To assess prospectively the risk of coronary heart disease associated with elevated plasma levels of homocyst(e)ine.
Nested case-control study using prospectively collected blood samples.
...Participants in the Physicians' Health Study.
A total of 14,916 male physicians, aged 40 to 84 years, with no prior myocardial infarction (MI) or stroke provided plasma samples at baseline and were followed up for 5 years. Samples from 271 men who subsequently developed MI were analyzed for homocyst(e)ine levels together with paired controls, matched by age and smoking.
Acute MI or death due to coronary disease.
Levels of homocyst(e)ine were higher in cases than in controls (11.1 +/- 4.0 SD vs 10.5 +/- 2.8 nmol/mL; P = .03). The difference was attributable to an excess of high values among men who later had MIs. The relative risk for the highest 5% vs the bottom 90% of homocyst(e)ine levels was 3.1 (95% confidence interval, 1.4 to 6.9; P = .005). After additional adjustment for diabetes, hypertension, aspirin assignment, Quetelet's Index, and total/high-density lipoprotein cholesterol, this relative risk was 3.4 (95% confidence interval, 1.3 to 8.8) (P = .01). Thirteen controls and 31 cases (11%) had values above the 95th percentile of the controls.
Moderately high levels of plasma homocyst(e)ine are associated with subsequent risk of MI independent of other coronary risk factors. Because high levels can often be easily treated with vitamin supplements, homocyst(e)ine may be an independent, modifiable risk factor.
Objective: Postmenopausal hormone use and risk of breast cancer by histopathology was examined in a large multicentered population-based case-control study. Methods: Women younger than 75 years newly ...diagnosed with invasive breast cancer between 1988 and 1991 were identified from statewide tumour registries in Wisconsin, Massachusetts, New Hampshire, and Maine. Only postmenopausal women were included in this analysis. Breast cancer cases (lobular (n = 219), ductal, NOS (n = 2172), and specific ductal subtypes (n = 242)) were compared with randomly selected population controls (n = 3179) using adjusted multi-variable polytomous logistic regression to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for each histology. Results: Lobular carcinoma was associated with recent (within 2 years) estrogen therapy (OR:1.8, 95%CI: 1.0-3.4) and recent use of combined estrogen-plus-progestin therapy (OR:3.6, 95%CI: 1.8-7.6). Risk of ductal carcinoma was not associated with recent use of either estrogen alone (OR: 0.9, 95%CI: 0.7-1.2) or combined therapy (OR:0.9, 95%CI: 0.6-1.3). No associations were found with ductal subtypes. Conclusions: The association between postmenopausal hormone use and risk of breast cancer may depend on histopathology. Of particular interest is the association between combined hormone therapy and increased risk of lobular carcinoma. This lesion is increasingly common but, nonetheless, comprises fewer than 10% of invasive breast cancers.
We examined the temporal trends in prostate cancer incidence and mortality rates in the Seattle-Puget Sound region.
Prostate cancer incidence and treatment data collected by the Cancer Surveillance ...System, part of the Surveillance, Epidemiology, and End Results program, were analyzed for temporal trends in disease and treatment. Analyses were restricted to white and African-American men 35 years or older residing in the 13-county area of northwestern Washington state and diagnosed between 1974 and 1994. Data for the treatment analyses were limited to the time period 1983 through 1992.
Incidence of prostate cancer increased slowly from 1974 (169/100,000) to 1984 (230/100,000) and then rapidly to a peak in 1991 (486/100,000) before declining (293/100,000 in 1994). Mortality increased from 49/100,000 in 1974 to 67/100,000 in 1994. All stages of prostate cancer followed the same incidence trend peaking in 1991, except distant stage disease, which peaked in 1986 and subsequently declined by over 60% (p <0.001). Proportions of men undergoing radical prostatectomy increased from 1983 to 1992 with the biggest increase in men under 65 years old.
The incidence rate of prostate cancer in the Seattle-Puget Sound region is higher than the rate in some other regions of the country. This is likely due to widespread, more intense prostate specific antigen screening of the population in this region compared to other areas of the country. The incidence rate of prostate cancer in the Seattle-Puget Sound region has peaked and is now declining.
Objectives: To evaluate whether smoking modifies the risk of endometrial cancer associated with body mass index (BMI), postmenopausal hormone use, and other hormonal factors. Methods: Using ...multivariate adjusted models we examined interview data from a population-based case-control study of Wisconsin women (n = 740 cases, n = 2372 controls). Results: The relative risk for endometrial cancer associated with current smoking was 0.8 (95% CI: 0.6-1.0) compared to never smokers. No clear dose-response relationship was evident for pack-years smoked. When examined according to smoking status the risk associated with the highest quartile of BMI seemed to be greater among non-smokers (OR = 3.6, 95% CI: 2.4-5.3) than among current smokers (OR = 2.8, 95% CI: 1.4-5.6). Among postmenopausal women the risk associated with current use of postmenopausal hormones appeared to be greater among non-smokers (OR = 3.3, 95% CI: 2.3-4.9) than among current smokers (OR = 2.7, 95% CI: 1.3-5.5). Risk for long-term use (10 or more years) compared with never users was 8.3 (95% CI: 4.6-15.1) among never smokers and 2.5 (95% CI: 0.8-7.9) among current smokers. The risk associated with non-insulin-dependent diabetes was greater among non-smokers (OR = 2.5, 95% ci: 1.7-3.6) than current smokers (OR = 1.1, 95% CI: 0.4-3.1). There was no modifying effect of smoking on the risk associated with parity. Conclusion: These results suggest that smoking moderates the risk associated with endometrial cancer among women at greatest risk, specifically women who are obese or who use postmenopausal hormones.
High levels of dehydroepiandrosterone sulfate (DHEAS) have been associated with decreased risks of cardiovascular disease. The authors analyzed DHEAS in plasma collected at baseline among 169 ...participants in the Physicians' Health Study who subsequently had a myocardial infarction and 169 matched controls. The mean prediagnostic plasma DHEAS levels between cases (p = 0.33) (mean, 3.54 mumol/liter; standard deviation, 2.30) and controls (mean, 3.61 mumol/liter; standard deviation, 2.16) did not differ significantly. The relative risk was 1.04 (95 percent confidence interval 0.42-2.60) comparing extreme quintiles after adjustment for several coronary risk factors. In conclusion, these findings do not support the hypothesis that elevated plasma DHEAS is associated with a decreased risk of coronary disease in men, but a small to moderate association cannot be excluded.
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