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Vol. LXI, No. 7
April 3, 2009

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Heart Failure Before Age 50 More Common in Blacks

As many as 1 in 100 black men and women develop heart failure before the age of 50, 20 times the rate in whites in this age group, according to new findings from NHLBI.

As many as 1 in 100 black men and women develop heart failure before the age of 50, 20 times the rate in whites in this age group, according to new findings from the National Heart, Lung, and Blood Institute. In the study, heart failure developed in black participants at an average age of 39, often preceded by risk factors such as high blood pressure, obesity and chronic kidney disease 10 to 20 years earlier. Findings from the 20-year observational study Coronary Artery Risk Development in Young Adults study (CARDIA) were published in the Mar. 19 issue of the New England Journal of Medicine.

By the 10th year of the study, when participants were between ages 28 and 40, 87 percent of black participants who later developed heart failure had untreated or poorly controlled high blood pressure. Black participants who developed heart failure were also more likely in their young adulthood to be obese and have diabetes and chronic kidney disease. Furthermore, 10 years before developing heart failure, they were more likely already to have some level of systolic dysfunction, or impairment in the ability of the heart muscle to contract, visible on echocardiograms.

“The disproportionate rate at which heart failure impacts relatively young African Americans in this country underscores the importance of recognizing and treating risk factors for heart disease,” said NHLBI director Dr. Elizabeth Nabel. About 5 million people in the United States have heart failure, and it results in about 300,000 deaths each year.

Vaccine Shows Promise in Preventing Cytomegalovirus Infection

Each year, approximately 8,000 infants in the United States develop severe hearing, mental or movement impairments after becoming infected with cytomegalovirus (CMV), a common virus passed on to them while still in the womb. Now, results of an NIAID-sponsored trial involving 441 CMV-negative women give rise to optimism that a vaccine to prevent congenital CMV may be closer. Women who received the trial vaccine were 50 percent less likely to later become infected with CMV than were women who received a saline injection. The research team, led by Dr. Robert Pass of the University of Alabama at Birmingham, published their findings in the Mar. 19 issue of the New England Journal of Medicine.

“This trial demonstrates that a statistically significant degree of protection against maternal CMV can be achieved through vaccination,” Pass said. “This is an important step along the path towards the ultimate goal—a vaccine that can protect infants from congenital CMV infection.” He notes that a larger trial would be needed to conclusively prove the efficacy of any candidate CMV vaccine for this purpose. “However, for everyone interested in CMV vaccine development, this is an encouraging result.”

The clinical team screened 18,463 women and the trial took 7 years to reach its enrollment goal. In the final analysis, women who received the trial vaccine were significantly more likely to remain uninfected throughout the 42-month follow-up period than those who received a saline injection.

Trial Shows No Early Mortality Benefit from Annual Prostate Cancer Screening

Six annual screenings for prostate cancer led to more diagnoses of the disease, but no fewer prostate cancer deaths, according to a major new report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a 17-year project of the National Cancer Institute. The PLCO was designed to provide answers about the effectiveness of prostate cancer screening.

“What this report tells us is that there may be some men who are diagnosed with prostate cancer and have the side-effects of treatment, such as impotence and incontinence, with little chance of benefit,” said NCI director Dr. John Niederhuber. “Clearly, we need a better way of detecting prostate cancer at its earliest stages and as importantly, a method of determining which tumors will progress. Many of the molecular studies we’re currently sponsoring will hopefully yield new, better ways of definitively classifying which men need treatment and which can consider watchful waiting. Until we have developed and verified a new test’s benefits and harms, as we have done with the PLCO, regular visits to your doctor to monitor your health are still strongly recommended.”

Results appeared online Mar. 18 in the New England Journal of Medicine and Mar. 26 in the print version. NCI does not have a recommendation about prostate cancer screening.

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