." In another report, Viola Vaccarino, M.D., Ph.D., of Emory University School of Medicine, Atlanta, and colleagues investigated trends in the rate of in-hospital deaths following heart attack from June 1, 1994, through Dec. 31, 2006. Data were collected from 916,380 patients through the National Registry of Myocardial Infarction. In-hospital death rates decreased among all patients between 1994 and 2006, but decreased more markedly in women than in men. The reduced risk of death was largest in women younger than 55 years (a 52.9 percent reduction) and lowest in men of the same age (33.3 percent). The absolute decrease in the risk of death among patients younger than 55 was three times larger in women (2.7 percent) than men (0.9 percent). "A large part (93 percent) of this sharper decrease in mortality of younger women compared with men in recent years was because the risk status of women on admission improved compared with that of men," the authors write. "Such improvement may be due to better recognition and management of coronary heart disease and its risk factors in women before the acute myocardial infarction event, as suggested by the narrowing sex difference in previous revascularization [surgical treatment for heart disease]." (Arch Intern Med. 2009;169[19]:1762-1766 and 1767-1774. 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: Prevention Is Key for Women and Heart Disease "Cardiovascular illnesses have been long neglected in their role as the primary cause of mortality in women, both by patients and physicians," write Sabine Oertelt-Prigione, M.D., and Vera Regitz-Zagrosek, M.D., Ph.D., of Charité Universitaetsmedizin, Berlin, in an accompanying editorial. "Men are still believed to be at greater risk for myocardial infarction and stroke and are thus more aggressively informed, counseled and treated for these diseases." "The improvements described by Towfighi et al and Vaccarino et al are encouraging and indicate that we are on the right track. However, much needs to be done, especially in consideration of the increase in prevalence of risk factors as obesity and type 2 diabetes mellitus in the general population." "As these studies show, increased and continuous vigorous attention to the prevention of cardiovascular risk factors-by healthy diet, regular physical activity and avoidance of smoke and smoking-is necessary for both men and women," they conclude. (Arch Intern Med. 2009;169[19]:1740-1741. 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. Go back to the top. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 26, 2009 Media Advisory: To contact Andrew S. Jackson, P.E.D., call Marisa Ramirez at 713-743-8152 or e-mail mrcannon{at}uh.edu. Fitness Levels Decline With Age, Especially After 45 Exercising, maintaining a healthy weight and not smoking associated with better cardiovascular health CHICAGO—Men and women become gradually less fit with age, with declines accelerating after age 45, according to a report in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, maintaining a healthy body mass index (BMI), not smoking and being physically active are associated with higher fitness levels throughout adult life. "The U.S. population is aging and is becoming more obese and sedentary," the authors write as background information in the article. "It is well documented that the cardiorespiratory fitness of men and women declines with age and that body composition and habitual physical activity are related to cardiorespiratory fitness." Low fitness levels increase the risk of diseases and interfere with older adults' ability to function independently. Andrew S. Jackson, P.E.D., of the University of Houston, and colleagues studied 3,429 women and 16,889 men age 20 to 96 who participated in the Aerobics Center Longitudinal Study (ACLS) between 1974 and 2006. During the study, participants completed between two and 33 health examinations that included counseling about diet, exercise and other lifestyle factors along with a treadmill exercise to assess fitness. Statistical models showed that while fitness levels declined continuously over time, the decrease was not linear or steady-cardiorespiratory fitness declined more rapidly after age 45. The decline for men was greater than that for women. The results also "showed that being active, keeping a normal BMI and not smoking were associated with substantially higher levels of cardiorespiratory fitness during the adult life span studied," the authors write. "Being inactive and having a high BMI were associated with a lower age at which an individual could be expected to reach threshold cardiorespiratory fitness levels associated with substantially higher health risks." Given the high rates of obesity and low levels of physical activity previously observed in the general population, the results also suggest that more men and women will reach the fitness level designated by the Social Security Administration as representing disability at a younger age, the authors note. "These data indicate the need for physicians to recommend to their patients the necessity to maintain their weight, engage in regular aerobic exercise and abstain from smoking," they conclude. (Arch Intern Med. 2009;169[19]:1781-1787. Available to the media pre-embargo at www.jamamedia.org) Editor's Note: The ACLS 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. Go back to the top. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 26, 2009 Media Advisory: To contact Shiriki K. Kumanyika, Ph.D., M.P.H., call Karen Kreeger at 215-349-5658 or 215-459-0544 (cell), or e-mail karen.kreeger{at}uphs.upenn.edu. Partners in Weight Loss Success May Help African-Americans Shed More Pounds CHICAGO—Enrolling in a weight loss program with a family member or friend appears to enhance weight loss among African Americans, but only if the involved partner attends sessions frequently or also loses weight, according to a report in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Obesity and its cardiovascular complications affect many African Americans, according to background information in the article. Standard behavioral treatments for obesity appear to be less successful in African Americans than in whites. Cultural modifications to these standard programs-such as the inclusion of family members and support networks-may enhance their effectiveness. Shiriki K. Kumanyika, Ph.D., M.P.H., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, conducted a two-year trial of a culturally specific weight loss program among 344 African American men and women. The goal was to achieve and maintain a 5 percent to 10 percent weight loss. Components of the program included counseling that encouraged self-monitoring of food intake and physical activity, distribution of pedometers, group sessions involving weight and activity checks and skill building, and community-based field workshops such as cooking demonstrations and gym visits. A total of 63 individuals enrolled in the program alone and 281 enrolled with a friend or family member (130 of whom were designated as the main, or index, participants and 151 as partners). Of the participants with partners, 65 (and 78 partners) were randomly assigned to a high-support group in which both individuals were expected to attend and participate fully in all treatment sessions. The remaining 65 (and 73 partners) were assigned to a low-support group, in which some portions of the program were restricted to the main participants. All participants' progress was measured at six, 12, 18 and 24 months. After 24 months, main participants had lost an average of 2.4 kilograms (about 5.3 pounds). Participants in the two family groups initially had better attendance and greater weight loss than those in the individual group, but these changes were not statistically significant and decreased over time. However, participants whose partners attended more personally tailored counseling sessions had lost more weight at six months in the high-support group and at six, 12 and 24 months in the low-support group. In addition, those in both family groups whose partner lost at least 5 percent of their body weight had greater weight loss at six months than those whose partner lost less than 5 percent (6.1 percent vs. 2.9 percent of body weight lost in the high-support group and 6.1 percent vs. 3.1 percent in the low-support group). "We evaluated family and friend social support as a specific cultural adaptation strategy, which was added to an ethnic-specific program that was also adapted in other respects," the authors conclude. "Beneficial effects on weight loss were linked to actual rather than assigned partner participation and to partner success in losing weight. Further studies may elucidate ways to facilitate effective family or friend participation and to improve absolute weight losses." (Arch Intern Med. 2009;169[19]:1795-1804. Available to the media pre-embargo at www.jamamedia.org) Editor's Note: This study was funded by a grant from the National Heart, Lung, and Blood Institute. Laboratory analyses were provided through a General Clinical Research Center Grant from the National Institutes of Health/National Center for Research Resources. 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. Go back to the top.