Jonathan Gardner

Varenicline triples the likelihood that a smoker will quit, compared with placebo, according to a Cochrane Collaboration review.

The review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers.

The trials indicate that varenicline is effective, but the reviewers said more comparisons with other smoking-cessation strategies—such as nicotine replacement therapy—are needed.

Three studies compared varenicline to bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking, according to the reviewers.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

All the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

Varenicline triples the likelihood that a smoker will quit, compared with placebo, according to a Cochrane Collaboration review.

The review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers.

The trials indicate that varenicline is effective, but the reviewers said more comparisons with other smoking-cessation strategies—such as nicotine replacement therapy—are needed.

Three studies compared varenicline to bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking, according to the reviewers.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

All the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

Varenicline triples the likelihood that a smoker will quit, compared with placebo, according to a Cochrane Collaboration review.

The review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers.

The trials indicate that varenicline is effective, but the reviewers said more comparisons with other smoking-cessation strategies—such as nicotine replacement therapy—are needed.

Three studies compared varenicline to bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking, according to the reviewers.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

All the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

Wrestlers should be tested for hepatitis B virus and vaccinated at the beginning of their careers in an effort to prevent the spread of the virus through sweat, according to a Turkish researcher who conducted a study on the prevalence of the disease among Olympic wrestlers.

Selda Bereket-Yücel of Celal Bayar University, Manisa, Turkey, examined blood and sweat samples from 70 male wrestlers who competed at the Turkish national championship for signs of hepatitis B virus (HBV).

Thirteen percent of the wrestlers tested positive for HBV DNA in their blood, and 11% had HBV DNA in their sweat.

In response to a questionnaire, 37% of the wrestlers stated that they also had suffered a bleeding wound during training or competition, raising concerns that the virus could be transmitted during wrestling matches.

Sporting organizations have focused on the spread of the human immunodeficiency virus through contact sports, but none has acted on HBV, which is transmitted more easily because it is present in higher concentrations in the blood and is more stable in the environment, Dr. Bereket-Yücel wrote (Br. J. Sports Med. 2007 March 1[Epub doi: 10.1136/bjsm. 2006.032847]).

“Various experts have produced guidelines on the management of players with bleeding wounds,” Dr. Bereket-Yücel wrote.

“However, the results of this study suggest that sweating may be another way of transmitting HBV infection. The correlation between sweat and blood HBV DNA was statistically significant in this study.”

No previously published study has examined HBV DNA in sweat and the incidence of transmission.

“If the origin of the HBV in the wrestlers who had (occult) HBV were identified by secant analysis, then that would strengthen the hypothesis that HBV could be transmitted by sweat in contact or collision sports,” Dr. Bereket-Yücel said.

Wrestlers tested for the study were between 18 and 30 years old. Samples of sweat collected during training were tested for HBV DNA for liver biochemistry, HBV serology, and HBV DNA.

The prevalence of HBV in wrestlers cannot be compared with prevalence in other athletes because no other researcher has measured it, Dr. Bereket-Yücel wrote.

In addition to the exposure to HBV through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training and competition or because of the use of anabolic steroids, although Dr. Bereket-Yücel noted that the wrestlers in this study had not been asked whether they used steroids.

In addition to HBV exposure through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training or from steroid use. ©Alex Cena/Photoshelter

Wrestlers should be tested for hepatitis B virus and vaccinated at the beginning of their careers in an effort to prevent the spread of the virus through sweat, according to a Turkish researcher who conducted a study on the prevalence of the disease among Olympic wrestlers.

Selda Bereket-Yücel of Celal Bayar University, Manisa, Turkey, examined blood and sweat samples from 70 male wrestlers who competed at the Turkish national championship for signs of hepatitis B virus (HBV).

Thirteen percent of the wrestlers tested positive for HBV DNA in their blood, and 11% had HBV DNA in their sweat.

In response to a questionnaire, 37% of the wrestlers stated that they also had suffered a bleeding wound during training or competition, raising concerns that the virus could be transmitted during wrestling matches.

Sporting organizations have focused on the spread of the human immunodeficiency virus through contact sports, but none has acted on HBV, which is transmitted more easily because it is present in higher concentrations in the blood and is more stable in the environment, Dr. Bereket-Yücel wrote (Br. J. Sports Med. 2007 March 1[Epub doi: 10.1136/bjsm. 2006.032847]).

“Various experts have produced guidelines on the management of players with bleeding wounds,” Dr. Bereket-Yücel wrote.

“However, the results of this study suggest that sweating may be another way of transmitting HBV infection. The correlation between sweat and blood HBV DNA was statistically significant in this study.”

No previously published study has examined HBV DNA in sweat and the incidence of transmission.

“If the origin of the HBV in the wrestlers who had (occult) HBV were identified by secant analysis, then that would strengthen the hypothesis that HBV could be transmitted by sweat in contact or collision sports,” Dr. Bereket-Yücel said.

Wrestlers tested for the study were between 18 and 30 years old. Samples of sweat collected during training were tested for HBV DNA for liver biochemistry, HBV serology, and HBV DNA.

The prevalence of HBV in wrestlers cannot be compared with prevalence in other athletes because no other researcher has measured it, Dr. Bereket-Yücel wrote.

In addition to the exposure to HBV through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training and competition or because of the use of anabolic steroids, although Dr. Bereket-Yücel noted that the wrestlers in this study had not been asked whether they used steroids.

In addition to HBV exposure through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training or from steroid use. ©Alex Cena/Photoshelter

Wrestlers should be tested for hepatitis B virus and vaccinated at the beginning of their careers in an effort to prevent the spread of the virus through sweat, according to a Turkish researcher who conducted a study on the prevalence of the disease among Olympic wrestlers.

Selda Bereket-Yücel of Celal Bayar University, Manisa, Turkey, examined blood and sweat samples from 70 male wrestlers who competed at the Turkish national championship for signs of hepatitis B virus (HBV).

Thirteen percent of the wrestlers tested positive for HBV DNA in their blood, and 11% had HBV DNA in their sweat.

In response to a questionnaire, 37% of the wrestlers stated that they also had suffered a bleeding wound during training or competition, raising concerns that the virus could be transmitted during wrestling matches.

Sporting organizations have focused on the spread of the human immunodeficiency virus through contact sports, but none has acted on HBV, which is transmitted more easily because it is present in higher concentrations in the blood and is more stable in the environment, Dr. Bereket-Yücel wrote (Br. J. Sports Med. 2007 March 1[Epub doi: 10.1136/bjsm. 2006.032847]).

“Various experts have produced guidelines on the management of players with bleeding wounds,” Dr. Bereket-Yücel wrote.

“However, the results of this study suggest that sweating may be another way of transmitting HBV infection. The correlation between sweat and blood HBV DNA was statistically significant in this study.”

No previously published study has examined HBV DNA in sweat and the incidence of transmission.

“If the origin of the HBV in the wrestlers who had (occult) HBV were identified by secant analysis, then that would strengthen the hypothesis that HBV could be transmitted by sweat in contact or collision sports,” Dr. Bereket-Yücel said.

Wrestlers tested for the study were between 18 and 30 years old. Samples of sweat collected during training were tested for HBV DNA for liver biochemistry, HBV serology, and HBV DNA.

The prevalence of HBV in wrestlers cannot be compared with prevalence in other athletes because no other researcher has measured it, Dr. Bereket-Yücel wrote.

In addition to the exposure to HBV through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training and competition or because of the use of anabolic steroids, although Dr. Bereket-Yücel noted that the wrestlers in this study had not been asked whether they used steroids.

In addition to HBV exposure through sweat, wrestlers may also be susceptible to infection because of weakened immune responses during training or from steroid use. ©Alex Cena/Photoshelter

Men should be circumcised to reduce the risk of heterosexually acquired HIV infection, the World Health Organization and UNAIDS have recommended.

Following an expert panel held in March in Montreaux, Switzerland, the two organizations are advising that circumcision be a part of a comprehensive HIV prevention package, which also includes testing and counseling, treatment, promotion of safe sex habits, and provision of condoms and instruction on their use.

In a March 28 statement, WHO and UNAIDS said they based their recommendation on three randomized, controlled trials conducted in Kenya, South Africa, and Uganda, which found that circumcision reduces the risk of heterosexually acquired HIV in men by about 60%. The trials followed observational studies in which lower HIV prevalence was found in African countries with higher circumcision rates.

“The recommendations represent a significant step forward in HIV prevention,” Dr Kevin M. De Cock, director of the WHO's HIV/AIDS department, said in a written statement. “Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.”

UNAIDS officials caution, however, that circumcision does not provide complete protection against the virus.

“Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners,” Catherine Hankins, Associate Director in the department of policy, evidence, and partnerships at UNAIDS, said in the statement.

The organizations estimate that 30% of men worldwide are circumcised.

Men should be circumcised to reduce the risk of heterosexually acquired HIV infection, the World Health Organization and UNAIDS have recommended.

Following an expert panel held in March in Montreaux, Switzerland, the two organizations are advising that circumcision be a part of a comprehensive HIV prevention package, which also includes testing and counseling, treatment, promotion of safe sex habits, and provision of condoms and instruction on their use.

In a March 28 statement, WHO and UNAIDS said they based their recommendation on three randomized, controlled trials conducted in Kenya, South Africa, and Uganda, which found that circumcision reduces the risk of heterosexually acquired HIV in men by about 60%. The trials followed observational studies in which lower HIV prevalence was found in African countries with higher circumcision rates.

“The recommendations represent a significant step forward in HIV prevention,” Dr Kevin M. De Cock, director of the WHO's HIV/AIDS department, said in a written statement. “Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.”

UNAIDS officials caution, however, that circumcision does not provide complete protection against the virus.

“Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners,” Catherine Hankins, Associate Director in the department of policy, evidence, and partnerships at UNAIDS, said in the statement.

The organizations estimate that 30% of men worldwide are circumcised.

Men should be circumcised to reduce the risk of heterosexually acquired HIV infection, the World Health Organization and UNAIDS have recommended.

Following an expert panel held in March in Montreaux, Switzerland, the two organizations are advising that circumcision be a part of a comprehensive HIV prevention package, which also includes testing and counseling, treatment, promotion of safe sex habits, and provision of condoms and instruction on their use.

In a March 28 statement, WHO and UNAIDS said they based their recommendation on three randomized, controlled trials conducted in Kenya, South Africa, and Uganda, which found that circumcision reduces the risk of heterosexually acquired HIV in men by about 60%. The trials followed observational studies in which lower HIV prevalence was found in African countries with higher circumcision rates.

“The recommendations represent a significant step forward in HIV prevention,” Dr Kevin M. De Cock, director of the WHO's HIV/AIDS department, said in a written statement. “Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.”

UNAIDS officials caution, however, that circumcision does not provide complete protection against the virus.

“Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners,” Catherine Hankins, Associate Director in the department of policy, evidence, and partnerships at UNAIDS, said in the statement.

The organizations estimate that 30% of men worldwide are circumcised.

Couples who are overweight or obese are more likely to have trouble conceiving than are normal-weight couples, according to a large Danish population-based study.

Among couples who were obese, the adjusted odds ratio for subfecundity was 2.74, compared with normal-weight couples. When both partners were overweight, the odds ratio was 1.41, investigators wrote in Human Reproduction.

Odds ratios were adjusted for both partners' ages, number of previous pregnancies, and socioeconomic group. Subfecundity was defined as a waiting time of at least 12 months to achieve a pregnancy that resulted in a live birth.

While previous research has shown that the weight of women and men individually affects fertility, this is the first study to examine fertility when both partners are overweight (body mass index of 25–29.99 kg/m

The researchers analyzed data from women enrolled in the Danish Birth Cohort, a nationwide study of pregnant women and their offspring, which enrolled more than 100,000 women between 1996 and 2002.

Included in the obesity study were couples who provided information on time to pregnancy and BMI for both the man and the woman. A population of 47,835 couples was analyzed for the study, 2,478 of whom had at least two births.

Obesity was reported in approximately 7% of men, 8% of women, and 1% of couples. A total of 53% of men and 68% of women were of normal weight.

Couples who are overweight or obese are more likely to have trouble conceiving than are normal-weight couples, according to a large Danish population-based study.

Among couples who were obese, the adjusted odds ratio for subfecundity was 2.74, compared with normal-weight couples. When both partners were overweight, the odds ratio was 1.41, investigators wrote in Human Reproduction.

Odds ratios were adjusted for both partners' ages, number of previous pregnancies, and socioeconomic group. Subfecundity was defined as a waiting time of at least 12 months to achieve a pregnancy that resulted in a live birth.

While previous research has shown that the weight of women and men individually affects fertility, this is the first study to examine fertility when both partners are overweight (body mass index of 25–29.99 kg/m

The researchers analyzed data from women enrolled in the Danish Birth Cohort, a nationwide study of pregnant women and their offspring, which enrolled more than 100,000 women between 1996 and 2002.

Included in the obesity study were couples who provided information on time to pregnancy and BMI for both the man and the woman. A population of 47,835 couples was analyzed for the study, 2,478 of whom had at least two births.

Obesity was reported in approximately 7% of men, 8% of women, and 1% of couples. A total of 53% of men and 68% of women were of normal weight.

Couples who are overweight or obese are more likely to have trouble conceiving than are normal-weight couples, according to a large Danish population-based study.

Among couples who were obese, the adjusted odds ratio for subfecundity was 2.74, compared with normal-weight couples. When both partners were overweight, the odds ratio was 1.41, investigators wrote in Human Reproduction.

Odds ratios were adjusted for both partners' ages, number of previous pregnancies, and socioeconomic group. Subfecundity was defined as a waiting time of at least 12 months to achieve a pregnancy that resulted in a live birth.

While previous research has shown that the weight of women and men individually affects fertility, this is the first study to examine fertility when both partners are overweight (body mass index of 25–29.99 kg/m

The researchers analyzed data from women enrolled in the Danish Birth Cohort, a nationwide study of pregnant women and their offspring, which enrolled more than 100,000 women between 1996 and 2002.

Included in the obesity study were couples who provided information on time to pregnancy and BMI for both the man and the woman. A population of 47,835 couples was analyzed for the study, 2,478 of whom had at least two births.

Obesity was reported in approximately 7% of men, 8% of women, and 1% of couples. A total of 53% of men and 68% of women were of normal weight.

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death during follow-up.

Having high scores on the Beck Depression Inventory (BDI) increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C. These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the BDI. Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death during follow-up.

Having high scores on the Beck Depression Inventory (BDI) increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C. These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the BDI. Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death during follow-up.

Having high scores on the Beck Depression Inventory (BDI) increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C. These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the BDI. Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

That finding emerged from a study presented at the American Psychosomatic Society meeting in Budapest, Hungary.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with patients with similar depression scores but without type 2 diabetes, according to investigators from Duke University, Durham, N.C.

These findings suggest that physicians should screen for and treat depression in their patients with diabetes and heart disease.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” lead researcher Anastasia Georgiades, Ph.D., said in a written statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

The study compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography. Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the follow-up period of 4.5 years (median, 3 years), the researchers documented 135 deaths among the study participants. Among the depressed patients, 19% died, compared with 12% of those patients without depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality. The highest mortality was among patients with both diabetes and elevated BDI scores. The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and create anxiety among patients.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Physicians treating patients with heart disease and diabetes need to screen them for depression and treat as needed.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

British researchers said they have identified in a bodybuilder the first case of frank diabetes triggered by misuse of human growth hormone, suggesting that physicians need to check for hyperglycemia in athletes who use the substances and remind them of their dangers.

Researchers at University Hospital Coventry and Warwick Hospital (England) said the patient, a 36-year-old man who admitted to using anabolic steroids for 15 years and growth hormone for 3 years, presented to a hospital emergency department with impaired liver function and hyperglycemia.

His blood glucose levels were 30.2 mmol/L, and he had mild hepatomegaly.

He had lost 88 pounds and now weighed 198 pounds; the weight loss was associated with polyuria (12 L/day), polydipsia, and polyphagia. There also was evidence of acute hepatitis.

During a 5-day hospital stay, the patient's biochemistry was stabilized with insulin and intravenous fluids. He was then discharged.

The patient stopped using steroids and growth hormone, and at a 6-weeks' follow-up his hyperglycemia had disappeared, confirmed by a glucose tolerance test.

“Treatment of these particular patients requires us to know their mind set, and to know what motivates them,” wrote the researchers, Dr. James Young and Dr. Aresh Anwar. “This will allow us to identify, and therefore educate, them with regard to the potential pitfalls of using performance-enhancing drugs.

“We would recommend checking for hyperglycemia in those taking supraphysiological doses of growth hormone,” they wrote. “Moreover, in those cases where diabetes resolves, we would recommend long-term follow-up for diabetes mellitus screening.”

Use of human growth hormone, which is undetectable in many assays used to screen for performance-enhancing drugs, is on the rise among athletes and bodybuilders, and is widely available through the Internet, they wrote.

Athletes who use growth hormones self-medicate with insulin, although the misuse of insulin may be intended as a performance-enhancing drug, not necessarily to counteract the insulin resistance that develops with use of growth hormone, according to the researchers.

It also is not clear whether the misuse of human growth hormone induces diabetes or reveals it at an early stage when it otherwise would by asymptomatic.

No studies have monitored the long-term effects of growth hormone misuse among healthy young people who have no hormone deficiency, they wrote (Br. J. Sports. Med. 2007 Feb. 26 [Epub doi:10.1136/bjsm.2006.030585])

British researchers said they have identified in a bodybuilder the first case of frank diabetes triggered by misuse of human growth hormone, suggesting that physicians need to check for hyperglycemia in athletes who use the substances and remind them of their dangers.

Researchers at University Hospital Coventry and Warwick Hospital (England) said the patient, a 36-year-old man who admitted to using anabolic steroids for 15 years and growth hormone for 3 years, presented to a hospital emergency department with impaired liver function and hyperglycemia.

His blood glucose levels were 30.2 mmol/L, and he had mild hepatomegaly.

He had lost 88 pounds and now weighed 198 pounds; the weight loss was associated with polyuria (12 L/day), polydipsia, and polyphagia. There also was evidence of acute hepatitis.

During a 5-day hospital stay, the patient's biochemistry was stabilized with insulin and intravenous fluids. He was then discharged.

The patient stopped using steroids and growth hormone, and at a 6-weeks' follow-up his hyperglycemia had disappeared, confirmed by a glucose tolerance test.

“Treatment of these particular patients requires us to know their mind set, and to know what motivates them,” wrote the researchers, Dr. James Young and Dr. Aresh Anwar. “This will allow us to identify, and therefore educate, them with regard to the potential pitfalls of using performance-enhancing drugs.

“We would recommend checking for hyperglycemia in those taking supraphysiological doses of growth hormone,” they wrote. “Moreover, in those cases where diabetes resolves, we would recommend long-term follow-up for diabetes mellitus screening.”

Use of human growth hormone, which is undetectable in many assays used to screen for performance-enhancing drugs, is on the rise among athletes and bodybuilders, and is widely available through the Internet, they wrote.

Athletes who use growth hormones self-medicate with insulin, although the misuse of insulin may be intended as a performance-enhancing drug, not necessarily to counteract the insulin resistance that develops with use of growth hormone, according to the researchers.

It also is not clear whether the misuse of human growth hormone induces diabetes or reveals it at an early stage when it otherwise would by asymptomatic.

No studies have monitored the long-term effects of growth hormone misuse among healthy young people who have no hormone deficiency, they wrote (Br. J. Sports. Med. 2007 Feb. 26 [Epub doi:10.1136/bjsm.2006.030585])

British researchers said they have identified in a bodybuilder the first case of frank diabetes triggered by misuse of human growth hormone, suggesting that physicians need to check for hyperglycemia in athletes who use the substances and remind them of their dangers.

Researchers at University Hospital Coventry and Warwick Hospital (England) said the patient, a 36-year-old man who admitted to using anabolic steroids for 15 years and growth hormone for 3 years, presented to a hospital emergency department with impaired liver function and hyperglycemia.

His blood glucose levels were 30.2 mmol/L, and he had mild hepatomegaly.

He had lost 88 pounds and now weighed 198 pounds; the weight loss was associated with polyuria (12 L/day), polydipsia, and polyphagia. There also was evidence of acute hepatitis.

During a 5-day hospital stay, the patient's biochemistry was stabilized with insulin and intravenous fluids. He was then discharged.

The patient stopped using steroids and growth hormone, and at a 6-weeks' follow-up his hyperglycemia had disappeared, confirmed by a glucose tolerance test.

“Treatment of these particular patients requires us to know their mind set, and to know what motivates them,” wrote the researchers, Dr. James Young and Dr. Aresh Anwar. “This will allow us to identify, and therefore educate, them with regard to the potential pitfalls of using performance-enhancing drugs.

“We would recommend checking for hyperglycemia in those taking supraphysiological doses of growth hormone,” they wrote. “Moreover, in those cases where diabetes resolves, we would recommend long-term follow-up for diabetes mellitus screening.”

Use of human growth hormone, which is undetectable in many assays used to screen for performance-enhancing drugs, is on the rise among athletes and bodybuilders, and is widely available through the Internet, they wrote.

Athletes who use growth hormones self-medicate with insulin, although the misuse of insulin may be intended as a performance-enhancing drug, not necessarily to counteract the insulin resistance that develops with use of growth hormone, according to the researchers.

It also is not clear whether the misuse of human growth hormone induces diabetes or reveals it at an early stage when it otherwise would by asymptomatic.

No studies have monitored the long-term effects of growth hormone misuse among healthy young people who have no hormone deficiency, they wrote (Br. J. Sports. Med. 2007 Feb. 26 [Epub doi:10.1136/bjsm.2006.030585])

Binge drinking is less common among British women with lower educational levels or job status when they are in their 20s than it is among those with higher educational levels or job status, but in their 30s the trend reverses, according to a new study.

The cohort study of more than 10,000 British men and women found that, while trends in both binge drinking and abstaining from alcohol remained stable over time for men, women were more likely to change their binge-drinking habits as they age (J. Epidemiol. Community Health 2007;61:150–3).

At age 23 years, less-educated women were 9% less likely to binge drink than were better-educated women. At age 33, they were 11% more likely, and at age 42, 28% more likely.

The researchers, led by Barbara Jefferis, of the Institute of Child Health in London, said their findings suggest that the differences in binge-drinking habits may reinforce alcohol-related health inequalities.

“The initial peak of alcohol use in the most educated women differs from characteristic social gradients in health behaviors, whereby healthier behaviors are taken up by the most educated in society, as seen with smoking in this cohort,” they wrote. “Social gradients in health behaviors, including alcohol consumption, differ across locations and times, and are influenced by cultural and economic contexts.”

The researchers followed a group of British men and women all born the same week in March 1958, surveying them on drinking habits at the ages of 23, 33, and 42 years.

Survey respondents were asked to describe their drinking habits, and binge drinkers were identified by dividing the number of units of alcohol consumed in the past week by their normal weekly frequency of drinking.

In both sexes and at all time points, abstaining from alcohol was more likely among those achieving lower educational and job status. At age 23, men in the less educated group were 31% more likely to be nondrinkers, decreasing to 19% at age 33 and 17% at age 42. Less-educated women were 23% more likely to abstain at age 23, decreasing to 20% at age 33, but then increasing to 28% at age 42. The trends were not statistically significant.

Abstainers were a small proportion of the study population, reaching a maximum of 3.7% of men and 6.3% of the women at age 42.

Among men, binge drinking was more likely among those with lower educational and job status at all time points. At age 23, men in the less-educated group were 13% more likely to binge drink, 17% more likely at age 33, and 18% more likely at age 42. That odds increase among the less-educated men was not statistically significant, however.

Binge drinkers were a larger share of the cohort than abstainers, with a maximum of 36% of men and 18% of women at age 23.

Binge drinking is less common among British women with lower educational levels or job status when they are in their 20s than it is among those with higher educational levels or job status, but in their 30s the trend reverses, according to a new study.

The cohort study of more than 10,000 British men and women found that, while trends in both binge drinking and abstaining from alcohol remained stable over time for men, women were more likely to change their binge-drinking habits as they age (J. Epidemiol. Community Health 2007;61:150–3).

At age 23 years, less-educated women were 9% less likely to binge drink than were better-educated women. At age 33, they were 11% more likely, and at age 42, 28% more likely.

The researchers, led by Barbara Jefferis, of the Institute of Child Health in London, said their findings suggest that the differences in binge-drinking habits may reinforce alcohol-related health inequalities.

“The initial peak of alcohol use in the most educated women differs from characteristic social gradients in health behaviors, whereby healthier behaviors are taken up by the most educated in society, as seen with smoking in this cohort,” they wrote. “Social gradients in health behaviors, including alcohol consumption, differ across locations and times, and are influenced by cultural and economic contexts.”

The researchers followed a group of British men and women all born the same week in March 1958, surveying them on drinking habits at the ages of 23, 33, and 42 years.

Survey respondents were asked to describe their drinking habits, and binge drinkers were identified by dividing the number of units of alcohol consumed in the past week by their normal weekly frequency of drinking.

In both sexes and at all time points, abstaining from alcohol was more likely among those achieving lower educational and job status. At age 23, men in the less educated group were 31% more likely to be nondrinkers, decreasing to 19% at age 33 and 17% at age 42. Less-educated women were 23% more likely to abstain at age 23, decreasing to 20% at age 33, but then increasing to 28% at age 42. The trends were not statistically significant.

Abstainers were a small proportion of the study population, reaching a maximum of 3.7% of men and 6.3% of the women at age 42.

Among men, binge drinking was more likely among those with lower educational and job status at all time points. At age 23, men in the less-educated group were 13% more likely to binge drink, 17% more likely at age 33, and 18% more likely at age 42. That odds increase among the less-educated men was not statistically significant, however.

Binge drinkers were a larger share of the cohort than abstainers, with a maximum of 36% of men and 18% of women at age 23.

Binge drinking is less common among British women with lower educational levels or job status when they are in their 20s than it is among those with higher educational levels or job status, but in their 30s the trend reverses, according to a new study.

The cohort study of more than 10,000 British men and women found that, while trends in both binge drinking and abstaining from alcohol remained stable over time for men, women were more likely to change their binge-drinking habits as they age (J. Epidemiol. Community Health 2007;61:150–3).

At age 23 years, less-educated women were 9% less likely to binge drink than were better-educated women. At age 33, they were 11% more likely, and at age 42, 28% more likely.

The researchers, led by Barbara Jefferis, of the Institute of Child Health in London, said their findings suggest that the differences in binge-drinking habits may reinforce alcohol-related health inequalities.

“The initial peak of alcohol use in the most educated women differs from characteristic social gradients in health behaviors, whereby healthier behaviors are taken up by the most educated in society, as seen with smoking in this cohort,” they wrote. “Social gradients in health behaviors, including alcohol consumption, differ across locations and times, and are influenced by cultural and economic contexts.”

The researchers followed a group of British men and women all born the same week in March 1958, surveying them on drinking habits at the ages of 23, 33, and 42 years.

Survey respondents were asked to describe their drinking habits, and binge drinkers were identified by dividing the number of units of alcohol consumed in the past week by their normal weekly frequency of drinking.

In both sexes and at all time points, abstaining from alcohol was more likely among those achieving lower educational and job status. At age 23, men in the less educated group were 31% more likely to be nondrinkers, decreasing to 19% at age 33 and 17% at age 42. Less-educated women were 23% more likely to abstain at age 23, decreasing to 20% at age 33, but then increasing to 28% at age 42. The trends were not statistically significant.

Abstainers were a small proportion of the study population, reaching a maximum of 3.7% of men and 6.3% of the women at age 42.

Among men, binge drinking was more likely among those with lower educational and job status at all time points. At age 23, men in the less-educated group were 13% more likely to binge drink, 17% more likely at age 33, and 18% more likely at age 42. That odds increase among the less-educated men was not statistically significant, however.

Binge drinkers were a larger share of the cohort than abstainers, with a maximum of 36% of men and 18% of women at age 23.

Varenicline triples the likelihood that a smoker will quit, compared with placebo, and bupropion and nortriptyline double the odds, according to a pair of evidence reviews published Jan. 24.

The Cochrane Collaboration review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers. However, the reviewers said more comparisons with other smoking-cessation strategies are needed.

Three of the studies did compare varenicline with bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo, the reviewers write. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

The reviewers found only one trial of another nicotine agonist, cytisine, that met the reviews' inclusion criteria. That trial increased by 77% the chances that a smoker will abstain from smoking 2 years after treatment.

For varenicline, a derivative of cytisine, the most serious adverse effects were nausea, at rates topping 50%, with discontinuation rates as high as 9.5%. Two of the trials found an increased nausea rate with higher doses, with 17.5% of those taking a 0.3-mg dose daily reporting nausea to 52% of those taking a 1-mg dose twice a day.

No treatment-related deaths were reported for any patients taking varenicline, although nonfatal serious adverse events occurred in all of them. However, all of the studies judged varenicline to be safe and well-tolerated at all dosages and time periods.

All of the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

The separate review of antidepressants, an update to an earlier report, identifies 17 new randomized controlled trials since 2004 using the medications for smoking cessation (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi 10.1002/14651858.CD000031.pub3]), bringing the total number of trials to 53.

In 31 trials testing bupropion as a sole medication, testing a total of 10,000 patients, the drug increased by 94% the chances that a smoker will quit, compared with a placebo, according to the reviewers, led by Dr. John R. Hughes, a professor in the department of psychiatry at the University of Vermont, Burlington.

In 17 trials with a 12-month follow-up period, smokers who take bupropion were 83% more likely than those on placebo to have abstained from smoking. The reviewers said evidence is insufficient to favor bupropion over nicotine replacement therapy or to add bupropion to nicotine replacement therapy.

Nortriptyline also doubles odds of success. Six trials with 975 patients show those taking nortriptyline are 2.34 times more likely to quit, compared with placebo. Other antidepressants did not demonstrate a long-term effect, the reviewers said.

The most serious side effect of the use of the antidepressants for smoking cessation was a 1 in 1,000 risk of seizures.

When used as a sole medication, bupropion increased by 94% the chances that a smoker will quit. DR. HUGHES

Varenicline triples the likelihood that a smoker will quit, compared with placebo, and bupropion and nortriptyline double the odds, according to a pair of evidence reviews published Jan. 24.

The Cochrane Collaboration review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers. However, the reviewers said more comparisons with other smoking-cessation strategies are needed.

Three of the studies did compare varenicline with bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo, the reviewers write. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

The reviewers found only one trial of another nicotine agonist, cytisine, that met the reviews' inclusion criteria. That trial increased by 77% the chances that a smoker will abstain from smoking 2 years after treatment.

For varenicline, a derivative of cytisine, the most serious adverse effects were nausea, at rates topping 50%, with discontinuation rates as high as 9.5%. Two of the trials found an increased nausea rate with higher doses, with 17.5% of those taking a 0.3-mg dose daily reporting nausea to 52% of those taking a 1-mg dose twice a day.

No treatment-related deaths were reported for any patients taking varenicline, although nonfatal serious adverse events occurred in all of them. However, all of the studies judged varenicline to be safe and well-tolerated at all dosages and time periods.

All of the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

The separate review of antidepressants, an update to an earlier report, identifies 17 new randomized controlled trials since 2004 using the medications for smoking cessation (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi 10.1002/14651858.CD000031.pub3]), bringing the total number of trials to 53.

In 31 trials testing bupropion as a sole medication, testing a total of 10,000 patients, the drug increased by 94% the chances that a smoker will quit, compared with a placebo, according to the reviewers, led by Dr. John R. Hughes, a professor in the department of psychiatry at the University of Vermont, Burlington.

In 17 trials with a 12-month follow-up period, smokers who take bupropion were 83% more likely than those on placebo to have abstained from smoking. The reviewers said evidence is insufficient to favor bupropion over nicotine replacement therapy or to add bupropion to nicotine replacement therapy.

Nortriptyline also doubles odds of success. Six trials with 975 patients show those taking nortriptyline are 2.34 times more likely to quit, compared with placebo. Other antidepressants did not demonstrate a long-term effect, the reviewers said.

The most serious side effect of the use of the antidepressants for smoking cessation was a 1 in 1,000 risk of seizures.

When used as a sole medication, bupropion increased by 94% the chances that a smoker will quit. DR. HUGHES

Varenicline triples the likelihood that a smoker will quit, compared with placebo, and bupropion and nortriptyline double the odds, according to a pair of evidence reviews published Jan. 24.

The Cochrane Collaboration review of varenicline, a nicotine receptor agonist, based its findings on five randomized controlled trials that included more than 4,900 people, more than 2,400 of whom took varenicline (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi: 10.1002/14651858.CD006103.pub2]).

Findings were validated in all of the studies included in the meta-analysis by measuring exhaled carbon monoxide levels.

At 12 months, the pooled odds of the smokers taking varenicline were 3.22 times as great as those taking placebo to have continuously abstained from smoking, according to the reviewers, led by Kate Cahill, of the primary health care department at Oxford University (England). At 12 weeks, patients taking varenicline were 4.07 times as likely as those taking a placebo to have continuously abstained from smoking, and at 24 weeks, 3.53 times as likely, according to the reviewers. However, the reviewers said more comparisons with other smoking-cessation strategies are needed.

Three of the studies did compare varenicline with bupropion, an antidepressant. At 12 months, the smokers taking varenicline were 66% more likely to have abstained from smoking.

The number of smokers needed to treat with varenicline to achieve one more successful quitter is eight, compared with placebo, the reviewers write. By comparison, nicotine replacement therapy requires 20 and bupropion 15.

The reviewers found only one trial of another nicotine agonist, cytisine, that met the reviews' inclusion criteria. That trial increased by 77% the chances that a smoker will abstain from smoking 2 years after treatment.

For varenicline, a derivative of cytisine, the most serious adverse effects were nausea, at rates topping 50%, with discontinuation rates as high as 9.5%. Two of the trials found an increased nausea rate with higher doses, with 17.5% of those taking a 0.3-mg dose daily reporting nausea to 52% of those taking a 1-mg dose twice a day.

No treatment-related deaths were reported for any patients taking varenicline, although nonfatal serious adverse events occurred in all of them. However, all of the studies judged varenicline to be safe and well-tolerated at all dosages and time periods.

All of the varenicline studies meeting the reviewers' inclusion criteria were funded by Pfizer Inc., which manufactures the medication under the brand name Chantix.

The separate review of antidepressants, an update to an earlier report, identifies 17 new randomized controlled trials since 2004 using the medications for smoking cessation (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi 10.1002/14651858.CD000031.pub3]), bringing the total number of trials to 53.

In 31 trials testing bupropion as a sole medication, testing a total of 10,000 patients, the drug increased by 94% the chances that a smoker will quit, compared with a placebo, according to the reviewers, led by Dr. John R. Hughes, a professor in the department of psychiatry at the University of Vermont, Burlington.

In 17 trials with a 12-month follow-up period, smokers who take bupropion were 83% more likely than those on placebo to have abstained from smoking. The reviewers said evidence is insufficient to favor bupropion over nicotine replacement therapy or to add bupropion to nicotine replacement therapy.

Nortriptyline also doubles odds of success. Six trials with 975 patients show those taking nortriptyline are 2.34 times more likely to quit, compared with placebo. Other antidepressants did not demonstrate a long-term effect, the reviewers said.

The most serious side effect of the use of the antidepressants for smoking cessation was a 1 in 1,000 risk of seizures.

When used as a sole medication, bupropion increased by 94% the chances that a smoker will quit. DR. HUGHES