June 12, 2009
NIH Podcast Episode #0086
Balintfy: Welcome to the 86th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: two features on the risks of drinking: they both include resources to help offset those risky patterns. Also, a detailed report about how a drug used to treat children with autism spectrum disorders doesn't really work. But first, how researchers have uncovered new clues to understand blood pressure. That's next on NIH Research Radio.
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Researchers Uncover Genetic Clues to Blood Pressure
Balintfy: An international research team has identified a number of unsuspected genetic variants associated with blood pressure. The findings suggesting potential avenues of investigation for the prevention or treatment of high blood pressure, also called hypertension.
Levy: High blood pressure is one of the most important causes of cardio-vascular disease.
Balintfy: That's Dr. Daniel Levy, Director of the Framingham Heart Study and Center for Population Studies at the National Heart Lung and Blood Institute. He says about a quarter of the adult population in the U.S. has high blood pressure, representing roughly 70 million people.
Levy: We know that high blood pressure treatment can reduce the high blood pressure levels and reduce risk for cardio-vascular disease complication. So identifying new genes associated with high blood pressure is potentially quite important because it may allow us to find people at high risk for the development of hypertension. And it may also allow us in the future to develop new drugs to prevent or treat high blood pressure.
Balintfy: Dr. Levy explains that the study, published online in the journal Nature Genetics, included more than 29,000 people from six different studies around the world.
Levy: And in each individual, we measured on average about 500,000 different genetic test results. And when you take those numbers of test results into 30,000 people, this represents an enormous amount of information.
Balintfy: Unlike previous attempts to identify genes associated with blood pressure that met with limited success, this study found eight. But Dr. Levy emphasizes that these results do not mean patients will be treated differently today.
Levy: We know that lowering blood pressure is beneficial. And the results of this study will not change the way doctors are treating people with blood pressure at this time. But clearly our study shows that there are many genes involved in blood pressure regulation; and abnormalities in many of these genes can contribute to high blood pressure.
Balintfy: Dr. Levy says that this information combined with future study has significant promise.
Levy: We may be able to come up with new approaches for picking up high risk people; and in the more distant future, understanding which genetic variance results in someone's high blood pressure may allow us to better individualize a given patient's treatment.
Balintfy: Hypertension can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems. It causes over seven million deaths worldwide each year; but effective medications for lowering blood pressure are available. For details on this study or for more on the risks of high blood pressure, visit www.nhlbi.nih.gov.
New NIAAA Web Site Offers Self-assessment for Risky Drinking Patterns
Balintfy: In these next two reports, we learn about resources relating to alcohol. This first story is about a new web site and booklet from the National Institute on Alcohol Abuse and Alcoholism. Called "Rethinking Drinking," the new materials present evidence-based information about: risky drinking patterns, the alcohol content of drinks, and the signs of an alcohol problem, along with resources to help people who choose to cut back or quit drinking. Dorie Hightower reports on how the information could help many people reduce their risk for alcohol problems.
Hightower: About 3 in 10 U.S. adults drink at levels that raise their risk for alcoholism, liver disease, and other problems. A new Web site and booklet called Rethinking Drinking can help evaluate drinking habits and find out how they may affect health.
Willenbring: This is really a wellness product.
Hightower: Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism says that the site offers valuable, research-based information as well as a convenient and anonymous way to find out about the alcohol content of drinks, the signs of an alcohol problem, along with information about medications and other resources to help people who choose to cut back or quit drinking.
Willenbring: I think people will be surprised at how user-friendly it is and how it doesn't have a judgmental quality to it. It's not about "you're doing a bad thing, you should be better, you shouldn't drink at all," it's not like that-it's really about informing people and giving them the tools and the information they need to manage their health better.
Hightower: Rethinking Drinking includes single-day and weekly low-risk limits for men and women. For men, these limits are no more than four drinks on any single day and 14 drinks per week, and for women, no more than three drinks on any day and seven per week.
Willenbring: There's a place where they can get information about what a standard drink is-for example, most people don't know what a drink is. A drink is the amount of alcohol in 12 ounces of beer, 5 ounces of wine, or a 1? ounce shot of spirits-80 proof spirits like vodka. They all contain the same amount of alcohol, so it doesn't really matter what kind of beverage you are drinking, it's the amount of alcohol inside that's really important to understand.
Hightower: Mixed cocktails like martinis or Long Island iced tea, might even contain the equivalent of several servings of alcohol. The Web site features a cocktail calculator that lets you enter the amounts of alcoholic and non-alcoholic beverages to find out how your recipe compares to a standard drink.
Willenbring: So this is really for people who want to evaluate their drinking, it's for people who have some concern about their drinking, it's for people who want to change how much they're drinking in order to be healthier, and if people need more than that then they may need to get some professional help, but we think that a large number of people who drink more than is advisable can benefit from this kind of a product.
Hightower: Dr. Willenbring recommends visiting RethinkingDrinking.niaaa.nih.gov-booklets are available by calling NIAAA at: 301-443-3860. This is Dorie Hightower, National Institutes of Health, Bethesda, Maryland.
New Publication: “Older Adults and Alcohol: You Can Get Help”
Balintfy: In this next feature we learn about a new booklet: "Older Adults and Alcohol: You Can Get Help." The booklet, From the National Institute on Aging and the National Institute on Alcohol Abuse and Alcoholism, is written for older adults and their families, friends, and caregivers. Belle Warring reports that the publication answers questions and provides ways to find help.
Waring: Talking about drinking is not always easy, especially with loved ones who, as they get older, may become more sensitive to alcohol. Dr. Marie Bernard, Deputy Director of the National Institute on Aging, explains how an alcohol problem in an older individual may be hard to recognize.
Bernard: It's a hidden problem because many times people have continued to drink as they did when they were younger and they don't recognize that it's a problem. It'll present with falls, or may present with problems with memory; and they think, their family thinks, even their doctor thinks, that it's related to some of the problems that occur with aging. And in actuality if they modify their alcohol intake, those things might be less problematic.
Waring: A new publication from the National Institute on Aging and National Institute on Alcohol Abuse and Alcoholism, entitled "Older Adults and Alcohol: You Can Get Help," explains how heavy drinking can make some health problems worse, and how alcohol and medicines don't mix. Again, Dr. Bernard:
Bernard: It's a nice, concise summary of challenges that older individuals may face with alcohol abuse. It's written at a very friendly level. You don't have to have a college degree to be able to read it. It has really good tips. It talks about the things that an older individual needs to look at in him or herself that might suggest that they have an alcohol problem. It provides a nice little checklist and gives some suggestions as to how to go about changing behavior if they do find that they have a problem. It provides recommendations to caregivers or family members as well.
Waring: Recommendations include how to talk about your worries when your loved one is sober, how to offer support, and how to support yourself, as well. The publication also highlights that it's important to stay away from labels like "alcoholic."
Bernard: Again, it is a hidden problem. Health care professionals as well as the public aren't necessarily sensitized to it, so one needs to think about it; one needs to recognize that if you're able to drink two glasses of wine each evening when you were younger, you may not be able to do that as you're older. And there's no shame associated with it. It's something that you simply need to try to address.
Waring: Dr. Bernard emphasizes that "Older Adults and Alcohol: You Can Get Help" is an excellent tool to help people talk with their doctors about their concerns
Bernard: I was a practicing academic geriatrician for the last 20 years and having a booklet such as this would have been very helpful with my patients.
Waring: To download or order free copies of "Older Adults and Alcohol: You Can Get Help," look up the publication at the NIA home page, www.nia.nih.gov, or call the NIA Information Center toll-free at 1-800-222-2225. This is Belle Waring, National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up next, Belle Warring brings us another report, this one on a drug that isn't working well for children with autism. Stay tuned.
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Citalopram No Better Than Placebo Treatment for Children with Autism Spectrum Disorders
Balintfy: A recent study has found that a medication commonly prescribed to children with autism spectrum disorders, was no more effective than placebo treatment for these children. Belle Warring brings us this report.
Waring: According to researchers funded by the National Institute of Mental Health, a medication called citalopram works no better than a placebo at reducing repetitive behaviors in children with autism spectrum disorders-ASD for short. Dr. Bryan King is Professor and Vice Chair of the Department of Psychiatry of the University of Washington and director of Child and Adolescent Psychiatry at Seattle Children's Hospital. He is lead author on the study and explains its scope.
King: We proposed a study to look at whether the common usage of drugs like citalopram-in this case citalopram itself-was truly justified; whether citalopram would be effective in reducing repetitive behaviors that are so common in children with autism.
Waring: Dr. King adds that repetitive behaviors can have a profound impact on quality of life and are often the targets of ASD treatment. The behaviors include hand flapping, spinning, swaying and rocking. Since they are repeated over and over without any clear purpose, such behaviors can be disruptive, causing problems for the children or the people around them. Dr. King says the study findings do not support using citalopram to treat repetitive behaviors in children with ASD:
King: We certainly didn't find any evidence to support the effectiveness of this medicine for this particular indication.
Waring: Citalopram is in a class of antidepressant medications called selective serotonin reuptake inhibitors, or SSRIs, and is sometimes prescribed for children with ASD to reduce repetitive behaviors. Dr. King explains how the drug was studied in children with ASD.
King: So we enrolled 149 children between 5 and 17 years of age and randomized them to receive either citalopram, the active drug, or placebo... and we followed these children over the course of a 12-week study. And at the end of that time we looked at their global improvements and wanted to see if their overall level of function had improved, as well as looking more specifically at repetitive behaviors.
Waring: In a controlled study, a placebo, an inactive substance, is given to one group, while the drug being tested is given to a similar group; then the results obtained in the two groups are compared. Again, Dr. King:
King: What we found was that citalopram and placebo did not distinguish themselves from one another; there was no separation in terms of the percentages of children who received active treatment versus those that didn't.
Waring: Roughly one out of three children in both groups-32.9 percent of those treated with citalopram and 34.2 percent those treated with placebo-showed fewer or less severe repetitive symptoms.
King: The other finding of interest is that side effects were more common in the children who received citalopram than the placebo.
Waring: Dr. King clarifies that while Citalopram did not work at treating repetitive behaviors in ASD, the drug is useful in treating such behaviors in obsessive compulsive disorder. He says Citalopram is in a class of medications that are among the most widely prescribed antidepressant drugs in the world, and also among the most widely prescribed medicines for people with autism.
King: The reason that people have been interested in drugs like citalopram and autism is because of similarities between some of the repetitive behaviors that are seen in autism and repetitive behaviors like those that are seen in obsessive compulsive disorder for which these drugs have long been shown to be helpful.
Waring: However, for Dr. King, the results raise questions about prescribing citalopram for children with ASD.
King: We need to rethink our use of this particular medicine for children with autism who are receiving it specifically in hopes that it will improve repetitive behaviors.
Waring: He adds that the results may challenge the idea that repetitive and inflexible behaviors in obsessive compulsive disorder are similar to repetitive behaviors in children with ASD. The study, conducted by researchers in the Studies to Advance Autism Research and Treatment network, was jointly funded by the National Institute of Mental Health and four other NIH institutes. The study was published in the June 2009 issue of Archives of General Psychiatry. This is Belle Waring, National Institutes of Health, Bethesda, Maryland.
Balintfy: That's it for this episode of NIH Research Radio. Please join us again on Friday, June 26 when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.