Patrice Wendling

TUCSON, ARIZ. — Family physicians are failing to diagnose obesity in a substantial number of their overweight pediatric patients.

A review of 100 pediatric charts from two family medicine residency outpatient clinics identified 20% of pediatric patients as overweight and 19% as being at risk for overweight.

Yet only 28% of the cases were correctly identified and documented, Dr. Jennifer Keehbauch and her colleagues reported in a poster at the annual meeting of the North American Primary Care Research Group. It has been reported in previous literature that pediatricians recognize only about 29% of their overweight patient population.

The pilot data were based on 100 charts randomly selected from a computer-generated list of well-child visits. The patients, aged 2–17 years, were identified as Hispanic (36%), white (30%), African American (8%), and other (26%).

Overall, 79% of the overweight children did not have appropriate screening for hyperlipidemia or glucose intolerance, and 21% had blood pressure above the 95th percentile of blood pressure for their sex and age.

It's unclear whether the physicians are failing to recognize obesity or are reluctant to label children as obese, said Dr. Keehbauch, assistant director of family practice residency, Florida Hospital, Orlando. One strategy for better identification of childhood obesity is an upgraded electronic health record (HER) system that generates and plots body mass index percentile for age.

The two clinics in the review use the EHR system from Epic System Corp., which calculates BMI, but plots only height and weight “A BMI of 19 in an adult might be normal, but in a child it might be obese. You have to plot the BMI percentile for age to get the diagnosis,” she said.

Other EMR systems plot BMI percentile for age as well. Evidence supports the use of BMI percentile for age, but less than 15% of pediatricians report using it. The next phase of the study is a follow-up survey to determine awareness and utilization of the BMI percentile by health care providers at both clinics.

TUCSON, ARIZ. — Family physicians are failing to diagnose obesity in a substantial number of their overweight pediatric patients.

A review of 100 pediatric charts from two family medicine residency outpatient clinics identified 20% of pediatric patients as overweight and 19% as being at risk for overweight.

Yet only 28% of the cases were correctly identified and documented, Dr. Jennifer Keehbauch and her colleagues reported in a poster at the annual meeting of the North American Primary Care Research Group. It has been reported in previous literature that pediatricians recognize only about 29% of their overweight patient population.

The pilot data were based on 100 charts randomly selected from a computer-generated list of well-child visits. The patients, aged 2–17 years, were identified as Hispanic (36%), white (30%), African American (8%), and other (26%).

Overall, 79% of the overweight children did not have appropriate screening for hyperlipidemia or glucose intolerance, and 21% had blood pressure above the 95th percentile of blood pressure for their sex and age.

It's unclear whether the physicians are failing to recognize obesity or are reluctant to label children as obese, said Dr. Keehbauch, assistant director of family practice residency, Florida Hospital, Orlando. One strategy for better identification of childhood obesity is an upgraded electronic health record (HER) system that generates and plots body mass index percentile for age.

The two clinics in the review use the EHR system from Epic System Corp., which calculates BMI, but plots only height and weight “A BMI of 19 in an adult might be normal, but in a child it might be obese. You have to plot the BMI percentile for age to get the diagnosis,” she said.

Other EMR systems plot BMI percentile for age as well. Evidence supports the use of BMI percentile for age, but less than 15% of pediatricians report using it. The next phase of the study is a follow-up survey to determine awareness and utilization of the BMI percentile by health care providers at both clinics.

TUCSON, ARIZ. — Family physicians are failing to diagnose obesity in a substantial number of their overweight pediatric patients.

A review of 100 pediatric charts from two family medicine residency outpatient clinics identified 20% of pediatric patients as overweight and 19% as being at risk for overweight.

Yet only 28% of the cases were correctly identified and documented, Dr. Jennifer Keehbauch and her colleagues reported in a poster at the annual meeting of the North American Primary Care Research Group. It has been reported in previous literature that pediatricians recognize only about 29% of their overweight patient population.

The pilot data were based on 100 charts randomly selected from a computer-generated list of well-child visits. The patients, aged 2–17 years, were identified as Hispanic (36%), white (30%), African American (8%), and other (26%).

Overall, 79% of the overweight children did not have appropriate screening for hyperlipidemia or glucose intolerance, and 21% had blood pressure above the 95th percentile of blood pressure for their sex and age.

It's unclear whether the physicians are failing to recognize obesity or are reluctant to label children as obese, said Dr. Keehbauch, assistant director of family practice residency, Florida Hospital, Orlando. One strategy for better identification of childhood obesity is an upgraded electronic health record (HER) system that generates and plots body mass index percentile for age.

The two clinics in the review use the EHR system from Epic System Corp., which calculates BMI, but plots only height and weight “A BMI of 19 in an adult might be normal, but in a child it might be obese. You have to plot the BMI percentile for age to get the diagnosis,” she said.

Other EMR systems plot BMI percentile for age as well. Evidence supports the use of BMI percentile for age, but less than 15% of pediatricians report using it. The next phase of the study is a follow-up survey to determine awareness and utilization of the BMI percentile by health care providers at both clinics.

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 8% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who remained in the study and who did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks).

Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/L, 1.7 mIU/L, and 0.9 mIU/L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/L vs. 621.1 kIU/L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

'Adequate selenium supplementation may reduce the inflammatory action of the thyroid glandafter delivery.' DR. NEGRO

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 8% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who remained in the study and who did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks).

Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/L, 1.7 mIU/L, and 0.9 mIU/L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/L vs. 621.1 kIU/L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

'Adequate selenium supplementation may reduce the inflammatory action of the thyroid glandafter delivery.' DR. NEGRO

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 8% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who remained in the study and who did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks).

Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/L, 1.7 mIU/L, and 0.9 mIU/L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/L vs. 621.1 kIU/L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

'Adequate selenium supplementation may reduce the inflammatory action of the thyroid glandafter delivery.' DR. NEGRO

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four communities across the United States. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, said Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The investigators also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for the progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was particularly stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, compared with 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by grants from the U.S. Department of Health and Human Services' Health Resources and Services Administration.

The findings provide new leads for investigation and possibly new strategies for intervention and prevention, Dr. Player said. Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients.

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four communities across the United States. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, said Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The investigators also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for the progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was particularly stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, compared with 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by grants from the U.S. Department of Health and Human Services' Health Resources and Services Administration.

The findings provide new leads for investigation and possibly new strategies for intervention and prevention, Dr. Player said. Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients.

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four communities across the United States. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, said Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The investigators also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for the progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was particularly stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, compared with 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by grants from the U.S. Department of Health and Human Services' Health Resources and Services Administration.

The findings provide new leads for investigation and possibly new strategies for intervention and prevention, Dr. Player said. Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients.

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four U.S. communities. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, reported Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The researchers also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, vs. 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by the U.S. Department of Health and Human Services' Health Resources and Services Administration.

Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients. Behavioral therapy may provide benefit for patients with prehypertension, Dr. Player said.

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four U.S. communities. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, reported Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The researchers also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, vs. 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by the U.S. Department of Health and Human Services' Health Resources and Services Administration.

Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients. Behavioral therapy may provide benefit for patients with prehypertension, Dr. Player said.

TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.

Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four U.S. communities. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.

Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, reported Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.

After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.

The researchers also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.

Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).

In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, vs. 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.

High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by the U.S. Department of Health and Human Services' Health Resources and Services Administration.

Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients. Behavioral therapy may provide benefit for patients with prehypertension, Dr. Player said.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes, and was strongly and independently associated with early signs of atherosclerosis in a new study conducted in Italy.

The results are provocative and add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“These findings confirm some previous evidence demonstrating that vitamin D deficiency is highly prevalent in people with type 2 diabetes, and suggest that hypovitaminosis might be an underestimated, novel risk factor for cardiovascular disease among type 2 diabetic adults,” Dr. Targher said in an interview.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with vitamin D-sufficient counterparts, diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L) and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations. Sex; body mass index; blood pressure; lipids; calcium; estimated glomerular filtration rate; diabetes duration and treatment; smoking history; and statin therapy were not significantly different between the groups of diabetic patients.

“Because a lack of vitamin D can negatively affect bone health and have other nonskeletal adverse effects on several organ systems, a widespread screening for vitamin D deficiency or routine vitamin D supplementation should be seriously considered for people with diabetes,” Dr. Targher said.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes, and was strongly and independently associated with early signs of atherosclerosis in a new study conducted in Italy.

The results are provocative and add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“These findings confirm some previous evidence demonstrating that vitamin D deficiency is highly prevalent in people with type 2 diabetes, and suggest that hypovitaminosis might be an underestimated, novel risk factor for cardiovascular disease among type 2 diabetic adults,” Dr. Targher said in an interview.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with vitamin D-sufficient counterparts, diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L) and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations. Sex; body mass index; blood pressure; lipids; calcium; estimated glomerular filtration rate; diabetes duration and treatment; smoking history; and statin therapy were not significantly different between the groups of diabetic patients.

“Because a lack of vitamin D can negatively affect bone health and have other nonskeletal adverse effects on several organ systems, a widespread screening for vitamin D deficiency or routine vitamin D supplementation should be seriously considered for people with diabetes,” Dr. Targher said.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes, and was strongly and independently associated with early signs of atherosclerosis in a new study conducted in Italy.

The results are provocative and add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“These findings confirm some previous evidence demonstrating that vitamin D deficiency is highly prevalent in people with type 2 diabetes, and suggest that hypovitaminosis might be an underestimated, novel risk factor for cardiovascular disease among type 2 diabetic adults,” Dr. Targher said in an interview.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with vitamin D-sufficient counterparts, diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L) and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations. Sex; body mass index; blood pressure; lipids; calcium; estimated glomerular filtration rate; diabetes duration and treatment; smoking history; and statin therapy were not significantly different between the groups of diabetic patients.

“Because a lack of vitamin D can negatively affect bone health and have other nonskeletal adverse effects on several organ systems, a widespread screening for vitamin D deficiency or routine vitamin D supplementation should be seriously considered for people with diabetes,” Dr. Targher said.

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their primary care practices, Dr. Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information that helped keep the practice up to date on new medications.

Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “It wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said. “They understood why others did it, but they worried about conflicts of interest with their interactions with the reps.”

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs,” he said.

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices.

That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration did not want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

Dr. Sohler said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways.

“The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” Dr. Sohler said. “We realize that all marketing has an influence, but we don't know if it harms our patients.

“People are drawing on their different values and perspectives to make a decision. We need hard evidence to make a policy, but in the meantime, we should keep these perspectives in mind as the data come in.”

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their primary care practices, Dr. Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information that helped keep the practice up to date on new medications.

Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “It wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said. “They understood why others did it, but they worried about conflicts of interest with their interactions with the reps.”

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs,” he said.

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices.

That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration did not want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

Dr. Sohler said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways.

“The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” Dr. Sohler said. “We realize that all marketing has an influence, but we don't know if it harms our patients.

“People are drawing on their different values and perspectives to make a decision. We need hard evidence to make a policy, but in the meantime, we should keep these perspectives in mind as the data come in.”

TUCSON, ARIZ. — Physicians are divided over whether it is ethical to use free sample medications in their primary care practices, Dr. Nancy Sohler, Ph.D., and Dr. Diane McKee reported at the annual meeting of the North American Primary Care Research Group.

Accepting samples was viewed either as being ethically questionable or as a useful way of helping provide health care to low-income patients, according to findings from a study of 24 family medicine and general internal medicine physicians, nurses, and administrators in practices affiliated with a large urban medical center serving low- and middle-income patients in New York.

Interactions with pharmaceutical representatives were viewed as a direct conflict of interest, an influence that could be controlled, or a source of useful information that helped keep the practice up to date on new medications.

Of the total, 10 respondents felt that they could control the influence of drug firm representatives by keeping them away from residents, by setting limits on what gifts or favors could be accepted, or by always being mindful that representatives are selling a product, Dr. Sohler said in an interview.

For the respondents who drew a hard ethical line, “It wasn't that they thought giving out samples [to patients] was unethical, but that it wasn't good practice,” she said. “They understood why others did it, but they worried about conflicts of interest with their interactions with the reps.”

Those who accepted samples said inadequacies in the health care system forced them to rely on gifts to care for their most needy patients.

All the respondents evaluated marketing practices from the perspective of protecting and serving their patients, said Dr. Sohler, professor of community health and social medicine, City University of New York, New York. No one was concerned that physicians were ignoring clinical symptoms to prescribe the “right drugs,” he said.

The study included in-depth, qualitative interviews and was prompted by an administrative decision at the medical center to ban samples and pharmaceutical representatives from the community practices.

That decision left many providers uncertain about how to care for patients without adequate health care coverage. Others suggested that the policy was changed because the administration did not want physicians taking the time to talk to sales representatives, didn't trust that staff would avoid entering into agreements with pharmaceutical firms, and did want a single policy, because teaching sites had a “no-rep” policy and other sites didn't need samples.

Dr. Sohler said further study would be needed to determine whether samples help poor patients more than they harm them, and whether representatives influence prescribing practices in mostly helpful or harmful ways.

“The empirical, quantitative evidence isn't good on whether free medications help or harm our patients,” Dr. Sohler said. “We realize that all marketing has an influence, but we don't know if it harms our patients.

“People are drawing on their different values and perspectives to make a decision. We need hard evidence to make a policy, but in the meantime, we should keep these perspectives in mind as the data come in.”

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 7.9% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who both remained in the study and did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks). Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/;L, 1.7 mIU/;L, and 0.9 mIU/;L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/;L vs. 621.1 kIU/;L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

Postpartum thyroid problem rates were lower in women who took selenium supplements. DR. NEGRO

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 7.9% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who both remained in the study and did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks). Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/;L, 1.7 mIU/;L, and 0.9 mIU/;L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/;L vs. 621.1 kIU/;L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

Postpartum thyroid problem rates were lower in women who took selenium supplements. DR. NEGRO

VERONA, ITALY — For the first time, selenium supplementation has been shown to lessen the progression of autoimmune chronic thyroiditis in pregnant women.

Pregnant women who are positive for thyroid peroxidase antibodies are prone to develop postpartum thyroid dysfunction and permanent hypothyroidism.

Selenium supplementation during and after pregnancy reduced the incidence of both conditions in a large prospective, randomized controlled trial of euthyroid pregnant women, Dr. Roberto Negro and associates reported in an award-winning poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

“Giving adequate selenium supplementation may reduce the inflammatory action of the thyroid gland after delivery,” Dr. Negro said in an interview. “This is not sufficient to recommend this treatment for all pregnant women affected by chronic autoimmune thyroiditis, but it may be considered.”

Of the 2,143 women who participated in the study, 7.9% were positive for thyroid peroxidase antibodies (TPOAb). Of the TPOAb-positive women who both remained in the study and did not miscarry, Dr. Negro and associates randomized 77 to 200 mcg/day selenomethionine beginning at the 12th week of pregnancy until 12 months after delivery, and 74 to placebo. Of the TPOAb-negative women, 81 were age matched and served as the control. Thyroid function tests were performed at 20 and 30 weeks' gestation, at delivery, and after delivery at months 1, 2, 5, 9, and 12.

Blood selenium concentrations were measured at the first endocrinologic visit (at an average 9.4 weeks' gestation), at 20 and 30 weeks' gestation, at delivery, and at 6 and 12 months after delivery. Thyroid ultrasound scans were performed by an independent radiologist at the first endocrinologic visit during pregnancy, at delivery, and at 12 months after delivery.

At baseline, there were no significant differences between the three groups in average age (28 years, 28 years, and 27 years, respectively), in free thyroxine levels, and in the time supplementation began (average 12 weeks). Significant differences were noted between groups in baseline thyroid-stimulating hormone (1.6 mIU/;L, 1.7 mIU/;L, and 0.9 mIU/;L, respectively) and in those requiring levothyroxine during pregnancy (19.4%, 21.6%, and 2.5%, respectively).

At 12 months after delivery, rates of postpartum thyroid dysfunction (28.6% vs. 48.6%) and permanent hypothyroidism (11.7% vs. 20.3%) were significantly lower in women taking the selenium supplements than in placebo-treated patients, the authors reported.

In addition, TPOAb titers were significantly lower in the supplement group compared with placebo-treated patients, with a 62.4% versus 43.9% reduction during pregnancy and lower titers during the postpartum period (323.2 kIU/;L vs. 621.1 kIU/;L).

When the ultrasound echogenicity patterns of the two groups were compared, the selenium-supplemented group displayed a significantly lower percentage of moderate to advanced thyroiditis (grades 2–3) at the end of the postpartum period (27.3% vs. 44.6%), the authors reported.

No side effects were reported in the mothers and no families have been recalled for newborn thyroid dysfunction, said Dr. Negro, of the endocrinology department at Azienda Ospedaliera “Vito Fazzi,” Lecce, Italy.

“Relatively high doses are needed to obtain a significant response on postpartum thyroid dysfunction,” he said.

Further investigations are required to know whether these beneficial effects are reversed if selenium supplementation is interrupted or whether they can be maintained for a long time if selenium is continued, the authors concluded.

Postpartum thyroid problem rates were lower in women who took selenium supplements. DR. NEGRO

CHICAGO — Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teens who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” Dr. Mathews said in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging. Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.” In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group. There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, a professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

CHICAGO — Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teens who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” Dr. Mathews said in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging. Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.” In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group. There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, a professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

CHICAGO — Adolescents who play violent video games demonstrate distinct alterations in brain activation on functional magnetic resonance imaging, investigators have shown for the first time.

In a study of 44 healthy adolescents, the teens who played violent video games demonstrated less activation in the frontal lobes associated with inhibition, concentration, and self-control, and more activation in the amygdala, which governs emotional arousal, Dr. Vincent Mathews reported at the annual meeting of the Radiological Society of North America.

Additional research is needed to determine if this combination of effects could make these individuals more likely to engage in violent behavior. But for now, the study provides parents, physicians, and scientists with data proving that differences in brain function exist in teens who play violent video games, compared with those who don't.

“The fact [that] we are seeing something should at least alert people to the fact [that] something is going on, and that they should be concerned with the types and amount of media they and their children are exposed to,” Dr. Mathews said in an interview.

He and his colleagues at Indiana University, Indianapolis, randomly assigned the adolescents to play either “Medal of Honor,” a violent video game, or “Need for Speed,” an equally exciting but nonviolent game, for 30 minutes immediately before imaging. Functional MRI data were acquired on a 3-Tesla scanner using a 2D gradient echo-planar imaging sequence during two modified Stroop paradigms.

In the emotional Stroop task, participants pressed different buttons according to the color of the visually presented words. Words indicating violent actions such as “hit” or “harm” were interspersed with nonviolent action words such as “run” or “walk.” In the counting Stroop task, participants were required to press buttons to indicate the number of displayed objects, with X's used as control events and numerals presented as activation stimulation.

There was no difference between groups in age, gender, IQ, video playing expertise, or overall violent media exposure. Their mean age was 15 years, and the average IQ was 110 in the nonviolent game group and 108 in the violent game group. There was no significant difference between groups in accuracy or reaction time during the tasks.

The group that played the nonviolent game showed more activation in the frontal lobes, including the anterior cingulate and dorsolateral prefrontal cortex, during both Stroop tasks, reported Dr. Mathews, a professor of radiology at the university.

The group that played the violent game demonstrated less activation in prefrontal lobes during both tasks and increased activation in the right amygdala during the emotional Stroop task. These differences remained after controlling for previous violent media exposure and gender, he said.

“There is a little bit more credence to [physicians] recommending limiting this activity,” he said, adding that further study is needed to examine behavior and duration of effect in adolescents who watch violent videos.

Functional MRI findings show less brain activation in the frontal lobes and more activation in the amygdala in teens playing violent versus nonviolent video games. Radiological Society of North America

TUCSON, ARIZ. — Customary vitamin D supplementation and springtime sun exposure in the southern United States are inadequate to protect elderly African American women from vitamin D deficiency and osteoporosis, data from a prospective cohort study show.

Not only were most of the women deficient in vitamin D despite 6 weeks of supplementation and nearly 10 hours a week of Texas vernal sunshine, but an unexpectedly high number were osteoporotic or osteopenic, Dr. Sally Weaver and associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

Darker skin pigmentation and aging are known to decrease the body's ability to synthesize vitamin D. But it has generally been assumed that sun exposure in southern latitudes is either sufficient to provide adequate vitamin D levels or would reduce the need for supplementation.

The study included 44 African American women living in central Texas who were given 1,000 mg of calcium with 400 IU vitamin D tablets daily for 6 weeks, and told not to make any changes in diet or sun exposure. Clinical evaluations were made at baseline in April and 6 weeks later in June.

That time frame was chosen because, theoretically, 6 weeks is enough time for the body to replenish its supply of vitamin D if it is deficient, and because sun exposure typically increases in the spring, said Dr. Weaver, research director for the McLennan County Medical Education and Research Foundation, in Waco, Tex.

Overall, 36 (82%) of women returned for follow-up. Their average age was 76 years (range 70–88 years) and average BMI (kg/m

The investigators chose 32 ng/mL as the cutoff for “normal” vitamin D levels because there is some work that supports this value as the minimum needed for bone health, Dr. Weaver said. The ideal cutoff is under debate: Many levels use 20–25 ng/mL, but many researchers use higher values, such as 30–32 ng/mL, she said.

No matter which measure was used, the majority of women remained vitamin D deficient. After 6 weeks of supplementation, 23 women (52%) had vitamin D levels lower than 20 ng/mL, 29 (66%) had levels lower than 25 ng/mL, and 37 (84%) had levels lower than 32 ng/mL. Moreover, some women's levels were inexplicably lower after supplementation. Changes in vitamin D levels varied widely, from a loss of 10 ng/mL to a gain of 19 ng/mL over the course of the study. The lower the women's levels at baseline, the more likely they were to show an increase, she said.

Overall, 24 of the women (55%) were osteopenic and 11 (25%) were osteoporotic. The finding was surprising because greater weight is associated with stronger bones, she said. Only 13 (30%) of patients were on medication for the prevention or treatment of osteoporosis or osteopenia.

The average bone mineral density T score was −1.7, with a range of 1.7 to −4.0. Interestingly, T scores were not correlated with vitamin D levels. This could be because of the high number of osteopenic patients in the population, she said.

The amount of sun exposure was not correlated with vitamin D levels or T scores at the beginning or end of the study. “I believe that the combination of darker skin pigmentation and older age is preventing adequate sun conversion of vitamin D to an active form, even in a southern latitude, leading these patients to require much higher doses of oral supplements,” Dr. Weaver said.

TUCSON, ARIZ. — Customary vitamin D supplementation and springtime sun exposure in the southern United States are inadequate to protect elderly African American women from vitamin D deficiency and osteoporosis, data from a prospective cohort study show.

Not only were most of the women deficient in vitamin D despite 6 weeks of supplementation and nearly 10 hours a week of Texas vernal sunshine, but an unexpectedly high number were osteoporotic or osteopenic, Dr. Sally Weaver and associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

Darker skin pigmentation and aging are known to decrease the body's ability to synthesize vitamin D. But it has generally been assumed that sun exposure in southern latitudes is either sufficient to provide adequate vitamin D levels or would reduce the need for supplementation.

The study included 44 African American women living in central Texas who were given 1,000 mg of calcium with 400 IU vitamin D tablets daily for 6 weeks, and told not to make any changes in diet or sun exposure. Clinical evaluations were made at baseline in April and 6 weeks later in June.

That time frame was chosen because, theoretically, 6 weeks is enough time for the body to replenish its supply of vitamin D if it is deficient, and because sun exposure typically increases in the spring, said Dr. Weaver, research director for the McLennan County Medical Education and Research Foundation, in Waco, Tex.

Overall, 36 (82%) of women returned for follow-up. Their average age was 76 years (range 70–88 years) and average BMI (kg/m

The investigators chose 32 ng/mL as the cutoff for “normal” vitamin D levels because there is some work that supports this value as the minimum needed for bone health, Dr. Weaver said. The ideal cutoff is under debate: Many levels use 20–25 ng/mL, but many researchers use higher values, such as 30–32 ng/mL, she said.

No matter which measure was used, the majority of women remained vitamin D deficient. After 6 weeks of supplementation, 23 women (52%) had vitamin D levels lower than 20 ng/mL, 29 (66%) had levels lower than 25 ng/mL, and 37 (84%) had levels lower than 32 ng/mL. Moreover, some women's levels were inexplicably lower after supplementation. Changes in vitamin D levels varied widely, from a loss of 10 ng/mL to a gain of 19 ng/mL over the course of the study. The lower the women's levels at baseline, the more likely they were to show an increase, she said.

Overall, 24 of the women (55%) were osteopenic and 11 (25%) were osteoporotic. The finding was surprising because greater weight is associated with stronger bones, she said. Only 13 (30%) of patients were on medication for the prevention or treatment of osteoporosis or osteopenia.

The average bone mineral density T score was −1.7, with a range of 1.7 to −4.0. Interestingly, T scores were not correlated with vitamin D levels. This could be because of the high number of osteopenic patients in the population, she said.

The amount of sun exposure was not correlated with vitamin D levels or T scores at the beginning or end of the study. “I believe that the combination of darker skin pigmentation and older age is preventing adequate sun conversion of vitamin D to an active form, even in a southern latitude, leading these patients to require much higher doses of oral supplements,” Dr. Weaver said.

TUCSON, ARIZ. — Customary vitamin D supplementation and springtime sun exposure in the southern United States are inadequate to protect elderly African American women from vitamin D deficiency and osteoporosis, data from a prospective cohort study show.

Not only were most of the women deficient in vitamin D despite 6 weeks of supplementation and nearly 10 hours a week of Texas vernal sunshine, but an unexpectedly high number were osteoporotic or osteopenic, Dr. Sally Weaver and associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

Darker skin pigmentation and aging are known to decrease the body's ability to synthesize vitamin D. But it has generally been assumed that sun exposure in southern latitudes is either sufficient to provide adequate vitamin D levels or would reduce the need for supplementation.

The study included 44 African American women living in central Texas who were given 1,000 mg of calcium with 400 IU vitamin D tablets daily for 6 weeks, and told not to make any changes in diet or sun exposure. Clinical evaluations were made at baseline in April and 6 weeks later in June.

That time frame was chosen because, theoretically, 6 weeks is enough time for the body to replenish its supply of vitamin D if it is deficient, and because sun exposure typically increases in the spring, said Dr. Weaver, research director for the McLennan County Medical Education and Research Foundation, in Waco, Tex.

Overall, 36 (82%) of women returned for follow-up. Their average age was 76 years (range 70–88 years) and average BMI (kg/m

The investigators chose 32 ng/mL as the cutoff for “normal” vitamin D levels because there is some work that supports this value as the minimum needed for bone health, Dr. Weaver said. The ideal cutoff is under debate: Many levels use 20–25 ng/mL, but many researchers use higher values, such as 30–32 ng/mL, she said.

No matter which measure was used, the majority of women remained vitamin D deficient. After 6 weeks of supplementation, 23 women (52%) had vitamin D levels lower than 20 ng/mL, 29 (66%) had levels lower than 25 ng/mL, and 37 (84%) had levels lower than 32 ng/mL. Moreover, some women's levels were inexplicably lower after supplementation. Changes in vitamin D levels varied widely, from a loss of 10 ng/mL to a gain of 19 ng/mL over the course of the study. The lower the women's levels at baseline, the more likely they were to show an increase, she said.

Overall, 24 of the women (55%) were osteopenic and 11 (25%) were osteoporotic. The finding was surprising because greater weight is associated with stronger bones, she said. Only 13 (30%) of patients were on medication for the prevention or treatment of osteoporosis or osteopenia.

The average bone mineral density T score was −1.7, with a range of 1.7 to −4.0. Interestingly, T scores were not correlated with vitamin D levels. This could be because of the high number of osteopenic patients in the population, she said.

The amount of sun exposure was not correlated with vitamin D levels or T scores at the beginning or end of the study. “I believe that the combination of darker skin pigmentation and older age is preventing adequate sun conversion of vitamin D to an active form, even in a southern latitude, leading these patients to require much higher doses of oral supplements,” Dr. Weaver said.

MONTREAL — Patients with systemic lupus erythematosus demonstrated significantly more perfusion abnormalities on gated scintigraphy scans, compared with well-matched controls, in a small pilot study.

The observed differences may represent early manifestations of cardiomyopathy or silent diffuse myocardial ischemia, Dr. Scott Yoder and colleagues at the University of Rochester (N.Y.) Medical Center reported in a poster at the annual meeting of the American Society of Nuclear Cardiology.

Although several studies have highlighted the utility of gated single photon emission CT (SPECT) scans for the diagnosis of coronary artery disease (CAD) in SLE patients, no specific recommendations have been formulated. Dr. Yoder advocates routine cardiac screening of all lupus patients, and repeat scans roughly every 6 months for any patient with identified CAD to track the progression and severity of the heart disease, as well as disease modification for SLE and treatment of underlying heart disease.

“Especially if they have evidence of heart disease on their initial screening, then every time they have an active flare of their SLE you should probably look to see if they have any worsening of their heart disease,” he said.

Lupus is associated with a two- to fourfold increased risk for coronary artery disease (CAD), and is typically difficult to diagnose because patients don't have classic symptoms and tend to present late with heart failure or some other myocardial injury, Dr. Yoder said in an interview.

The study included 15 SLE patients and 15 controls who were randomly selected from the center's patient database, and matched for age (55 years), gender (90% female), and coronary risk factors such as hypercholesterolemia (80%), hypertension (80%), tobacco use (33%), and family history of CAD (80%). All patients underwent gated SPECT scans, plus either exercise using the Bruce or modified Bruce protocols, or pharmacologic stress testing using dobutamine or adenosine.

Patients with SLE had significantly worse end-systolic volume indices (45 mL/m

Nonsignificant differences also were noted in end-diastolic volume indices (84 mL/m

The study was prompted by a case in which gated-SPECT imaging was used to risk-stratify a 35-year-old male who came to the clinic with active lupus and chest pain, and was found to have significant stress and resting perfusion defects and inducible ischemia in the anterior wall. Aggressive treatment for SLE and cardiac risk factors with prednisone, mycophenolate, aspirin, and atorvastatin resulted in significant regression of the ischemia at 1 year. His ejection fraction recovered from 23% to 47%, and stress-induced cavity dilation of the left ventricle improved from 1.68 to 1.25.

SPECT imaging shows below normal perfusion at rest (top left) and stress-induced ischemia (top right) in an SLE patient with chest pain. SLE and CAD treatment improved resting perfusion (lower left) with no evidence of stress-induced ischemia (lower right). Photos courtesy Dr. Scott Yoder

MONTREAL — Patients with systemic lupus erythematosus demonstrated significantly more perfusion abnormalities on gated scintigraphy scans, compared with well-matched controls, in a small pilot study.

The observed differences may represent early manifestations of cardiomyopathy or silent diffuse myocardial ischemia, Dr. Scott Yoder and colleagues at the University of Rochester (N.Y.) Medical Center reported in a poster at the annual meeting of the American Society of Nuclear Cardiology.

Although several studies have highlighted the utility of gated single photon emission CT (SPECT) scans for the diagnosis of coronary artery disease (CAD) in SLE patients, no specific recommendations have been formulated. Dr. Yoder advocates routine cardiac screening of all lupus patients, and repeat scans roughly every 6 months for any patient with identified CAD to track the progression and severity of the heart disease, as well as disease modification for SLE and treatment of underlying heart disease.

“Especially if they have evidence of heart disease on their initial screening, then every time they have an active flare of their SLE you should probably look to see if they have any worsening of their heart disease,” he said.

Lupus is associated with a two- to fourfold increased risk for coronary artery disease (CAD), and is typically difficult to diagnose because patients don't have classic symptoms and tend to present late with heart failure or some other myocardial injury, Dr. Yoder said in an interview.

The study included 15 SLE patients and 15 controls who were randomly selected from the center's patient database, and matched for age (55 years), gender (90% female), and coronary risk factors such as hypercholesterolemia (80%), hypertension (80%), tobacco use (33%), and family history of CAD (80%). All patients underwent gated SPECT scans, plus either exercise using the Bruce or modified Bruce protocols, or pharmacologic stress testing using dobutamine or adenosine.

Patients with SLE had significantly worse end-systolic volume indices (45 mL/m

Nonsignificant differences also were noted in end-diastolic volume indices (84 mL/m

The study was prompted by a case in which gated-SPECT imaging was used to risk-stratify a 35-year-old male who came to the clinic with active lupus and chest pain, and was found to have significant stress and resting perfusion defects and inducible ischemia in the anterior wall. Aggressive treatment for SLE and cardiac risk factors with prednisone, mycophenolate, aspirin, and atorvastatin resulted in significant regression of the ischemia at 1 year. His ejection fraction recovered from 23% to 47%, and stress-induced cavity dilation of the left ventricle improved from 1.68 to 1.25.

SPECT imaging shows below normal perfusion at rest (top left) and stress-induced ischemia (top right) in an SLE patient with chest pain. SLE and CAD treatment improved resting perfusion (lower left) with no evidence of stress-induced ischemia (lower right). Photos courtesy Dr. Scott Yoder

MONTREAL — Patients with systemic lupus erythematosus demonstrated significantly more perfusion abnormalities on gated scintigraphy scans, compared with well-matched controls, in a small pilot study.

The observed differences may represent early manifestations of cardiomyopathy or silent diffuse myocardial ischemia, Dr. Scott Yoder and colleagues at the University of Rochester (N.Y.) Medical Center reported in a poster at the annual meeting of the American Society of Nuclear Cardiology.

Although several studies have highlighted the utility of gated single photon emission CT (SPECT) scans for the diagnosis of coronary artery disease (CAD) in SLE patients, no specific recommendations have been formulated. Dr. Yoder advocates routine cardiac screening of all lupus patients, and repeat scans roughly every 6 months for any patient with identified CAD to track the progression and severity of the heart disease, as well as disease modification for SLE and treatment of underlying heart disease.

“Especially if they have evidence of heart disease on their initial screening, then every time they have an active flare of their SLE you should probably look to see if they have any worsening of their heart disease,” he said.

Lupus is associated with a two- to fourfold increased risk for coronary artery disease (CAD), and is typically difficult to diagnose because patients don't have classic symptoms and tend to present late with heart failure or some other myocardial injury, Dr. Yoder said in an interview.

The study included 15 SLE patients and 15 controls who were randomly selected from the center's patient database, and matched for age (55 years), gender (90% female), and coronary risk factors such as hypercholesterolemia (80%), hypertension (80%), tobacco use (33%), and family history of CAD (80%). All patients underwent gated SPECT scans, plus either exercise using the Bruce or modified Bruce protocols, or pharmacologic stress testing using dobutamine or adenosine.

Patients with SLE had significantly worse end-systolic volume indices (45 mL/m

Nonsignificant differences also were noted in end-diastolic volume indices (84 mL/m

The study was prompted by a case in which gated-SPECT imaging was used to risk-stratify a 35-year-old male who came to the clinic with active lupus and chest pain, and was found to have significant stress and resting perfusion defects and inducible ischemia in the anterior wall. Aggressive treatment for SLE and cardiac risk factors with prednisone, mycophenolate, aspirin, and atorvastatin resulted in significant regression of the ischemia at 1 year. His ejection fraction recovered from 23% to 47%, and stress-induced cavity dilation of the left ventricle improved from 1.68 to 1.25.

SPECT imaging shows below normal perfusion at rest (top left) and stress-induced ischemia (top right) in an SLE patient with chest pain. SLE and CAD treatment improved resting perfusion (lower left) with no evidence of stress-induced ischemia (lower right). Photos courtesy Dr. Scott Yoder