A. Gentile

Association between certain foods and risk of acute myocardial infarction in women.

STUDY OBJECTIVE--To examine the relation between selected foods and acute myocardial infarction in women. DESIGN--Case-control study conducted over five years. SETTING--30 Hospitals with coronary care units in northern Italy. SUBJECTS--287 Women who had had an acute myocardial infarction (median age 49, range 22-69 years) and 649 controls with acute disorders unrelated to ischaemic heart disease (median age 50, range 21-69 years) admitted to hospital during 1983-9. MAIN OUTCOME MEASURES--Frequency of consumption of various foods and odds ratios of risks associated with these foods. RESULTS--The risk of acute myocardial infarction was directly associated with frequency of consumption of meat (odds ratio 1.5 for upper v lower thirds of consumption), ham and salami (1.4), butter (2.3), total fat added to food (1.6), and coffee (2.8). Significant inverse relations were observed for fish (0.6), carrots (0.4), green vegetables (0.6), and fresh fruit (0.4). The risk was below one for moderate alcohol consumption (0.7) and above one for heavier intake (1.2). Allowance for major non-dietary covariates, including years of education, smoking, hyperlipidaemia, diabetes, hypertension, and body mass index, did not appreciably alter the estimates of risk for most of the foods; for coffee, however, the odds ratio fell to 1.8 on account of its high correlation with smoking. CONCLUSIONS--The frequency of consumption of a few simple foods may provide useful indicators of the risk of myocardial infarction. Furthermore, specific foods such as fish, alcohol, or vegetables and fruits may have an independent protective role in the risk of cardiovascular diseases.

Dietary factors and the risk of breast cancer

We evaluated the risk of breast cancer in relation to the frequency of consumption of a few selected dietary items. Data were used from a case-control study of 1,108 histologically confirmed breast cancer patients and 1,281 control subjects who were in the hospital for acute conditions unrelated to any of the established or suspected risk factors for breast cancer. Moderately elevated risk estimates were associated with higher levels of fat consumption in seasonings [butter, margarine, and oil, relative risk (RR) = 1.34, 95% confidence interval (CI) = 1.06-1.71] and meat (RR = 1.36, 95% CI = 1.12-1.65), whereas a reduced risk (RR = 0.42, 95% CI = 0.34-0.51) was associated with a more frequent green vegetable consumption. It was not possible to show that these associations were incidental, because allowance for several identified potential confounding factors, including the major identified or potential risk factors for breast cancer, did not materially modify the risk estimates. Further, no appreciable interaction emerged with age or menopausal status, because the diet-related risk estimates were similar in pre- or postmenopausal women. However, the implications of these findings in terms of specific micronutrients (e.g., retinol or beta-carotene) and biological correlates are still unclear. Alcohol consumption was significantly greater among breast cancer cases, with a multivariate risk estimate of 2.92 for the highest level. Thus, the present findings confirm that various aspects of diet may influence the risk of breast cancer, although the small amount of available knowledge does introduce serious uncertainties in any discussion of the potential implications in terms of prevention on a public health scale.

Pap smear and the risk of cervical neoplasia: quantitative estimates from a case-control study.

The relation between Papanicolau (Pap) smear and the risk of cervical neoplasia was evaluated in a case-control study in which 145 women with cervical intra-epithelial neoplasia (CIN) were compared with 145 age-matched outpatient controls, and 191 cases of invasive cervical cancer were compared with 191 control subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer. Compared with women with no previous screening smear, the relative risk (RR) estimate for invasive cancer was 0.44 (with 95% confidence interval [CI] = 0.24-0.80) for those who had had one smear and 0.20 (95% CI = 0.13-0.32) for those who had had two or more smears. The corresponding estimates for CIN were 0.27 (95% CI = 0.10-0.71) and 0.12 (95% CI = 0.06-0.25), respectively. The risk estimates for intervals of more than 5, 3-5, and less than 3 years were 0.36, 0.18, and 0.10 for invasive cancer, and 0.45, 0.31, and 0.07 for CIN. These results were not materially modified by adjustment for the major risk factors for cervical cancer, such as indicators of socioeconomic status and sexual habits. According to the estimates of this study, 64% of invasive cervical cancers could be prevented by screening at intervals of more than 5 years, an additional 18% by reducing the interval to 3-5 years, and a further 8% to less than 3 years.

Menstrual and reproductive factors and the risk of myocardial infarction in women under fifty-five years of age

The relationship between menstrual and reproductive factors and subsequent risk of coronary heart disease was investigated in a hospital-based case-control study of 202 women with acute myocardial infarction and 374 control subjects admitted for a wide spectrum of acute conditions unrelated to any of the established risk factors for ischemic heart disease. No consistent association was observed with age at menarche or menopausal status, but women with a lifelong irregular menstrual cycle pattern were at significantly elevated risk of myocardial infarction (relative risk = 1.8, 95% confidence interval = 1.1 to 2.9). No clear trend in risk was evident with the number of livebirths, miscarriages, or induced abortions. However, women whose first pregnancy or livebirth occurred before age 20 years showed elevated risks of subsequent myocardial infarction compared with nulliparous ones (relative risks = 2.3; 95% confidence interval = 1.1 to 4.9), and there was a significant trend of increasing risk with earlier first birth. These associations were evident in both younger and middle-age women and were not explained by allowance for several identified potential confounding factors.

Oral contraceptives and cancers of the breast and of the female genital tract. Interim results from a case-control study

We analysed data from a case-control investigation conducted in Milan, Northern Italy, to evaluate the relation between the use of combination oral contraceptives and the risk of cancers of the breast, ovary, endometrium and cervix uteri. For the present analysis, 776 cases of histologically confirmed breast cancer, 406 of epithelial ovarian cancer and 170 of endometrial cancer aged under 60 were compared with a group of 1,282 subjects below age 60 admitted for a spectrum of acute conditions apparently unrelated to oral contraceptive use or to any of the known or potential risk factors for the diseases under study. Likewise, 225 cases of invasive cervical cancer were compared with 225 age-matched inpatient controls, and 202 cases of cervical intra-epithelial neoplasia with 202 outpatient controls identified in the same screening clinics. The age-adjusted relative risk estimates for ever vs. never use of combination oral contraceptives were 1.04 (95% confidence interval (CI) 0.73-1.37) for breast cancer, 0.68 (95% CI = 0.48-0.97) for epithelial ovarian cancer, 0.50 (95% CI = 0.23-1.12) for endometrial cancer, 1.49 (95% CI = 0.88-2.55) for cervical cancer and 0.77 (95% CI = 0.50-1.18) for cervical intra-epithelial neoplasia. The risk of ovarian cancer decreased and that of invasive cervical cancer increased with longer duration of use. Neither duration of oral contraceptive use nor time since first or last use significantly altered a users risk of other neoplasms considered. Likewise, analysis of sub-groups of age, parity or other potentially important covariates did not show any important interaction, and allowance for them by means of logistic regression did not materially modify any of the results. These data confirm that combination oral contraceptives confer some protection against ovarian and endometrial cancers but may increase the risk of invasive cervical cancer if used for several years, and indicate that the past or current pattern of oral contraceptive use in Italy is unlikely materially to affect the risk of breast cancer.

Oral contraceptives and non-contraceptive oestrogens in the risk of gallstone disease requiring surgery.

STUDY OBJECTIVE--The aim was to investigate the relationship between oral contraceptives, non-contraceptive oestrogens, and the risk of gallstone disease requiring surgery. DESIGN--This was a hospital based case-control study carried out between 1987 and 1990. Main outcome measures were frequency of consumption of oral contraceptives and non-contraceptive oestrogens, and the corresponding multivariate relative risk estimates and 95% confidence intervals (CI) in relation to various measures of use of the preparations. SETTING--A network including major teaching and general hospitals in the greater Milan area, northern Italy. SUBJECTS--Subjects were 235 women with gallstones requiring surgery and 538 controls admitted for acute diseases, other than digestive or hormonal diseases or those potentially influencing the use of female hormone preparations. MAIN RESULTS--For oral contraceptives, the relative risk for ever use was 0.8 with 95% CI 0.4 to 1.5. With reference to duration of use, the multivariate relative risk was 1.0 for less than two and 0.5 for two or more years of use. The relative risk was 1.7 (95% CI 0.6 to 4.7) in women who had last used the pill less than five years before diagnosis, but declined to 0.4 (95% CI 0.2 to 1.0) in those who had stopped more than five years before. With reference to oestrogen replacement treatment, the relative risk for ever use was 1.9 (95% CI 1.0 to 3.1). The relative risk, however, was not related to duration of use, since it was 1.8 for less than two and 1.5 for two or more years of use. Relative risk was higher for women who had last used non-contraceptive oestrogens 10 or more years before diagnosis (2.4) than for shorter periods since last use (1.3). CONCLUSIONS--On a clinical and public health scale, oral contraceptives and non-contraceptive oestrogens are unlikely to have an important influence in the aetiology of gallbladder disease.

Smoking and myocardial infarction in women: a case-control study from northern Italy.

STUDY OBJECTIVE: To examine the relationship between smoking and myocardial infarction in women. DESIGN: Case-control study over 5 years. SETTING: Cases were women admitted to 30 coronary care units in northern Italy. Controls were admitted to the same hospitals with other acute disorders. PARTICIPANTS: These were 262 young and middle aged women with acute myocardial infarction (median age 49 years, range 24-69) and 519 controls with other acute disorders unrelated to ischaemic heart disease (median age 47 years, range 22-69). MEASUREMENTS AND MAIN RESULTS: Stratification and the Mantel-Haenszel procedure, and unconditional multiple logistic regression were used to obtain relative risks according to levels of cigarette smoking. The regression equations included terms for age, education, coffee and alcohol consumption, diabetes, hypertension, hyperlipidaemia, body mass index and oral contraceptive use. Compared to life long non-smokers, relative risk was not significantly above unity for ex-smokers but among current smokers showed a significant trend to increasing risk with larger numbers of cigarettes smoked, with risk estimates of 2.3, 5.9 and 11.0 for less than 15, 15-24 and greater than or equal to 25 cigarettes per day respectively. Smoking related risks were consistently raised across strata of hyperlipidaemia, hypertension and increased alcohol and coffee intake. CONCLUSIONS: In terms of population attributable risk, about 48% of all myocardial infarctions in young and middle aged Italian women were attributable to cigarette smoking, which is therefore by far the most important preventable determinant of the disease.

Salt preference and the risk of gastrointestinal cancers

The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case-control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0-1.8) and 1.2 (0.8-1.7) for stomach, 1.0 (0.8-1.3) and 1.1 (0.8-1.5) for colon, and 1.2 (0.9-1.6) and 0.9 (0.6-1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.

Contents Vol. 16, 2013

R. Adany, Debrecen, Hungary A. Aaro, Odense, Denmark D. Avard, Montréal, Qué., Canada I. Blancquaert, Montréal, Qué., Canada J.-J. Cassiman, Leuven, Belgium E.E. Castilla, Rio de Janeiro, Brazil S. Grosse, Atlanta, Ga., USA J. Harris, Nydalen, Norway A. Haslberger, Vienna, Austria D. Ibarreta, Sevilla, Spain M. Karmali, Toronto, Ont., Canada H. Lehrach, Berlin, Germany J. Little, Ottawa, Ont., Canada N. Malats, Madrid, Spain M.J. Martin-Moreno, Copenhagen, Denmark C. McBride, Bethesda, Md., USA S.A. Morré, Amsterdam, Th e Netherlands D. Niese, Basel, Switzerland Editors-in-Chief