News Release

American Thoracic Society journal news tips for August (first issue)

Peer-Reviewed Publication

American Thoracic Society

Smoking cessation associated with significantly reduced heart disease

Smoking cessation was associated with significant reductions in fatal or nonfatal cardiovascular disease and coronary artery disease among participants in the 5-year Lung Health Study funded by the National Institutes of Health. Researchers revealed that smoking among the 5,887 participants, as shown at their annual follow-up visit, was associated with a 50 to 70 percent higher hazard rates for death, cardiovascular disease, and coronary disease than were rates for non-smokers. The Lung Health Study was a cooperative, 10-center randomized trial involving smokers, ages 35 to 60, who did not regard themselves as ill but who had mild to moderate lung impairment at the start of the study. Participants were placed randomly in one of three groups: smoking intervention plus drug inhaler (1,961 participants); smoking intervention plus placebo inhaler (1,962 study members); and usual care (1,964 patients). In the smoking intervention groups, which included both drug and placebo inhalers, over 21 percent of the participants achieved long-term smoking cessation success, versus only 5.4 percent in the usual care group. The 149 fatal events, approximately 25 percent of which were caused either by coronary heart disease or other cardiovascular illnesses, were less common in the smoking intervention, plus placebo inhaler group. The study appears in the first issue for August 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

Significantly improved survival in intensive care for hiv patients

A patient infected with human immunodeficiency virus (HIV) who is admitted to the intensive care unit (ICU) in this era of highly active antiretroviral therapy (HAART) has a markedly improved survival rate. The survival rate to hospital discharge of HIV-infected patients has improved significantly from early in the era of the acquired immunodeficiency syndrome (AIDS)epidemic (1981 - 1985) when it was 35 percent. Currently, the survival rate is 71 percent. From 1992 - 1995, 63 percent of the patients survived to discharge. The improved rate has been especially marked among patients receiving HAART. In the last several years, the characteristics of the ICU HIV population has changed from homosexual white men to African American men and women, along with intravenous drug users. Of the total study group of 295 HIV-infected patients admitted to the ICU at San Francisco General Hospital from 1996 to 1999, 89 patients were receiving HAART upon ICU admission. Following admission, the median long-term survival time for all subjects in the study was 324 days. For those on HAART at the time of admission who were admitted with a non-AIDS-associated diagnosis, long-term survival was 971 days. For those not on HAART with a non-AIDS-associated diagnosis, it was 728 days. With an AIDS-associated diagnosis, it was 30 days for HAART patients and 26 for those not on HAART. The study appears in the first issue for August 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

Editorial questions whether hiv-related admissions to the icu will continue to decline

In an editorial directed at whether HIV-related admissions to the ICU will continue to decline, Henry Masur, M.D., of the Critical Care Department, National Institutes of Health, Bethesda, Maryland, said that, after the HAART era began, more and more patients started to be admitted to the ICU for problems unrelated to their AIDS. These included drug overdose, trauma, and gastrointestinal bleeding. However, he decried the large number of patients not under medical supervision who show up daily in the hospital emergency room with an acute opportunistic infection. For many patients, that acute opportunistic infection is their first clue of an HIV infection. Dr. Masur said that the U.S. needs to do far better in terms of educating the at-risk population and providing them with the care they need before they develop an acute opportunistic infection. In most clinical trials directed at evaluating today's drug regimens recommended by HIV guidelines, only 50 to 60 percent of the patients have a sustained response to HAART use. Consequently, more patients will develop resistance to currently available antiretroviral agents, and will suffer immunologic decline. As this trend continues, ICUs are likely to see an upsurge in acute opportunistic infections among their admissions. The editorial appears in the first issue for August 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

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For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news mailing list (please select either postal or electronic delivery), contact Cathy Carlomagno at (212) 315-6442, or by e-mail at ccarlomagno@thoracic.org


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