Heidi Splete

A lifestyle intervention combining diet and physical activity resulted in significant weight loss and improved cardiovascular risk factors after 12 months in a study of 101 severely obese adults. The results were published online Oct. 9 in JAMA.

Few clinical trials have focused on the effectiveness of diet and exercise interventions for the severely obese, said Bret H. Goodpaster, Ph.D., of the University of Pittsburgh and his colleagues.

In this study, 130 severely obese adults were randomized to the diet and exercise intervention for 12 months or dietary intervention only for the first 6 months with physical activity added after 6 months. Of these, 101 completed the 12-month study (JAMA 2010 Oct. 9 [doi:10.1001/jama.2010.1505]).

Both groups lost significant weight after 6 months, but those in the group that started exercising immediately lost significantly more weight on average in the first 6 months than did those in the delayed-exercise group (10.9 kg vs. 8.2 kg, respectively). The immediate-exercise group maintained their average weight loss advantage at 1 year, although the difference in weight loss between the two groups was no longer significant (12.1 kg vs. 9.9 kg, respectively).

In addition, participants in both groups showed significant improvement in blood pressure and insulin resistance, as well as reductions in waist circumference, visceral abdominal fat, and hepatic fat content after 12 months, compared with baseline levels. However, the hepatic fat content loss was significantly greater in the immediate exercise group, compared with the delayed exercise group after 12 months, the researchers noted. No differences in adverse events were reported between the two groups.

The participants were prescribed a weight-loss diet based on their initial body weight, and they received low-cost exercise supplies, including pedometers and exercise videos. During the first 6 months, participants had one individual meeting and three group meetings each month. In the next 6 months, they had two group meetings and two telephone calls per month. Participants who met their weight-loss goals were eligible for periodic small financial incentives.

The participants were aged 30-55 years, more than 80% were women, and 37% were black. A total of 98 patients (75%) had a body mass index of 40 kg/m2 or greater (class III obesity), and the remaining 25% had a BMI between 35 and 39.9 (class II obesity).

Patients with uncontrolled hypertension or diabetes, as well as those with a history of cancer, bariatric surgery, or participation in a formal weight-loss program were excluded. Women who had been pregnant during the past 6 months or individuals being treated for coronary artery disease also were excluded.

A total of 78% of individuals in the immediate activity group lost more than 5% of their baseline body weight after 12 months, compared with 65% in the delayed activity group. Regardless of intervention group, the class III obesity patients lost significantly more of their body weight than did the class II patients after 12 months (10.9% vs. 7.0%), the researchers noted.

The results reflect findings from similar studies in overweight and class I obese individuals, the researchers said. “In addition, despite the slightly lower weight loss in African Americans, the interventions were effective in white as well as African American individuals,” they added.

“Although this lifestyle intervention did not achieve the degree of weight loss typically observed following bariatric surgery, this magnitude of weight loss was associated with significant improvements in insulin resistance, blood pressure, and levels of plasma triglycerides,” the researchers noted. “Our data make a strong case that serious consideration should be given by health care systems to incorporating more intensive lifestyle interventions similar to those used in our study.” However, more research is needed to determine cost-effectiveness and long-term efficacy, they said.

The study was funded by the Commonwealth of Pennsylvania Department of Health. Dr. Goodpaster had no financial conflicts. Study coauthor John M. Jakicic, Ph.D., reported serving on the scientific advisory board for Free and Clear (an organization that specializes in Internet- and Web-based cognitive behavioral coaching), serving as a consultant to Proctor & Gamble, BodyMedia (a weight-loss system), and the University of Pittsburgh Medical Center Health Plan. Dr. Jakicic also reported receiving research support from BodyMedia and the Beverage Institute for Health & Wellness.

Dr. Ryan disclosed having received compensation from NutriSystem and from companies that develop weight-loss medications, but reported that she has not received any compensation from “the weight-loss sector” since January 2008. Dr. Kushner disclosed receiving compensation from the weight-loss service Diet.com and companies developing weight-loss medications.

A lifestyle intervention combining diet and physical activity resulted in significant weight loss and improved cardiovascular risk factors after 12 months in a study of 101 severely obese adults. The results were published online Oct. 9 in JAMA.

Few clinical trials have focused on the effectiveness of diet and exercise interventions for the severely obese, said Bret H. Goodpaster, Ph.D., of the University of Pittsburgh and his colleagues.

In this study, 130 severely obese adults were randomized to the diet and exercise intervention for 12 months or dietary intervention only for the first 6 months with physical activity added after 6 months. Of these, 101 completed the 12-month study (JAMA 2010 Oct. 9 [doi:10.1001/jama.2010.1505]).

Both groups lost significant weight after 6 months, but those in the group that started exercising immediately lost significantly more weight on average in the first 6 months than did those in the delayed-exercise group (10.9 kg vs. 8.2 kg, respectively). The immediate-exercise group maintained their average weight loss advantage at 1 year, although the difference in weight loss between the two groups was no longer significant (12.1 kg vs. 9.9 kg, respectively).

In addition, participants in both groups showed significant improvement in blood pressure and insulin resistance, as well as reductions in waist circumference, visceral abdominal fat, and hepatic fat content after 12 months, compared with baseline levels. However, the hepatic fat content loss was significantly greater in the immediate exercise group, compared with the delayed exercise group after 12 months, the researchers noted. No differences in adverse events were reported between the two groups.

The participants were prescribed a weight-loss diet based on their initial body weight, and they received low-cost exercise supplies, including pedometers and exercise videos. During the first 6 months, participants had one individual meeting and three group meetings each month. In the next 6 months, they had two group meetings and two telephone calls per month. Participants who met their weight-loss goals were eligible for periodic small financial incentives.

The participants were aged 30-55 years, more than 80% were women, and 37% were black. A total of 98 patients (75%) had a body mass index of 40 kg/m2 or greater (class III obesity), and the remaining 25% had a BMI between 35 and 39.9 (class II obesity).

Patients with uncontrolled hypertension or diabetes, as well as those with a history of cancer, bariatric surgery, or participation in a formal weight-loss program were excluded. Women who had been pregnant during the past 6 months or individuals being treated for coronary artery disease also were excluded.

A total of 78% of individuals in the immediate activity group lost more than 5% of their baseline body weight after 12 months, compared with 65% in the delayed activity group. Regardless of intervention group, the class III obesity patients lost significantly more of their body weight than did the class II patients after 12 months (10.9% vs. 7.0%), the researchers noted.

The results reflect findings from similar studies in overweight and class I obese individuals, the researchers said. “In addition, despite the slightly lower weight loss in African Americans, the interventions were effective in white as well as African American individuals,” they added.

“Although this lifestyle intervention did not achieve the degree of weight loss typically observed following bariatric surgery, this magnitude of weight loss was associated with significant improvements in insulin resistance, blood pressure, and levels of plasma triglycerides,” the researchers noted. “Our data make a strong case that serious consideration should be given by health care systems to incorporating more intensive lifestyle interventions similar to those used in our study.” However, more research is needed to determine cost-effectiveness and long-term efficacy, they said.

The study was funded by the Commonwealth of Pennsylvania Department of Health. Dr. Goodpaster had no financial conflicts. Study coauthor John M. Jakicic, Ph.D., reported serving on the scientific advisory board for Free and Clear (an organization that specializes in Internet- and Web-based cognitive behavioral coaching), serving as a consultant to Proctor & Gamble, BodyMedia (a weight-loss system), and the University of Pittsburgh Medical Center Health Plan. Dr. Jakicic also reported receiving research support from BodyMedia and the Beverage Institute for Health & Wellness.

Dr. Ryan disclosed having received compensation from NutriSystem and from companies that develop weight-loss medications, but reported that she has not received any compensation from “the weight-loss sector” since January 2008. Dr. Kushner disclosed receiving compensation from the weight-loss service Diet.com and companies developing weight-loss medications.

A lifestyle intervention combining diet and physical activity resulted in significant weight loss and improved cardiovascular risk factors after 12 months in a study of 101 severely obese adults. The results were published online Oct. 9 in JAMA.

Few clinical trials have focused on the effectiveness of diet and exercise interventions for the severely obese, said Bret H. Goodpaster, Ph.D., of the University of Pittsburgh and his colleagues.

In this study, 130 severely obese adults were randomized to the diet and exercise intervention for 12 months or dietary intervention only for the first 6 months with physical activity added after 6 months. Of these, 101 completed the 12-month study (JAMA 2010 Oct. 9 [doi:10.1001/jama.2010.1505]).

Both groups lost significant weight after 6 months, but those in the group that started exercising immediately lost significantly more weight on average in the first 6 months than did those in the delayed-exercise group (10.9 kg vs. 8.2 kg, respectively). The immediate-exercise group maintained their average weight loss advantage at 1 year, although the difference in weight loss between the two groups was no longer significant (12.1 kg vs. 9.9 kg, respectively).

In addition, participants in both groups showed significant improvement in blood pressure and insulin resistance, as well as reductions in waist circumference, visceral abdominal fat, and hepatic fat content after 12 months, compared with baseline levels. However, the hepatic fat content loss was significantly greater in the immediate exercise group, compared with the delayed exercise group after 12 months, the researchers noted. No differences in adverse events were reported between the two groups.

The participants were prescribed a weight-loss diet based on their initial body weight, and they received low-cost exercise supplies, including pedometers and exercise videos. During the first 6 months, participants had one individual meeting and three group meetings each month. In the next 6 months, they had two group meetings and two telephone calls per month. Participants who met their weight-loss goals were eligible for periodic small financial incentives.

The participants were aged 30-55 years, more than 80% were women, and 37% were black. A total of 98 patients (75%) had a body mass index of 40 kg/m2 or greater (class III obesity), and the remaining 25% had a BMI between 35 and 39.9 (class II obesity).

Patients with uncontrolled hypertension or diabetes, as well as those with a history of cancer, bariatric surgery, or participation in a formal weight-loss program were excluded. Women who had been pregnant during the past 6 months or individuals being treated for coronary artery disease also were excluded.

A total of 78% of individuals in the immediate activity group lost more than 5% of their baseline body weight after 12 months, compared with 65% in the delayed activity group. Regardless of intervention group, the class III obesity patients lost significantly more of their body weight than did the class II patients after 12 months (10.9% vs. 7.0%), the researchers noted.

The results reflect findings from similar studies in overweight and class I obese individuals, the researchers said. “In addition, despite the slightly lower weight loss in African Americans, the interventions were effective in white as well as African American individuals,” they added.

“Although this lifestyle intervention did not achieve the degree of weight loss typically observed following bariatric surgery, this magnitude of weight loss was associated with significant improvements in insulin resistance, blood pressure, and levels of plasma triglycerides,” the researchers noted. “Our data make a strong case that serious consideration should be given by health care systems to incorporating more intensive lifestyle interventions similar to those used in our study.” However, more research is needed to determine cost-effectiveness and long-term efficacy, they said.

The study was funded by the Commonwealth of Pennsylvania Department of Health. Dr. Goodpaster had no financial conflicts. Study coauthor John M. Jakicic, Ph.D., reported serving on the scientific advisory board for Free and Clear (an organization that specializes in Internet- and Web-based cognitive behavioral coaching), serving as a consultant to Proctor & Gamble, BodyMedia (a weight-loss system), and the University of Pittsburgh Medical Center Health Plan. Dr. Jakicic also reported receiving research support from BodyMedia and the Beverage Institute for Health & Wellness.

Dr. Ryan disclosed having received compensation from NutriSystem and from companies that develop weight-loss medications, but reported that she has not received any compensation from “the weight-loss sector” since January 2008. Dr. Kushner disclosed receiving compensation from the weight-loss service Diet.com and companies developing weight-loss medications.

WASHINGTON - Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

"I am optimistic that we are becoming a culture of prevention," Dr. Schaffner said.

"Plenty of flu vaccine is anticipated for this year," along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

"Flu vaccination is the best way to protect yourself against the flu," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A(H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, "When H3N2 is dominant, we see more illness in children and older adults," he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

"Pediatricians can play a critical role," Dr. Palfrey emphasized. "In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination."

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barr? syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON - Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

"I am optimistic that we are becoming a culture of prevention," Dr. Schaffner said.

"Plenty of flu vaccine is anticipated for this year," along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

"Flu vaccination is the best way to protect yourself against the flu," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A(H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, "When H3N2 is dominant, we see more illness in children and older adults," he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

"Pediatricians can play a critical role," Dr. Palfrey emphasized. "In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination."

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barr? syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON - Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

"I am optimistic that we are becoming a culture of prevention," Dr. Schaffner said.

"Plenty of flu vaccine is anticipated for this year," along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

"Flu vaccination is the best way to protect yourself against the flu," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A(H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, "When H3N2 is dominant, we see more illness in children and older adults," he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

"Pediatricians can play a critical role," Dr. Palfrey emphasized. "In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination."

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barr? syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON (EGMN) – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON (EGMN) – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON (EGMN) – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

WASHINGTON – Of 400 United States physicians surveyed online, 95% said they have received flu vaccinations for the 2010-2011 flu season or plan to do so, according to data collected by the National Foundation for Infectious Diseases.

These results are encouraging, because they show that more physicians are practicing what they preach about flu vaccination, Dr. William Schaffner, president of the NFID, said at a press conference on influenza.

“I am optimistic that we are becoming a culture of prevention,” Dr. Schaffner said.

“Plenty of flu vaccine is anticipated for this year,” along with a plentiful supply of antiviral medication, he emphasized, and vaccines are available at pharmacies as well as doctors’ offices.

“Flu vaccination is the best way to protect yourself against the flu,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Every year thousands of Americans die from influenza, he said. For the 2010-2011 flu season, the CDC recommends universal vaccination for everyone aged 6 months and older. Several vaccination options are available, including a flu shot, a nasal spray, and a high-dose vaccine for older adults, Dr. Frieden said.

Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases, said that this year’s vaccine contains antibodies against three flu viruses: influenza B, influenza A (H3N2), and influenza A (H1N1). Approximately 119 million doses of 2010-2011 flu vaccine already have been distributed in the United States, with a total of 160 million doses anticipated, Dr. Jernigan said. There is no need for a separate H1N1 vaccine this year, he noted.

So far this year, the H3N2 virus has been the most commonly seen, said Dr. Jernigan. Although children were disproportionately affected by the 2009 H1N1 virus, “When H3N2 is dominant, we see more illness in children and older adults,” he said.

Another important reason to vaccinate children is that they are incredibly efficient at spreading the flu – to their peers, family members, and other close contacts, said Dr. Judith S. Palfrey, past president of the American Academy of Pediatrics.

“Pediatricians can play a critical role,” Dr. Palfrey emphasized. “In a recent NFID consumer survey of mothers, nearly 7 in 10 mothers said their child’s pediatrician was the first person they would turn to for information about influenza and vaccination.”

Dr. Palfrey added that children under 9 years of age who have never been vaccinated against the flu should receive two doses this year, given at about four weeks apart. One dose is sufficient for previously vaccinated children, she said. A complete algorithm for childhood vaccination is available at the American Academy of Pediatrics website.

More information about this year’s flu vaccine is available at the CDC’s flu website, cdc.gov/flu.

Although flu vaccination is recommended for most individuals, some people should not receive the flu vaccine. According to the CDC, individuals who are allergic to eggs or who have had a history of severe reaction to an influenza vaccination should not be vaccinated, nor should anyone who has developed Guillian-Barré syndrome within 6 weeks of receiving an influenza vaccine. Those with a moderate to severe illness that includes a fever should wait until they recover before getting vaccinated. And children younger than 6 months of age should not receive any type of flu vaccine.

Click for video report.

The press conference was sponsored by the National Foundation for Infectious Diseases in partnership with the National Influenza Vaccine Summit. It was supported in part by the Centers for Disease Control and Prevention and by unrestricted educational grants to the NFID from Flu Vaccine Business Practices Initiative (c/o HIDA), Genentech, GlaxoSmithKline, MedImmune, Merck and Co., Novartis Vaccines, Pfizer, Sanofi Pasteur, and Walgreens.

NATIONAL HARBOR, Md. – Age 50 years or older, initial clinical tumor size greater than 5 cm, and pathologic tumor response to neoadjuvant chemotherapy were significant independent predictors of locoregional failure in women who underwent neoadjuvant chemotherapy in two large breast cancer trials.

Investigators presented these results from a 10-year follow-up study of 2,961 patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 and NSABP B-27 trials at the 2010 Breast Cancer Symposium.

Dr. Eleftherios P. Mamounas of Aultman Hospital in Canton, Ohio, and his colleagues reported the 10-year incidence of local or regional failure based on type of surgery was 12.3% in patients who had mastectomies and 10.3% in those who had lumpectomies plus chemotherapy. The incidence of local failure was 8.9% in the mastectomy group and 8.1% in the lumpectomy plus chemotherapy group. The incidence of regional failure was 3.4% and 2.2%, respectively.

In a multivariate analysis based on 318 locoregional failure events in all 2,961 patients, the overall significant predictors of locoregional failure included age 50 years or older (hazard ratio 0.79, P = .04), clinical tumor size greater than 5 cm (HR 1.52, P = .0005), and positive clinical nodal status (HR 1.64, P less than .0001). In addition, being node negative without pathologic complete response (HR 1.65, P less than .001) or node positive with pathologic complete response (HR 2.77, P less than 0.001) were significant predictors as well.

The lack of data on predictors of locoregional failure after neoadjuvant chemotherapy has raised questions about whether to use radiation therapy and when to perform sentinel node biopsies in these patients, said Dr. Mamounas.

He also presented data on locoregional failure in lumpectomy patients and mastectomy patients separately, for the purpose of developing separate treatment nomograms for each procedure. A majority of the locoregional failures in the lumpectomy patients were in-breast recurrences. In mastectomy patients, rates of chest wall recurrence were inversely correlated to pathologic nodal response, Dr. Mamounas said.

“The effect of age (in lumpectomy patients), clinical tumor size (in mastectomy patients), and clinical nodal status at locoregional failure appears to diminish with increasing pathologic response in the breast and axillary nodes,” said Dr. Mamounas.

The neoadjuvant chemotherapy regimens were one of two: doxorubicin (Adriamycin) and cyclophosphamide (AC) for four cycles, or the AC regimen for four cycles followed by four cycles of neoadjuvant/adjuvant docetaxel (Taxotere). Patients in the B-27 trial received tamoxifen in addition to their neoadjuvant chemotherapy. Lumpectomy patients were treated with radiation, but mastectomy patients were not.

The independent predictors were incorporated into two nomograms: one for mastectomy and one for lumpectomy plus breast radiation, Dr. Mamounas explained. Additional studies are planned to include treatment effects in the development and validation of the nomograms, he said.

Disclosures: Dr. Mamounas disclosed serving as a consultant for Eli Lilly & Co. and receiving honoraria from AstraZeneca and Sanofi-Aventis.

NATIONAL HARBOR, Md. – Age 50 years or older, initial clinical tumor size greater than 5 cm, and pathologic tumor response to neoadjuvant chemotherapy were significant independent predictors of locoregional failure in women who underwent neoadjuvant chemotherapy in two large breast cancer trials.

Investigators presented these results from a 10-year follow-up study of 2,961 patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 and NSABP B-27 trials at the 2010 Breast Cancer Symposium.

Dr. Eleftherios P. Mamounas of Aultman Hospital in Canton, Ohio, and his colleagues reported the 10-year incidence of local or regional failure based on type of surgery was 12.3% in patients who had mastectomies and 10.3% in those who had lumpectomies plus chemotherapy. The incidence of local failure was 8.9% in the mastectomy group and 8.1% in the lumpectomy plus chemotherapy group. The incidence of regional failure was 3.4% and 2.2%, respectively.

In a multivariate analysis based on 318 locoregional failure events in all 2,961 patients, the overall significant predictors of locoregional failure included age 50 years or older (hazard ratio 0.79, P = .04), clinical tumor size greater than 5 cm (HR 1.52, P = .0005), and positive clinical nodal status (HR 1.64, P less than .0001). In addition, being node negative without pathologic complete response (HR 1.65, P less than .001) or node positive with pathologic complete response (HR 2.77, P less than 0.001) were significant predictors as well.

The lack of data on predictors of locoregional failure after neoadjuvant chemotherapy has raised questions about whether to use radiation therapy and when to perform sentinel node biopsies in these patients, said Dr. Mamounas.

He also presented data on locoregional failure in lumpectomy patients and mastectomy patients separately, for the purpose of developing separate treatment nomograms for each procedure. A majority of the locoregional failures in the lumpectomy patients were in-breast recurrences. In mastectomy patients, rates of chest wall recurrence were inversely correlated to pathologic nodal response, Dr. Mamounas said.

“The effect of age (in lumpectomy patients), clinical tumor size (in mastectomy patients), and clinical nodal status at locoregional failure appears to diminish with increasing pathologic response in the breast and axillary nodes,” said Dr. Mamounas.

The neoadjuvant chemotherapy regimens were one of two: doxorubicin (Adriamycin) and cyclophosphamide (AC) for four cycles, or the AC regimen for four cycles followed by four cycles of neoadjuvant/adjuvant docetaxel (Taxotere). Patients in the B-27 trial received tamoxifen in addition to their neoadjuvant chemotherapy. Lumpectomy patients were treated with radiation, but mastectomy patients were not.

The independent predictors were incorporated into two nomograms: one for mastectomy and one for lumpectomy plus breast radiation, Dr. Mamounas explained. Additional studies are planned to include treatment effects in the development and validation of the nomograms, he said.

Disclosures: Dr. Mamounas disclosed serving as a consultant for Eli Lilly & Co. and receiving honoraria from AstraZeneca and Sanofi-Aventis.

NATIONAL HARBOR, Md. – Age 50 years or older, initial clinical tumor size greater than 5 cm, and pathologic tumor response to neoadjuvant chemotherapy were significant independent predictors of locoregional failure in women who underwent neoadjuvant chemotherapy in two large breast cancer trials.

Investigators presented these results from a 10-year follow-up study of 2,961 patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 and NSABP B-27 trials at the 2010 Breast Cancer Symposium.

Dr. Eleftherios P. Mamounas of Aultman Hospital in Canton, Ohio, and his colleagues reported the 10-year incidence of local or regional failure based on type of surgery was 12.3% in patients who had mastectomies and 10.3% in those who had lumpectomies plus chemotherapy. The incidence of local failure was 8.9% in the mastectomy group and 8.1% in the lumpectomy plus chemotherapy group. The incidence of regional failure was 3.4% and 2.2%, respectively.

In a multivariate analysis based on 318 locoregional failure events in all 2,961 patients, the overall significant predictors of locoregional failure included age 50 years or older (hazard ratio 0.79, P = .04), clinical tumor size greater than 5 cm (HR 1.52, P = .0005), and positive clinical nodal status (HR 1.64, P less than .0001). In addition, being node negative without pathologic complete response (HR 1.65, P less than .001) or node positive with pathologic complete response (HR 2.77, P less than 0.001) were significant predictors as well.

The lack of data on predictors of locoregional failure after neoadjuvant chemotherapy has raised questions about whether to use radiation therapy and when to perform sentinel node biopsies in these patients, said Dr. Mamounas.

He also presented data on locoregional failure in lumpectomy patients and mastectomy patients separately, for the purpose of developing separate treatment nomograms for each procedure. A majority of the locoregional failures in the lumpectomy patients were in-breast recurrences. In mastectomy patients, rates of chest wall recurrence were inversely correlated to pathologic nodal response, Dr. Mamounas said.

“The effect of age (in lumpectomy patients), clinical tumor size (in mastectomy patients), and clinical nodal status at locoregional failure appears to diminish with increasing pathologic response in the breast and axillary nodes,” said Dr. Mamounas.

The neoadjuvant chemotherapy regimens were one of two: doxorubicin (Adriamycin) and cyclophosphamide (AC) for four cycles, or the AC regimen for four cycles followed by four cycles of neoadjuvant/adjuvant docetaxel (Taxotere). Patients in the B-27 trial received tamoxifen in addition to their neoadjuvant chemotherapy. Lumpectomy patients were treated with radiation, but mastectomy patients were not.

The independent predictors were incorporated into two nomograms: one for mastectomy and one for lumpectomy plus breast radiation, Dr. Mamounas explained. Additional studies are planned to include treatment effects in the development and validation of the nomograms, he said.

Disclosures: Dr. Mamounas disclosed serving as a consultant for Eli Lilly & Co. and receiving honoraria from AstraZeneca and Sanofi-Aventis.

Major Finding: The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke.

Data Source: A meta-analysis of 87 studies involving 951,083 adults.

Disclosures: Mr. Mottillo was supported by a Canadian Institutes of Health Research grant in cardiovascular outcomes research. Study coauthor Dr. Jacques Genest is on the speakers bureau for AstraZeneca and Merck.

The constellation of risk factors known as the metabolic syndrome was associated with a 1.5-fold increase in all-cause mortality and a 2-fold increase in cardiovascular outcomes, in a meta-analysis of 87 studies in 951,083 patients.

Salvatore Mottillo of the Jewish General Hospital and McGill University, Montreal, and his colleagues reviewed data onom 87 prospective, observational studies of cardiovascular risk and metabolic syndrome based on either the National Cholesterol Education Program (NCEP) definition of three or more of five cardiovascular risk factors, or the revised NCEP (rNCEP) issued in 2004.

The five factors in the NCEP definition are waist circumference (greater than 88 cm for women, greater than 102 cm for men), triglycerides (150 mg/dL or higher for men and women), systemic hypertension (130/85 mm Hg or higher), HDL cholesterol level (less than 50 mg/dL for women, less than 40 for men), and fasting glucose of 110 mg/dL or higher. The revised version dropped the fasting glucose to 100 mg/dL or higher and modified the central obesity measurements to be greater than or equal to 102 cm for men and greater than or equal to 88 cm for women.

Some of the studies involved more than one cardiovascular risk factor and more than one definition of metabolic syndrome.

Overall, metabolic syndrome was associated with an increase in all-cause mortality, with a relative risk of 1.54 based on the NCEP definition and 1.63 based on the rNCEP definition. In a pooled analysis, the risk of cardiovascular disease (CVD) mortality approximately doubled (relative risk, 2.40), as did the risk for CVD (RR, 2.35), stroke (RR, 2.27), and MI (1.99).

Metabolic syndrome remained significantly associated with an increased risk of CVD mortality in patients without type 2 diabetes. The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke (J. Am. Coll. Cardiol. 2010;56:1113–32).

The metabolic syndrome does not require type 2 diabetes in its definition “to be closely associated with cardiovascular risk,” the researchers wrote.

The results were limited by the use of observational studies and the variation in follow-up times. However, in a sensitivity analysis, the risk for CVD mortality associated with metabolic syndrome was similar in studies with follow-up times both longer and shorter than the median time.

Prospective studies of cardiovascular risk associated with metabolic syndrome itself, rather than the different components, are needed, “to establish whether or not the metabolic syndrome adds any prognostic significance,” the researchers said. Meanwhile, “we recommend that health care workers use the metabolic syndrome to identify patients who are at particularly high risk for cardiovascular complications,” they said.

Major Finding: The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke.

Data Source: A meta-analysis of 87 studies involving 951,083 adults.

Disclosures: Mr. Mottillo was supported by a Canadian Institutes of Health Research grant in cardiovascular outcomes research. Study coauthor Dr. Jacques Genest is on the speakers bureau for AstraZeneca and Merck.

The constellation of risk factors known as the metabolic syndrome was associated with a 1.5-fold increase in all-cause mortality and a 2-fold increase in cardiovascular outcomes, in a meta-analysis of 87 studies in 951,083 patients.

Salvatore Mottillo of the Jewish General Hospital and McGill University, Montreal, and his colleagues reviewed data onom 87 prospective, observational studies of cardiovascular risk and metabolic syndrome based on either the National Cholesterol Education Program (NCEP) definition of three or more of five cardiovascular risk factors, or the revised NCEP (rNCEP) issued in 2004.

The five factors in the NCEP definition are waist circumference (greater than 88 cm for women, greater than 102 cm for men), triglycerides (150 mg/dL or higher for men and women), systemic hypertension (130/85 mm Hg or higher), HDL cholesterol level (less than 50 mg/dL for women, less than 40 for men), and fasting glucose of 110 mg/dL or higher. The revised version dropped the fasting glucose to 100 mg/dL or higher and modified the central obesity measurements to be greater than or equal to 102 cm for men and greater than or equal to 88 cm for women.

Some of the studies involved more than one cardiovascular risk factor and more than one definition of metabolic syndrome.

Overall, metabolic syndrome was associated with an increase in all-cause mortality, with a relative risk of 1.54 based on the NCEP definition and 1.63 based on the rNCEP definition. In a pooled analysis, the risk of cardiovascular disease (CVD) mortality approximately doubled (relative risk, 2.40), as did the risk for CVD (RR, 2.35), stroke (RR, 2.27), and MI (1.99).

Metabolic syndrome remained significantly associated with an increased risk of CVD mortality in patients without type 2 diabetes. The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke (J. Am. Coll. Cardiol. 2010;56:1113–32).

The metabolic syndrome does not require type 2 diabetes in its definition “to be closely associated with cardiovascular risk,” the researchers wrote.

The results were limited by the use of observational studies and the variation in follow-up times. However, in a sensitivity analysis, the risk for CVD mortality associated with metabolic syndrome was similar in studies with follow-up times both longer and shorter than the median time.

Prospective studies of cardiovascular risk associated with metabolic syndrome itself, rather than the different components, are needed, “to establish whether or not the metabolic syndrome adds any prognostic significance,” the researchers said. Meanwhile, “we recommend that health care workers use the metabolic syndrome to identify patients who are at particularly high risk for cardiovascular complications,” they said.

Major Finding: The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke.

Data Source: A meta-analysis of 87 studies involving 951,083 adults.

Disclosures: Mr. Mottillo was supported by a Canadian Institutes of Health Research grant in cardiovascular outcomes research. Study coauthor Dr. Jacques Genest is on the speakers bureau for AstraZeneca and Merck.

The constellation of risk factors known as the metabolic syndrome was associated with a 1.5-fold increase in all-cause mortality and a 2-fold increase in cardiovascular outcomes, in a meta-analysis of 87 studies in 951,083 patients.

Salvatore Mottillo of the Jewish General Hospital and McGill University, Montreal, and his colleagues reviewed data onom 87 prospective, observational studies of cardiovascular risk and metabolic syndrome based on either the National Cholesterol Education Program (NCEP) definition of three or more of five cardiovascular risk factors, or the revised NCEP (rNCEP) issued in 2004.

The five factors in the NCEP definition are waist circumference (greater than 88 cm for women, greater than 102 cm for men), triglycerides (150 mg/dL or higher for men and women), systemic hypertension (130/85 mm Hg or higher), HDL cholesterol level (less than 50 mg/dL for women, less than 40 for men), and fasting glucose of 110 mg/dL or higher. The revised version dropped the fasting glucose to 100 mg/dL or higher and modified the central obesity measurements to be greater than or equal to 102 cm for men and greater than or equal to 88 cm for women.

Some of the studies involved more than one cardiovascular risk factor and more than one definition of metabolic syndrome.

Overall, metabolic syndrome was associated with an increase in all-cause mortality, with a relative risk of 1.54 based on the NCEP definition and 1.63 based on the rNCEP definition. In a pooled analysis, the risk of cardiovascular disease (CVD) mortality approximately doubled (relative risk, 2.40), as did the risk for CVD (RR, 2.35), stroke (RR, 2.27), and MI (1.99).

Metabolic syndrome remained significantly associated with an increased risk of CVD mortality in patients without type 2 diabetes. The relative risks of cardiovascular outcomes in individuals without type 2 diabetes were 1.62 for MI, 1.75 for CVD mortality, and 1.86 for stroke (J. Am. Coll. Cardiol. 2010;56:1113–32).

The metabolic syndrome does not require type 2 diabetes in its definition “to be closely associated with cardiovascular risk,” the researchers wrote.

The results were limited by the use of observational studies and the variation in follow-up times. However, in a sensitivity analysis, the risk for CVD mortality associated with metabolic syndrome was similar in studies with follow-up times both longer and shorter than the median time.

Prospective studies of cardiovascular risk associated with metabolic syndrome itself, rather than the different components, are needed, “to establish whether or not the metabolic syndrome adds any prognostic significance,” the researchers said. Meanwhile, “we recommend that health care workers use the metabolic syndrome to identify patients who are at particularly high risk for cardiovascular complications,” they said.

Ten recommendations for how best to investigate and follow patients with undifferentiated peripheral inflammatory arthritis were developed by an expert panel of nearly 700 rheumatologists from 17 countries.

Many patients who present to rheumatologists have recent-onset arthritis that doesn't meet clinical criteria, but they are concerned about their odds of developing a more serious disease, wrote Dr. Pedro Machado of the University of Coimbra (Portugal) Hospital and colleagues on behalf of the panel (Ann. Rheum. Dis. 2010 Aug. 19 [doi:10.1136/ard.2010.130625]).

To develop the recommendations, the panelists participating in the 3E (Evidence, Expertise, Exchange) Initiative created 10 clinical questions related to undifferentiated peripheral inflammatory arthritis (UPIA) and reviewed the evidence-based literature that addressed each one.

They agreed on 10 recommendations, and each participant indicated whether the recommendations would change their current clinical practices:

▸ Consider all alternatives. UPIA is a diagnosis of exclusion. All causes of arthritis — including trauma, malignancy, and metabolic problems, as well as autoimmune causes — should be ruled out. This recommendation applies only if arthritis persists, and not if it is self-limiting.

▸ Note red flags during the history and physical. Previous studies have shown that older age, female sex, and greater morning stiffness are predictors of an ultimate rheumatoid arthritis diagnosis.

▸ Perform erythrocyte sedimentation rate and C-reactive protein assessments. Do these at baseline, and repeat when clinically relevant.

▸ Test for rheumatoid factor and/or anticytoplasmic antibodies (ACPA) in patients with UPIA. But remember that negative results do not exclude eventual progression to RA.

▸ Perform baseline x-rays of affected joints. Be sure to review x-rays of affected hands, wrists, and feet when evaluating a patient for UPIA, as erosions in these areas can predict future RA. Repeat within a year of the first evaluation.

▸ MRI can be used, cautiously, to diagnose UPIA in the hands and wrists. Some evidence shows that MRI can be useful for predicting RA in UPIA patients, but the data are too limited to recommend the routine use of MRI or ultrasound imaging in these patients.

▸ Consider HLA-B27 genetic test in certain clinical settings. Although no genetic test is available that can be routinely recommended for UPIA, the HLA-B27 test might be helpful in patients with suspected spondyloarthritis.

▸ Synovial biopsy can help in the differential diagnosis in patients with monoarthritis. However, there is not enough evidence to recommend this as a routine procedure in UPIA patients.

▸ Document predictors of persistent inflammatory arthritis. Predictors include duration of 6 weeks or longer, over 30 minutes of morning stiffness, involvement of more than three joints, and evidence of radiographic erosion.

▸ Monitor disease activity as well as possible. In five studies that evaluated four different questionnaires, none stood out as fully validated for use in UPIA, but it is important to make an effort to record disease activity using a tool such as the WHO Disability Assessment Scale or the London Handicap Scale.

When the panelists were asked which recommendations were most likely to change the way they approach patients with suspected UPIA, 25% mentioned the recommendation on documenting predictors of persistent inflammatory arthritis. About 18% of the panelists said that the recommendation on MRI and ultrasound would change their practice.

The development of new criteria for RA from ACR/EULAR will likely make it harder to diagnose UPIA, because some of these patients meet the new criteria for RA, the researchers noted.

Disclosures: The study was supported by Abbott Laboratories.

View on The News

Guidelines Lack Definition

This is a very difficult area, and the authors are to be commended for the tremendous amount of work they did to try to make undifferentiated peripheral inflammatory arthritis a little clearer. They did a careful literature search and a grading system so they could be transparent about what data they had.

The question is how much the guidelines will be used. There are some problems because of the lack of data in some areas. This unavoidably led to several recommendations that were based on expert opinion rather than evidence.

Ultimately, what makes the guidelines difficult to use is that we do not end up with a definition. This document tells us how to try to define what is going on with a patient, but it doesn't say, “So this is what UPIA is.” Instead, it says a lot about what it is not. The guidelines lean strongly toward a diagnosis of RA, but it would help to have a table of tests the researchers recommend and why they recommend them.

A key point the recommendations make is to do a good history and physical, plus appropriate laboratory investigations. It is good to have that in writing.

These recommendations are a good effort, and more helpful in what not to do than what to do.

DANIEL E. FURST, M.D., is Carl M. Pearson Professor of Rheumatology at the University of California, Los Angeles. He reports having no conflicts relevant to this discussion.

Ten recommendations for how best to investigate and follow patients with undifferentiated peripheral inflammatory arthritis were developed by an expert panel of nearly 700 rheumatologists from 17 countries.

Many patients who present to rheumatologists have recent-onset arthritis that doesn't meet clinical criteria, but they are concerned about their odds of developing a more serious disease, wrote Dr. Pedro Machado of the University of Coimbra (Portugal) Hospital and colleagues on behalf of the panel (Ann. Rheum. Dis. 2010 Aug. 19 [doi:10.1136/ard.2010.130625]).

To develop the recommendations, the panelists participating in the 3E (Evidence, Expertise, Exchange) Initiative created 10 clinical questions related to undifferentiated peripheral inflammatory arthritis (UPIA) and reviewed the evidence-based literature that addressed each one.

They agreed on 10 recommendations, and each participant indicated whether the recommendations would change their current clinical practices:

▸ Consider all alternatives. UPIA is a diagnosis of exclusion. All causes of arthritis — including trauma, malignancy, and metabolic problems, as well as autoimmune causes — should be ruled out. This recommendation applies only if arthritis persists, and not if it is self-limiting.

▸ Note red flags during the history and physical. Previous studies have shown that older age, female sex, and greater morning stiffness are predictors of an ultimate rheumatoid arthritis diagnosis.

▸ Perform erythrocyte sedimentation rate and C-reactive protein assessments. Do these at baseline, and repeat when clinically relevant.

▸ Test for rheumatoid factor and/or anticytoplasmic antibodies (ACPA) in patients with UPIA. But remember that negative results do not exclude eventual progression to RA.

▸ Perform baseline x-rays of affected joints. Be sure to review x-rays of affected hands, wrists, and feet when evaluating a patient for UPIA, as erosions in these areas can predict future RA. Repeat within a year of the first evaluation.

▸ MRI can be used, cautiously, to diagnose UPIA in the hands and wrists. Some evidence shows that MRI can be useful for predicting RA in UPIA patients, but the data are too limited to recommend the routine use of MRI or ultrasound imaging in these patients.

▸ Consider HLA-B27 genetic test in certain clinical settings. Although no genetic test is available that can be routinely recommended for UPIA, the HLA-B27 test might be helpful in patients with suspected spondyloarthritis.

▸ Synovial biopsy can help in the differential diagnosis in patients with monoarthritis. However, there is not enough evidence to recommend this as a routine procedure in UPIA patients.

▸ Document predictors of persistent inflammatory arthritis. Predictors include duration of 6 weeks or longer, over 30 minutes of morning stiffness, involvement of more than three joints, and evidence of radiographic erosion.

▸ Monitor disease activity as well as possible. In five studies that evaluated four different questionnaires, none stood out as fully validated for use in UPIA, but it is important to make an effort to record disease activity using a tool such as the WHO Disability Assessment Scale or the London Handicap Scale.

When the panelists were asked which recommendations were most likely to change the way they approach patients with suspected UPIA, 25% mentioned the recommendation on documenting predictors of persistent inflammatory arthritis. About 18% of the panelists said that the recommendation on MRI and ultrasound would change their practice.

The development of new criteria for RA from ACR/EULAR will likely make it harder to diagnose UPIA, because some of these patients meet the new criteria for RA, the researchers noted.

Disclosures: The study was supported by Abbott Laboratories.

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Guidelines Lack Definition

This is a very difficult area, and the authors are to be commended for the tremendous amount of work they did to try to make undifferentiated peripheral inflammatory arthritis a little clearer. They did a careful literature search and a grading system so they could be transparent about what data they had.

The question is how much the guidelines will be used. There are some problems because of the lack of data in some areas. This unavoidably led to several recommendations that were based on expert opinion rather than evidence.

Ultimately, what makes the guidelines difficult to use is that we do not end up with a definition. This document tells us how to try to define what is going on with a patient, but it doesn't say, “So this is what UPIA is.” Instead, it says a lot about what it is not. The guidelines lean strongly toward a diagnosis of RA, but it would help to have a table of tests the researchers recommend and why they recommend them.

A key point the recommendations make is to do a good history and physical, plus appropriate laboratory investigations. It is good to have that in writing.

These recommendations are a good effort, and more helpful in what not to do than what to do.

DANIEL E. FURST, M.D., is Carl M. Pearson Professor of Rheumatology at the University of California, Los Angeles. He reports having no conflicts relevant to this discussion.

Ten recommendations for how best to investigate and follow patients with undifferentiated peripheral inflammatory arthritis were developed by an expert panel of nearly 700 rheumatologists from 17 countries.

Many patients who present to rheumatologists have recent-onset arthritis that doesn't meet clinical criteria, but they are concerned about their odds of developing a more serious disease, wrote Dr. Pedro Machado of the University of Coimbra (Portugal) Hospital and colleagues on behalf of the panel (Ann. Rheum. Dis. 2010 Aug. 19 [doi:10.1136/ard.2010.130625]).

To develop the recommendations, the panelists participating in the 3E (Evidence, Expertise, Exchange) Initiative created 10 clinical questions related to undifferentiated peripheral inflammatory arthritis (UPIA) and reviewed the evidence-based literature that addressed each one.

They agreed on 10 recommendations, and each participant indicated whether the recommendations would change their current clinical practices:

▸ Consider all alternatives. UPIA is a diagnosis of exclusion. All causes of arthritis — including trauma, malignancy, and metabolic problems, as well as autoimmune causes — should be ruled out. This recommendation applies only if arthritis persists, and not if it is self-limiting.

▸ Note red flags during the history and physical. Previous studies have shown that older age, female sex, and greater morning stiffness are predictors of an ultimate rheumatoid arthritis diagnosis.

▸ Perform erythrocyte sedimentation rate and C-reactive protein assessments. Do these at baseline, and repeat when clinically relevant.

▸ Test for rheumatoid factor and/or anticytoplasmic antibodies (ACPA) in patients with UPIA. But remember that negative results do not exclude eventual progression to RA.

▸ Perform baseline x-rays of affected joints. Be sure to review x-rays of affected hands, wrists, and feet when evaluating a patient for UPIA, as erosions in these areas can predict future RA. Repeat within a year of the first evaluation.

▸ MRI can be used, cautiously, to diagnose UPIA in the hands and wrists. Some evidence shows that MRI can be useful for predicting RA in UPIA patients, but the data are too limited to recommend the routine use of MRI or ultrasound imaging in these patients.

▸ Consider HLA-B27 genetic test in certain clinical settings. Although no genetic test is available that can be routinely recommended for UPIA, the HLA-B27 test might be helpful in patients with suspected spondyloarthritis.

▸ Synovial biopsy can help in the differential diagnosis in patients with monoarthritis. However, there is not enough evidence to recommend this as a routine procedure in UPIA patients.

▸ Document predictors of persistent inflammatory arthritis. Predictors include duration of 6 weeks or longer, over 30 minutes of morning stiffness, involvement of more than three joints, and evidence of radiographic erosion.

▸ Monitor disease activity as well as possible. In five studies that evaluated four different questionnaires, none stood out as fully validated for use in UPIA, but it is important to make an effort to record disease activity using a tool such as the WHO Disability Assessment Scale or the London Handicap Scale.

When the panelists were asked which recommendations were most likely to change the way they approach patients with suspected UPIA, 25% mentioned the recommendation on documenting predictors of persistent inflammatory arthritis. About 18% of the panelists said that the recommendation on MRI and ultrasound would change their practice.

The development of new criteria for RA from ACR/EULAR will likely make it harder to diagnose UPIA, because some of these patients meet the new criteria for RA, the researchers noted.

Disclosures: The study was supported by Abbott Laboratories.

View on The News

Guidelines Lack Definition

This is a very difficult area, and the authors are to be commended for the tremendous amount of work they did to try to make undifferentiated peripheral inflammatory arthritis a little clearer. They did a careful literature search and a grading system so they could be transparent about what data they had.

The question is how much the guidelines will be used. There are some problems because of the lack of data in some areas. This unavoidably led to several recommendations that were based on expert opinion rather than evidence.

Ultimately, what makes the guidelines difficult to use is that we do not end up with a definition. This document tells us how to try to define what is going on with a patient, but it doesn't say, “So this is what UPIA is.” Instead, it says a lot about what it is not. The guidelines lean strongly toward a diagnosis of RA, but it would help to have a table of tests the researchers recommend and why they recommend them.

A key point the recommendations make is to do a good history and physical, plus appropriate laboratory investigations. It is good to have that in writing.

These recommendations are a good effort, and more helpful in what not to do than what to do.

DANIEL E. FURST, M.D., is Carl M. Pearson Professor of Rheumatology at the University of California, Los Angeles. He reports having no conflicts relevant to this discussion.

CRYSTAL CITY, VA. — The combination of smoking and an active lifestyle was associated with significantly worse lung function than was the combination of nonsmoking and a sedentary lifestyle in blacks, on the basis of data from more than 3,000 participants in the Jackson Heart Study.

Previous studies have shown that the poor lung function associated with a sedentary lifestyle can significantly predict cardiovascular problems, said Brenda Campbell Jenkins, Ph.D., and her colleagues at Jackson (Miss.) State University. Additional research suggests that blacks might be especially vulnerable to lung damage from smoking, they noted.

But no study has examined the combined effects of smoking and sedentary lifestyle and their effects on lung function, Dr. Campbell Jenkins said in an interview.

“We know that among African Americans there is a low prevalence of smoking and a high prevalence of sedentary lifestyle,” she said.

In this study, the researchers examined the joint effect of smoking and sedentary lifestyle on heart health in blacks, using data from the Jackson Heart Study, a population-based observational study including black adults aged 21–94 years living in the area of Jackson, Miss.

The researchers measured pulmonary function using forced vital capacity (FVC) and forced expiratory volume per second (FEV₁). The study findings were presented in a poster at the meeting.

The participants were divided into four groups: nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary. Sedentary lifestyle was defined as the lowest quartile of physical activity.

The mean percentages of predicted FEV₁ values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups were 95%, 94%, 89%, and 85%. The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after controlling for multiple variables.

The mean percentages of predicted FVC values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups was 94%, 92%, 89%, and 88%, respectively.

The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after adjustment for multiple variables.

For men, the mean percentages of predicted FEV₁ values in the four groups were 93%, 89%, 88%, 76%, respectively, but these differences were not significant. In addition, the mean percentages of predicted FVC values in each group were 91%, 88%, 91%, and 80%, respectively, and these differences were not significant.

However, after controlling for multiple variables, the mean FEV₁ to FVC ratio was significantly higher among men in the nonsmoking sedentary group, compared with the smoking nonsedentary group (78.8 vs. 77.5).

Based on these findings, smoking and sedentary lifestyle were both negatively associated with lung function, but smoking tended to have more harmful effects, which was consistent with the literature, noted Dr. Sarpong, director, co—principal investigator, and senior biostatistician of the Jackson Heart Study.

However, more research is needed to determine the clinical implications of the findings.

Study participants were enrolled during 2000–2004. The current study included 1,191 men and 2,065 women aged 21–93 years (average, 54 years). Participants with prevalent cardiovascular disease, asthma, and incomplete measures of smoking or lung function were excluded.

The researchers had no financial conflicts to disclose. The study was supported by grants from the National Heart, Lung, and Blood Institute and the National Center for Minority Health and Health Disparities.

CRYSTAL CITY, VA. — The combination of smoking and an active lifestyle was associated with significantly worse lung function than was the combination of nonsmoking and a sedentary lifestyle in blacks, on the basis of data from more than 3,000 participants in the Jackson Heart Study.

Previous studies have shown that the poor lung function associated with a sedentary lifestyle can significantly predict cardiovascular problems, said Brenda Campbell Jenkins, Ph.D., and her colleagues at Jackson (Miss.) State University. Additional research suggests that blacks might be especially vulnerable to lung damage from smoking, they noted.

But no study has examined the combined effects of smoking and sedentary lifestyle and their effects on lung function, Dr. Campbell Jenkins said in an interview.

“We know that among African Americans there is a low prevalence of smoking and a high prevalence of sedentary lifestyle,” she said.

In this study, the researchers examined the joint effect of smoking and sedentary lifestyle on heart health in blacks, using data from the Jackson Heart Study, a population-based observational study including black adults aged 21–94 years living in the area of Jackson, Miss.

The researchers measured pulmonary function using forced vital capacity (FVC) and forced expiratory volume per second (FEV₁). The study findings were presented in a poster at the meeting.

The participants were divided into four groups: nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary. Sedentary lifestyle was defined as the lowest quartile of physical activity.

The mean percentages of predicted FEV₁ values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups were 95%, 94%, 89%, and 85%. The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after controlling for multiple variables.

The mean percentages of predicted FVC values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups was 94%, 92%, 89%, and 88%, respectively.

The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after adjustment for multiple variables.

For men, the mean percentages of predicted FEV₁ values in the four groups were 93%, 89%, 88%, 76%, respectively, but these differences were not significant. In addition, the mean percentages of predicted FVC values in each group were 91%, 88%, 91%, and 80%, respectively, and these differences were not significant.

However, after controlling for multiple variables, the mean FEV₁ to FVC ratio was significantly higher among men in the nonsmoking sedentary group, compared with the smoking nonsedentary group (78.8 vs. 77.5).

Based on these findings, smoking and sedentary lifestyle were both negatively associated with lung function, but smoking tended to have more harmful effects, which was consistent with the literature, noted Dr. Sarpong, director, co—principal investigator, and senior biostatistician of the Jackson Heart Study.

However, more research is needed to determine the clinical implications of the findings.

Study participants were enrolled during 2000–2004. The current study included 1,191 men and 2,065 women aged 21–93 years (average, 54 years). Participants with prevalent cardiovascular disease, asthma, and incomplete measures of smoking or lung function were excluded.

The researchers had no financial conflicts to disclose. The study was supported by grants from the National Heart, Lung, and Blood Institute and the National Center for Minority Health and Health Disparities.

CRYSTAL CITY, VA. — The combination of smoking and an active lifestyle was associated with significantly worse lung function than was the combination of nonsmoking and a sedentary lifestyle in blacks, on the basis of data from more than 3,000 participants in the Jackson Heart Study.

Previous studies have shown that the poor lung function associated with a sedentary lifestyle can significantly predict cardiovascular problems, said Brenda Campbell Jenkins, Ph.D., and her colleagues at Jackson (Miss.) State University. Additional research suggests that blacks might be especially vulnerable to lung damage from smoking, they noted.

But no study has examined the combined effects of smoking and sedentary lifestyle and their effects on lung function, Dr. Campbell Jenkins said in an interview.

“We know that among African Americans there is a low prevalence of smoking and a high prevalence of sedentary lifestyle,” she said.

In this study, the researchers examined the joint effect of smoking and sedentary lifestyle on heart health in blacks, using data from the Jackson Heart Study, a population-based observational study including black adults aged 21–94 years living in the area of Jackson, Miss.

The researchers measured pulmonary function using forced vital capacity (FVC) and forced expiratory volume per second (FEV₁). The study findings were presented in a poster at the meeting.

The participants were divided into four groups: nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary. Sedentary lifestyle was defined as the lowest quartile of physical activity.

The mean percentages of predicted FEV₁ values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups were 95%, 94%, 89%, and 85%. The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after controlling for multiple variables.

The mean percentages of predicted FVC values in women in the nonsmoking nonsedentary, nonsmoking sedentary, smoking nonsedentary, and smoking sedentary groups was 94%, 92%, 89%, and 88%, respectively.

The differences between women in the nonsmoking sedentary and in the smoking nonsedentary groups were significant after adjustment for multiple variables.

For men, the mean percentages of predicted FEV₁ values in the four groups were 93%, 89%, 88%, 76%, respectively, but these differences were not significant. In addition, the mean percentages of predicted FVC values in each group were 91%, 88%, 91%, and 80%, respectively, and these differences were not significant.

However, after controlling for multiple variables, the mean FEV₁ to FVC ratio was significantly higher among men in the nonsmoking sedentary group, compared with the smoking nonsedentary group (78.8 vs. 77.5).

Based on these findings, smoking and sedentary lifestyle were both negatively associated with lung function, but smoking tended to have more harmful effects, which was consistent with the literature, noted Dr. Sarpong, director, co—principal investigator, and senior biostatistician of the Jackson Heart Study.

However, more research is needed to determine the clinical implications of the findings.

Study participants were enrolled during 2000–2004. The current study included 1,191 men and 2,065 women aged 21–93 years (average, 54 years). Participants with prevalent cardiovascular disease, asthma, and incomplete measures of smoking or lung function were excluded.

The researchers had no financial conflicts to disclose. The study was supported by grants from the National Heart, Lung, and Blood Institute and the National Center for Minority Health and Health Disparities.

Memantine might improve behavioral symptoms and reduce brain deterioration in patients with mild to moderate Lewy body dementia, but not Parkinson's disease dementia, data from a randomized, placebo-controlled trial show.

The higher amount of Alzheimer's disease–like amyloid pathology that is normally observed in patients with dementia with Lewy bodies (DLB) might explain why the drug appears to provide symptomatic relief to that group but not to patients with Parkinson's disease dementia (PDD), in whom amyloid pathology is encountered less often, Dr. Murat Emre of Istanbul (Turkey) University and his colleagues reported online.

Dr. Emre and his coauthors conducted the study of memantine, which is approved in the United States for treating moderate to severe Alzheimer's disease, because previous studies had suggested that the drug might yield similar benefits in patients with Lewy body–related dementias such as PDD or DLB, which have some overlap in pathology.

The researchers randomized 78 patients with DLB and 121 patients with PDD to a 20-mg dose of memantine once daily or a placebo. Concomitant use of cholinesterase inhibitors was not allowed (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70194-0]).

Patients were assessed when they were screened, at baseline, and at weeks 4, 12, 16, and 24. The study included patients from 30 sites in Austria, France, Germany, Greece, Italy, Spain, Turkey, and the United Kingdom.

In DLB patients, memantine significantly improved scores on the ADCS-CGIC (Alzheimer's Disease Cooperative Study–Clinical Global Impression of Change) scale from baseline to 24 weeks, compared with placebo (mean change from baseline, 3.3 vs. 3.9, respectively). In addition, NPI (Neuropsychiatry Inventory) scores improved significantly more from baseline to 24 weeks in memantine-treated patients than in placebo-treated patients.

Among PDD patients, memantine did not significantly change scores with either measurement, compared with placebo. “Memantine might exert stronger beneficial effects in patients with more prominent Alzheimer's disease–type pathology,” the investigators wrote. The differences in effects between DLB and PDD patients also could be accounted for by the range in symptoms and in concomitant drug use between these two patient populations, they added.

Disclosures: The study was funded by Lundbeck, a maker and distributor of memantine. Dr. Emre and some of his coauthors disclosed financial relationships with Lundbeck and other pharmaceutical companies. One author is an employee of Lundbeck.

View on the News

Hopeful Results

The study by Dr. Emre raises the possibility that memantine could improve global function by improving mood symptoms.

More research is needed, but memantine could be part of a plan to manage DLB and PDD symptoms until definitive cognitive therapies are developed.

LAURA MARSH, M.D., is from Baylor College of Medicine in Houston. Her comments are paraphrased from an editorial (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70208-8]). Dr. Marsh has received funding from Forest Research Institute to study the effects of memantine on the treatment of dementia in Parkinson's ddisease.

Vitals

Memantine might improve behavioral symptoms and reduce brain deterioration in patients with mild to moderate Lewy body dementia, but not Parkinson's disease dementia, data from a randomized, placebo-controlled trial show.

The higher amount of Alzheimer's disease–like amyloid pathology that is normally observed in patients with dementia with Lewy bodies (DLB) might explain why the drug appears to provide symptomatic relief to that group but not to patients with Parkinson's disease dementia (PDD), in whom amyloid pathology is encountered less often, Dr. Murat Emre of Istanbul (Turkey) University and his colleagues reported online.

Dr. Emre and his coauthors conducted the study of memantine, which is approved in the United States for treating moderate to severe Alzheimer's disease, because previous studies had suggested that the drug might yield similar benefits in patients with Lewy body–related dementias such as PDD or DLB, which have some overlap in pathology.

The researchers randomized 78 patients with DLB and 121 patients with PDD to a 20-mg dose of memantine once daily or a placebo. Concomitant use of cholinesterase inhibitors was not allowed (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70194-0]).

Patients were assessed when they were screened, at baseline, and at weeks 4, 12, 16, and 24. The study included patients from 30 sites in Austria, France, Germany, Greece, Italy, Spain, Turkey, and the United Kingdom.

In DLB patients, memantine significantly improved scores on the ADCS-CGIC (Alzheimer's Disease Cooperative Study–Clinical Global Impression of Change) scale from baseline to 24 weeks, compared with placebo (mean change from baseline, 3.3 vs. 3.9, respectively). In addition, NPI (Neuropsychiatry Inventory) scores improved significantly more from baseline to 24 weeks in memantine-treated patients than in placebo-treated patients.

Among PDD patients, memantine did not significantly change scores with either measurement, compared with placebo. “Memantine might exert stronger beneficial effects in patients with more prominent Alzheimer's disease–type pathology,” the investigators wrote. The differences in effects between DLB and PDD patients also could be accounted for by the range in symptoms and in concomitant drug use between these two patient populations, they added.

Disclosures: The study was funded by Lundbeck, a maker and distributor of memantine. Dr. Emre and some of his coauthors disclosed financial relationships with Lundbeck and other pharmaceutical companies. One author is an employee of Lundbeck.

View on the News

Hopeful Results

The study by Dr. Emre raises the possibility that memantine could improve global function by improving mood symptoms.

More research is needed, but memantine could be part of a plan to manage DLB and PDD symptoms until definitive cognitive therapies are developed.

LAURA MARSH, M.D., is from Baylor College of Medicine in Houston. Her comments are paraphrased from an editorial (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70208-8]). Dr. Marsh has received funding from Forest Research Institute to study the effects of memantine on the treatment of dementia in Parkinson's ddisease.

Vitals

Memantine might improve behavioral symptoms and reduce brain deterioration in patients with mild to moderate Lewy body dementia, but not Parkinson's disease dementia, data from a randomized, placebo-controlled trial show.

The higher amount of Alzheimer's disease–like amyloid pathology that is normally observed in patients with dementia with Lewy bodies (DLB) might explain why the drug appears to provide symptomatic relief to that group but not to patients with Parkinson's disease dementia (PDD), in whom amyloid pathology is encountered less often, Dr. Murat Emre of Istanbul (Turkey) University and his colleagues reported online.

Dr. Emre and his coauthors conducted the study of memantine, which is approved in the United States for treating moderate to severe Alzheimer's disease, because previous studies had suggested that the drug might yield similar benefits in patients with Lewy body–related dementias such as PDD or DLB, which have some overlap in pathology.

The researchers randomized 78 patients with DLB and 121 patients with PDD to a 20-mg dose of memantine once daily or a placebo. Concomitant use of cholinesterase inhibitors was not allowed (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70194-0]).

Patients were assessed when they were screened, at baseline, and at weeks 4, 12, 16, and 24. The study included patients from 30 sites in Austria, France, Germany, Greece, Italy, Spain, Turkey, and the United Kingdom.

In DLB patients, memantine significantly improved scores on the ADCS-CGIC (Alzheimer's Disease Cooperative Study–Clinical Global Impression of Change) scale from baseline to 24 weeks, compared with placebo (mean change from baseline, 3.3 vs. 3.9, respectively). In addition, NPI (Neuropsychiatry Inventory) scores improved significantly more from baseline to 24 weeks in memantine-treated patients than in placebo-treated patients.

Among PDD patients, memantine did not significantly change scores with either measurement, compared with placebo. “Memantine might exert stronger beneficial effects in patients with more prominent Alzheimer's disease–type pathology,” the investigators wrote. The differences in effects between DLB and PDD patients also could be accounted for by the range in symptoms and in concomitant drug use between these two patient populations, they added.

Disclosures: The study was funded by Lundbeck, a maker and distributor of memantine. Dr. Emre and some of his coauthors disclosed financial relationships with Lundbeck and other pharmaceutical companies. One author is an employee of Lundbeck.

View on the News

Hopeful Results

The study by Dr. Emre raises the possibility that memantine could improve global function by improving mood symptoms.

More research is needed, but memantine could be part of a plan to manage DLB and PDD symptoms until definitive cognitive therapies are developed.

LAURA MARSH, M.D., is from Baylor College of Medicine in Houston. Her comments are paraphrased from an editorial (Lancet Neurology 2010 Aug. 23 [doi:10.1016/S1474-4422(10)70208-8]). Dr. Marsh has received funding from Forest Research Institute to study the effects of memantine on the treatment of dementia in Parkinson's ddisease.

Vitals

Only one in four women diagnosed with breast cancer in the 1940s was alive 10 years later, compared with three of four women diagnosed in recent years, based on data gathered over a 6-decade period at a single institution.

Overall, the 10-year survival rate for all types of breast cancer improved significantly over 60 years, from 25% between 1944 and 1954, to 77% between 1995 and 2004. This improvement is because of earlier disease detection and a multimodal approach to managing and treating patients with different stages of breast cancer, Dr. Aman Buzdar, the study’s lead author, reported Sept. 29.

The goal of the study was to quantify the steady improvements in breast cancer survival rates over the past 6 decades in patients seen at the MD Anderson Cancer Center in Houston. Dr. Buzdar said he believes that the survival rates seen at MD Anderson are generalizable to survival rates at smaller regional hospitals and community cancer centers, given the rapid adoption of the multimodal treatment model and new therapies.

“If patients are appropriately managed, they have a much better chance of surviving breast cancer today than they would have had 30 or 20 or even 10 years ago, because the therapies are constantly evolving and improving,” Dr. Buzdar, professor of medicine and breast medical oncology at the center, said in a written statement. Therefore, if the approaches used at MD Anderson are applied in the community, similar outcomes can be achieved, he said during a press briefing sponsored by the American Society of Clinical Oncology.

Dr. Buzdar and his colleagues reviewed the center’s detailed database on breast cancer patients dating back to the 1940s. The database included approximately 57,000 breast cancer patients seen between 1944 and 2004. The review included 12,809 patients who had their diagnoses established and treatments initiated at MD Anderson.

Ten-year survival rates improved significantly from the 1944-1954 period to the 1995-2004 period: For local breast cancer, the rates rose from 55% to 86% and for regional breast cancer they increased from 16% to 76%. The survival rate for metastatic disease improved from 3% to 22%.

Disclosures: Dr. Buzdar said he had no financial conflicts to disclose.

Only one in four women diagnosed with breast cancer in the 1940s was alive 10 years later, compared with three of four women diagnosed in recent years, based on data gathered over a 6-decade period at a single institution.

Overall, the 10-year survival rate for all types of breast cancer improved significantly over 60 years, from 25% between 1944 and 1954, to 77% between 1995 and 2004. This improvement is because of earlier disease detection and a multimodal approach to managing and treating patients with different stages of breast cancer, Dr. Aman Buzdar, the study’s lead author, reported Sept. 29.

The goal of the study was to quantify the steady improvements in breast cancer survival rates over the past 6 decades in patients seen at the MD Anderson Cancer Center in Houston. Dr. Buzdar said he believes that the survival rates seen at MD Anderson are generalizable to survival rates at smaller regional hospitals and community cancer centers, given the rapid adoption of the multimodal treatment model and new therapies.

“If patients are appropriately managed, they have a much better chance of surviving breast cancer today than they would have had 30 or 20 or even 10 years ago, because the therapies are constantly evolving and improving,” Dr. Buzdar, professor of medicine and breast medical oncology at the center, said in a written statement. Therefore, if the approaches used at MD Anderson are applied in the community, similar outcomes can be achieved, he said during a press briefing sponsored by the American Society of Clinical Oncology.

Dr. Buzdar and his colleagues reviewed the center’s detailed database on breast cancer patients dating back to the 1940s. The database included approximately 57,000 breast cancer patients seen between 1944 and 2004. The review included 12,809 patients who had their diagnoses established and treatments initiated at MD Anderson.

Ten-year survival rates improved significantly from the 1944-1954 period to the 1995-2004 period: For local breast cancer, the rates rose from 55% to 86% and for regional breast cancer they increased from 16% to 76%. The survival rate for metastatic disease improved from 3% to 22%.

Disclosures: Dr. Buzdar said he had no financial conflicts to disclose.

Only one in four women diagnosed with breast cancer in the 1940s was alive 10 years later, compared with three of four women diagnosed in recent years, based on data gathered over a 6-decade period at a single institution.

Overall, the 10-year survival rate for all types of breast cancer improved significantly over 60 years, from 25% between 1944 and 1954, to 77% between 1995 and 2004. This improvement is because of earlier disease detection and a multimodal approach to managing and treating patients with different stages of breast cancer, Dr. Aman Buzdar, the study’s lead author, reported Sept. 29.

The goal of the study was to quantify the steady improvements in breast cancer survival rates over the past 6 decades in patients seen at the MD Anderson Cancer Center in Houston. Dr. Buzdar said he believes that the survival rates seen at MD Anderson are generalizable to survival rates at smaller regional hospitals and community cancer centers, given the rapid adoption of the multimodal treatment model and new therapies.

“If patients are appropriately managed, they have a much better chance of surviving breast cancer today than they would have had 30 or 20 or even 10 years ago, because the therapies are constantly evolving and improving,” Dr. Buzdar, professor of medicine and breast medical oncology at the center, said in a written statement. Therefore, if the approaches used at MD Anderson are applied in the community, similar outcomes can be achieved, he said during a press briefing sponsored by the American Society of Clinical Oncology.

Dr. Buzdar and his colleagues reviewed the center’s detailed database on breast cancer patients dating back to the 1940s. The database included approximately 57,000 breast cancer patients seen between 1944 and 2004. The review included 12,809 patients who had their diagnoses established and treatments initiated at MD Anderson.

Ten-year survival rates improved significantly from the 1944-1954 period to the 1995-2004 period: For local breast cancer, the rates rose from 55% to 86% and for regional breast cancer they increased from 16% to 76%. The survival rate for metastatic disease improved from 3% to 22%.

Disclosures: Dr. Buzdar said he had no financial conflicts to disclose.