Conference Highlights



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Am Fam Physician. 1998 Jun 1;57(11):2809-2810.

Study Looks at Anger, Ethnicity and Cardiovascular Reactivity

(Annual Meeting of the American Psychosomatic Society) A study to determine the effects of racist provocations in blacks showed that holding back anger places an unhealthy load on the blood vessels which, over time, may cause hypertension. In the study, 46 male college students (23 black subjects and 23 white subjects) participated in one of two debates: one with a racist theme and one with a nonracist theme. Physiologic reactions were assessed at baseline, during the debate and after the debate in all of the subjects. The black subjects had higher peripheral resistance at baseline, while the white subjects had higher cardiac output. After the debates, one half of the subjects were given the opportunity to express their anger by rating their opponent, but the remaining participants were not given this opportunity. Systolic blood pressure was higher in black subjects during the racist debate than during the nonracist debate. In both the black subjects and the white subjects who did not express their anger, the blood vessels were constricted at greater than normal levels for 10 minutes after the anger-provoking situation. In those subjects who expressed their anger, the blood vessels returned to normal almost immediately. Although the results suggest that inhibition of anger places an unhealthy load on the blood vessels in both blacks and whites, the investigators believe that blacks are more likely to be in anger-provoking situations because of racism, and other research indicates that blacks have a tendency to inhibit their anger more than whites.—nancy dorr, ph.d., et al., Jamestown College, Jamestown, North Dakota.

Newer Oral Contraceptives May Offer Cardiovascular Benefits

(American Psychosomatic Society) Women who take the newer formulations of oral contraceptive pills that contain either desogestrel or norgestimate as the progesterone component may not have the cardiovascular risks that are associated with the older formulations of oral contraceptive pills that contain the progesterone levonorgestrel. This was the conclusion of a study in which 48 healthy women who used oral contraceptives (one half of whom were regular cigarette smokers) were evaluated for blood pressure and vascular resistance at rest and under stress. The results in women taking the older formulation of contraceptive pills were compared with those in women taking the newer formulations. The women receiving the newer formulation showed reduced blood pressure levels and vascular resistance during stress. The results were especially dramatic for smokers using the newer formulations, compared with those receiving older versions of the pill. The investigators believe that these study results are particularly important for the women who continue to smoke and use oral contraceptives.—susan girdler, m.d., et al., University of North Carolina at Chapel Hill School of Medicine.

Study Indicates the Prevalence of Thyroid Disease May Be Over 11 Percent

(70th Annual Meeting of the American Thyroid Association) The prevalence of abnormal thyroid function was 11.7 percent in a large observational cohort study, even though only 1 percent of the subjects in the study were receiving therapy for thyroid disease. A total of 25,862 subjects were included in the study. Serum thyroid-stimulating hormone (TSH) levels and total thyroxine (T4) concentrations, serum lipid levels and responses to a self-administered questionnaire on symptoms of hypothyroidism were obtained. The prevalence of an elevated TSH level in this screening population was 9.5 percent and of a low TSH level was 2.2 percent. Most of these persons were not receiving thyroid hormone medication. Of the 1,525 persons who were taking thyroid medication for elevated or low thyroid hormone levels, 40 percent had an abnormal TSH level (18.4 percent had an elevated TSH level and 21.6 percent had a low TSH level). The study also demonstrated an association between abnormal thyroid function and elevated cholesterol levels. Study participants with an elevated TSH level had higher total cholesterol levels and low-density lipoprotein levels than the subjects with normal thyroid activity. Symptoms were reported more often in hypothyroid individuals than in those with a normal thyroid function, suggesting that patients who have multiple symptoms may warrant thyroid testing. The investigators believe that education is needed about the importance of routine thyroid screening, and that those individuals who have been diagnosed with abnormal thyroid activity need to be managed properly.—gay j. canaris, m.d., m.s.p.h., et al., University of Nebraska Medical Center, Lincoln.

Alendronate Increases Bone Mass in Patients Receiving Steroid Therapy

(61st National Scientific Meeting of the American College of Rheumatology) Results of a large investigational study demonstrate that alendronate (Fosamax) is effective in the prevention and treatment of osteoporosis in persons who have or are at risk of osteoporosis as a result of long-term steroid therapy for rheumatoid arthritis, asthma, inflammatory bowel disease, or other conditions. The study included 76 men and 156 women 19 to 83 years of age who were expected to continue receiving at least 7.5 mg per day of oral prednisone or equivalent for at least one year. Rheumatologic patients represented 53 percent of the study population. At study entry, 33 percent of the patients had received steroid therapy for less than four months and 49 percent had been receiving the therapy for more than one year. All of the patients received supplemental calcium and vitamin D. The patients were randomized to receive 5 or 10 mg per day of alendronate or placebo. The patients receiving alendronate had significantly increased bone mineral density at the spine, trochanter and femoral neck, compared with the patients receiving placebo and compared with baseline measurements.—kenneth saag, m.d., m.sc., et al., University of Iowa, Iowa City.

Etidronate Is Effective in Steroid-Induced Osteoporosis

(American College of Rheumatology) Etidronate (Didronel) is effective in the prevention of steroid-induced osteoporosis, according to a study of 141 patients who were receiving high doses of steroids for one year. The patients were randomized to receive either etidronate or placebo for 14 days followed by 76 days of calcium. This cycle was repeated three times. At the end of the study, the patients receiving etidronate had increased bone mass in the spine and in the hip, compared with patients receiving placebo. In addition, the occurrence of vertebral fracture was significantly reduced in the patients receiving etidronate. Loss of height was also lower in the patients receiving etidronate.—william bensen, m.d., and rick adachi, m.d., McMaster University, Hamilton, Ontario.



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