Breast Cancer Risk Decreases with Longer NSAID Use

The longer a woman uses nonsteroidal antiinflammatory drugs (NSAIDs), the lower her risk of breast cancer. Regular NSAID use (defined as daily use for at least 2 months) and breast cancer risk were examined in 3125 women with breast cancer and 3062 age-matched healthy controls. NSAID use was shown to reduce breast cancer risk by 24%. Women with ≥7 years of use had the lowest breast cancer rates. This inverse association between NSAID use and breast cancer was not influenced by hormone receptor status, smoking history, or concurrent arthritis. Longer-duration use of both acetylsalicylic acid and nonacetylsalicylic acid agents was associated with similar reductions in breast cancer risk.

Kirsh VA, et al. Nonsteroidal antiinflammatory drug use and breast cancer risk. Am J Epidemiol. 2007;166:709-716.

Elevated WBCs May Signal Invasive Cancer

Elevated white blood cell (WBC) counts are associated with an increased risk of invasive breast, colorectal, endometrial, and lung cancer in postmenopausal women, according to a prospective cohort study of 143,748 postmenopausal women aged 50 to 79 years enrolled in the Women's Health Initiative who were free of cancer at baseline. On multivariate analysis, compared with the lowest WBC count quartile (2.50-4.79 x 109 cells/L), women with a WBC count in the upper quartile (6.80-15.00 x 109 cells/L) had increased risks of 15% for invasive breast cancer, 19% for colorectal cancer, 42% for endometrial cancer, and 63% for lung cancer. Higher WBC counts were also significantly associated with higher rates of breast cancer, lung cancer, and overall cancer mortality.

Margolis KL, et al. Prospective study of leukocyte count as a predictor of incident breast, colorectal, endometrial, and lung cancer and mortality in postmenopausal women. Arch Intern Med. 2007;167:1837-1844.

New Biomarker Predicts Heart Failure Mortality

Growth differentiation factor (GDF)-15 is a useful biomarker for mortality risk in patients with chronic heart failure (CHF). Levels of GDF-15, a stress-responsive member of the transforming growth factor-beta cytokine superfamily, were evaluated in 455 patients (median age, 64 years) with CHF. The median GDF-15 level was 1949 ng/L, and 75% of the patients had GDF-15 levels >1200 ng/L, the upper limit of normal in healthy older persons. GDF-15 levels were closely related to New York Heart Association functional class. The mortality rates of 10.0% and 9.4% at 48 months in the lower 2 GDF-15 quartiles increased to 33.4% and 56.2% in the higher 2 quartiles (P <.001). GDF-15 remained an independent predictor of mortality after adjusting for established biomarkers of adverse prognosis, and it provided prognostic information in clinically relevant patient subgroups defined according to age, body mass index, heart failure etiology, and other variables.

Kempf T, et al. Prognostic utility of growth differentiation factor-15 in patients with chronic heart failure. J Am Coll Cardiol. 2007; 50:1054-1060.

Vitamin E Lowers VTE Risk in Women 

Women who take vitamin E supplements may be reducing their risk of venous thromboembolism (VTE), particularly if they have a history of or a genetic predisposition to VTE. In the Women's Health Initiative study, 39,876 women aged ≥45 years were randomized to receive 600 IU of vitamin E or placebo on alternate days. During a median follow-up of 10.2 years, VTE occurred in 213 women in the vitamin E group and 269 in the placebo group. Vitamin E supplementation was associated with a 21% reduction in the risk of VTE (P = .010). In women without recent surgery, trauma, or a cancer diagnosis, risk of VTE was decreased by 27% (P = .016). In subgroup analyses, vitamin E supplementation decreased the risk of VTE by 44% (P = .048) in women with a history of VTE, and by 18% (P = .04) in women without previous VTE. In women with factor V Leiden or the G20210A prothrombin mutation, vitamin E supplementation lowered VTE risk by 49% (P = .014).

Glynn RJ, et al. Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism. Circulation. 2007;116:1497-1503.

Treating Sleep Apnea Improves Atherosclerosis

Data showing that the treatment of obstructive sleep apnea (OSA) significantly improves early signs of atherosclerosis supports the theory that OSA is an independent risk factor for atherosclerosis. A group of 24 patients (mean age, 46 years) with severe OSA who were free of comorbidities were randomized to receive no treatment or continuous positive airway pressure (CPAP). After 4 months of treatment, the patients randomized to CPAP experienced significant decreases in carotid intima-media thickness (P = .04), pulse-wave velocity (P <.001), and levels of C-reactive protein (P = .001) and catecholamines (P <.001). None of these parameters changed significantly in the control group; carotid diameter did not change significantly in either group. Changes in carotid intima-media thickness correlated with changes in catecholamines, and changes in pulse-wave velocity correlated with changes in C-reactive protein and catecholamines.

Drager LF, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2007;176:706-712.

Metabolic Syndrome Linked to Brain Damage

Metabolic syndrome is significantly associated with leukoaraiosis, a marker of ischemic brain damage, on magnetic resonance imaging (MRI). Some 1030 healthy persons (mean age, 52.7 years) with no history of stroke underwent MRI. Overall, 296 persons (28.8%) had leukoaraiosis on MRI. Metabolic syndrome, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, was associated with a significantly increased odds ratio for any leukoaraiosis, for minimal leukoaraiosis, and for leukoaraiosis combining mild, moderate, and severe grades. The individual components of metabolic syndrome, including elevated blood pressure, impaired fasting glucose, and hypertriglyceridemia, were also independently associated with all grades of leukoaraiosis.

Park K, et al. Significant association between leukoaraiosis and metabolic syndrome in healthy subjects. Neurology. 2007:69:974-978.

Retinal Changes a Harbinger of Death in Nondiabetics?

Retinal changes are associated with an increased risk of death among persons without diabetes, according to a study of 4294 persons (age, 43-84 years) without the disease who underwent retinal photography at baseline and were followed for 14 years. The prevalence of retinopathy at baseline was 7.7%. Moderate retinopathy at baseline was associated with an increased hazard ratio for all-cause mortality and ischemic heart disease mortality at 14 years, after adjusting for age, gender, and significant confounders. The presence of retinal hemorrhages only was associated with increased risk of all-cause mortality and ischemic heart disease mortality when analyzing survival in 5-year intervals using time-varying covariates.

Hirai FE, et al. Retinopathy and survival in a population without diabetes. Am J Epidemiol. 2007;166:724-730.

Cancer Identified in 33% of Prostate Biopsies

About one third of prostate biopsies demonstrate prostate cancer, according to an evaluation of the outcomes of 10,429 needle biopsies performed in 8273 men aged ≥65 years. Overall, 32% of the biopsies showed prostate cancer. The likelihood of cancer increased with age, with cancer being found in 26% of the biopsies in men aged 65 to 69 years, 31% in men aged 70 to 74 years, 35% in men aged 75 to 79 years, and 41% in men aged ≥80 years (P for trend <.001). Among men whose first biopsy did not reveal prostate cancer, the risk of undergoing a subsequent biopsy was 12% at 1 year and 38% at 5 years This is notable, since the cumulative risk of a prostate cancer diagnosis increased with repeated biopsy, with 50% of men receiving a prostate cancer diagnosis after 2 biopsies, 62% after 3 biopsies, and 68% after 4 biopsies.

Welch HG, et al. Detection of prostate cancer via biopsy in the Medicare–SEER population during the PSA era. J Natl Cancer Inst. 2007;99:1395-1400.

OC May Reduce Risk of Some Cancers 

The use of oral contraceptives (OC) is associated with a significant decrease in the risk of colorectal, uterine, and other cancer types. The finding emerged from an analysis of a database providing about 339,000 woman-years of observation for never users of OC and 744,000 woman-years for ever users of OC. Compared with never users, ever users had significantly lower rates of cancer of the large bowel or rectum, uterine body, and ovaries; tumors of unknown site; primary gynecological cancers combined; and any cancer. Increasing duration of OC use was associated with a significant trend for increasing risk of cervical and central nervous system or pituitary cancer and decreasing risk of uterine body and ovarian malignancies. The reduced relative risks for ovarian and uterine body cancer persisted for many years after stopping OC use. The overall rate reduction of any cancer among ever users of OC was 45 per 100,000 woman-years.

Hannaford PC, et al. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ. 2007;335:651-658.

RA Lowers Risk for Cancer Mortality

Rheumatoid arthritis (RA) is associated with higher rates of all-cause mortality, but it may lower the risk of cancer-related death by 40%. Mortality rates and causes of death were determined in 257 patients with RA, in 371 of their same-gender siblings without RA, and in 485 patients with hip and knee osteoarthritis (OA). The mortality rate was significantly greater (P <.05) in RA patients (54%) than in their siblings (28%) or in those with OA (32%). The ratio of observed/expected deaths due to ischemic heart disease was elevated in the patients with RA and OA (1.66 and 1.96, respectively) but not in the RA patients' siblings (1.05). However, in patients with RA the ratio of observed/expected cancer-related deaths was significantly decreased (0.62).

Kumar N, et al. Causes of death in patients with rheumatoid arthritis: comparison with siblings and matched osteoarthritis controls. J Rheumatol. 2007;34:1695-1698.