PaulD. Stolley

ORAL-CONTRACEPTIVE USE IN RELATION TO MYOCARDIAL INFARCTION

The effect of oral-contraceptive use on the risk of myocardial infarction and, in particular, the possible accentuation of that effect by cigarette smoking, was investigated in 234 premenopausal women with a first infarction and 1742 hospital controls. The overall rate ratio estimate of acute myocardial infarction for women who had used oral contraceptives in the preceding month was 4.0 (95% confidence interval, 2.5--6.3). Women who smoked heavily and used oral contraceptives had a point estimate of 39 (lower two-sided 95% confidence limit, 22) compared with those who did neither. This value was appreciably larger than could be accounted for by the separate effects of cigarettes and oral contraceptives, and this suggests a considerable accentuation by cigarette smoking of the effect of oral contraceptive use on myocardial infarction.

BREAST CANCER AND ALCOHOLIC-BEVERAGE CONSUMPTION

The relation between breast cancer and alcoholic-beverage consumption was evaluated in a case-control study of 1152 women with breast cancer and two groups of control women-519 with endometrial or ovarian cancer, and 2702 with non-malignant disorders. The relative-risk estimate of breast cancer, with allowance for all potential distorting factors, for women who had ever drunk alcoholic beverages relative to those who had never drunk was 1.4 (95% confidence interval, 1.0-2.0) when the comparison group was the group with endometrial or ovarian cancer and 1.9 (1.5-2.4) when the controls who had non-malignant disorders were the comparison group. The association was evident for beer, wine, and spirits. The association was not explained by any of the major known risk factors for breast cancer, but we had no information on dietary factors. The findings support the hypothesis that alcohol consumption, or related dietary factors, increases the risk of breast cancer.

Alcoholic beverages and myocardial infarction in young women.

Moderate alcohol consumption has been associated with a reduction in the risk of myocardial infarction (MI) in men. To evaluate this relation in young women, we studied 513 patients with first infarctions and 918 hospital controls, all of whom were less than 50 years of age. The estimated relative risk of MI for current drinkers, after allowance for potential confounding factors, was 0.7 (95 per cent confidence interval. 0.5 - 1.0), and the apparent reduction in risk was strongest for women drank wine. There was no evidence of an effect among ex-drinkers.

DIAZEPAM AND THE RISK OF BREAST CANCER

The relation of breast cancer to diazepam use was evaluated in a case-control study of 1236 women with breast cancer and 728 control subjects with other malignancies. Compared to women who never used diazepam, the relative risk for women who used the drug at least 4 days per week for at least 6 months was estimated to be 0.9, with 95% confidence limits of 0.5 and 1.6. There was no apparent association for recent use, or for use in the distant past, although confidence intervals were fairly wide in these categories. The results were not explained by various potential confounding factors, including the major risk factors for breast cancer. The findings suggest that regular diazepam use does not increase the risk of breast cancer relative to other cancers.

Hydralazine use in relation to cancers of the lung, colon, and rectum

SummaryIt has been suggested, based on animal experiments and limited human data, that the antihypertensive drug hydralazine might be carcinogenic, and among the sites of concern are the lung and colon.To assess the possible relationship between the use of hydralazine and lung and colorectal cancers in humans, we compared 1006 cases of lung cancer with 3531 hospital control subjects, and 972 cases of colorectal cancer with 3276 controls. Data were collected by interview in hospitals in the United States and Canada.Overall, 1.1% of the lung cancer cases, 1.6% of the colorectal cancer cases, and 1.5% of the controls had used hydralazine. Compared with those who had never used hydralazine, the relative risk estimate of lung cancer for those who first took the drug at least 18 months before hospital admission was 1.1 (95% confidence interval 0.4–2.9). The estimate for use for at least 1 year was 1.4 (0.5–3.8) and for use for at least 5 years the estimate was 0.9 (0.2–4.3). The corresponding relative risk estimates for colorectal cancer were 1.2 (0.5–2.5) for any use, 1.7 (0.8–3.7) for use for at least one year, and 2.4 (0.8–6.9) for five or more years of use. Other antihypertensive treatments and risk factors, including cigarette smoking in the analysis of lung cancer, were taken into account in these estimates.Although the effect of use after long latent intervals could not be evaluated, the results provide no support for the hypothesis that hydralazine use increases the risk of lung cancer. There is also no evidence that hydralazine increases the risk of colorectal cancer, but an effect after extended durations of use cannot be ruled out.

Side of origin of epithelial ovarian cancer.

prompt haemolysis of infected erythrocytes. Another feature of homozygous Hb O disease is that the three patients were all of small stature and had young, almost childish faces. The inheritance of homozygosity for Hb O Arab in this family was also associated with another rare recessive inheritance for conjugated hyperbilirubin aemia of the Dubin-Johnson type. The total copro porphyrin concentration in the urine of the three patients and that of their brother was within normal limits. A preponderance of isomer I varying in total between 76% and 85% clearly suggested, however, the Dubin-Johnson syndrome.3 In all cases liver function tests gave normal results. One of the largest surveys conducted in Saudi Arabia did not detect Hb O Arab.4 The finding of Hb O Arab in isolated cases in other countries is probably the result of gene transmission from the Sudan in these countries through historical links.5

Aspirin and myocardial infarction in young women.

To assess whether aspirin reduces the risk of a first myocardial infarction (MI) in young women, we evaluated data from a case-control study among women less than 50 years of age without a prior MI: 48 of 551 cases of MI and 67 of 896 hospital controls had taken aspirin regularly for at least 12 weeks immediately before admission. The relative risk estimate was 0.8 upon allowance for confounding factors but it was not statistically significant (95 per cent confidence interval, 0.5-1.4). These data alone do not provide evidence of protection by aspirin against a first infarction in young women.