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Steroids and cancer
42 studied. The Lewis blood group phenotypes are quite differently distributed within different populations. In the Copenhagen Male Study we have previously found an increased risk of ischaemic heart disease (IHD) in men with the Lewis blood group phenotype Le(a-b-). We investigated the association between alcohol consumption, Lewis phenotypes and risk of IHD. Some 2929 men aged 53 to 75 years free from cardiovascular disease at baseline had their morbidity and mortality recorded for a period of four years. The following potential confounders were taken into account: physical activity, tobacco smoking, serum cotinine, serum lipids, body mass index, blood pressure, social class, hypertension, and non-insulin dependent diabetes mellitus. In 280 (9.6%) men with Le(a-b-), alcohol was the only risk factor associated with risk of IHD. There was a significant inverse dose-effect relationship between alcohol consumption and risk of non-fatal + fatal IHD: P = 0.03; for risk of fatal IHD: P = 0.02; in men with other phenotypes, N = 2,649 (90.4%) associations were limited and not significant. In men consuming O-10 alcoholic beverages/week, compared to others, Le(a-b-) had a relative risk (95% confidence interval) of fatal IHD of RR = 8.3 (2.6-26.3). P = 0.0002, of all IHD events, RR = 2.8 (1.3-5.8). P = 0.02, and of all causes of mortality, RR = 2.3 (1.2-4.3), P = 0.02. In conclusion, alcohol consumption was associated with an especially strong reduction of IHD in Le(a-b-) men. This observation might contribute considerably to the explanation of inconsistencies in previous epidemiological studies on the association between alcohol consumption and risk of IHD. HO Hein (1) Rigs hospitalet, University Hospital, DK 2200, Denmark
Conclusion - Steroids are frequently prescribed for cancer patients. Communication concerning the rationale for their use and the planned regime is often deficient both between doctors, and between doctor and patient. The frequent lack of perceived benefit and the possibility of adverse effects suggests the need to monitor closely the response to steroids in patients with advanced cancer. RF Lennard (2) Manorlands Hospice, West Yorks BD 22 9HJ, UK Lipoprotein (a) and risk for the development artery disease in transplant recipients.
High concentrations of serum lipoprotein (a) (Lp(a)) are associated with an increased risk of atherosclerotic vascular disease in the non-transplanted population. However, its relation with accelerated coronary artery disease (CAD) in cardiac transplant recipients has not been reported. We measured serum Lp(a) in 130 cardiac transplant recipients undergoing routine follow-up, which included annual coronary angiography. The median Lp(a) concentration in 33 patients with CAD was 71 mg/dl, which was significantly higher than the corresponding value of 22 mg/dL in the 97 patients without CAD (P = 0.0006). Multivariant analysis showed the serum Lp(a) value to be a higher significant risk factor for CAD irrespective of the other factors included in the regression analysis. Thus, a high concentration of serum Lp(a) is an important, independent risk factor for the development of accelerated CAD in transplant recipients. M Barbir (3) Hamfield Hospital, Harefield, Middlesex UB9 6JH, UK
Steroids and cancer. Design - Survey of 100 consecutive patients with advanced cancer admitted to a hospice. Main’ Outcome Measures - Incidence, rationale and duration of steroid use; patients’ knowledge of their steroid medication; patients’ perception of benefit. Results - 33 patients were taking steroids at the time of admission, with a wide range in duration of use. Only two of the 23 patients admitted via their GP or hospital doctor were accompanied by documentation giving adequate information about their steroid medication. In four, the reason for steroid prescription could not be identified. The commonest reason for use was weakness/anorexia. Only 29% of patients felt the steroids had been beneficial. Eighteen percent of patients had distressing side effects attributable to prolonged steroid use. Only 29% knew that stopping steroids might suddenly be dangerous. (1) Lancer (1993) 341, 392
of coronary
Corticosteroid
osteoporosis:
prevention.
Treatment with calcium and calcitrial reduces bone loss in the lumbar spine in patients receiving therapy, suggesting that the incidence of vertebral fractures related to steroid treatment can be reduced. In a 2-year study conducted at St Vincent’s Hospital, Sydney, Australia, 92 patients who had recently begun treatment with corticosteroids (mean dose 13.5 mglday) for the treatment of rheumatic immunological or respiratory diseases were randomised to either calcium, calcium and calcitrial or calcium, calcitrial and calcitonin. Bone loss occurred in the lumbar spine in the group receiving calcium alone but was prevented or reduced in the other two groups. There was no apparent advantage in the group which received calcitonin in addition to the cal(2) BMJ (1992) 305, 999 (3) Lancer (1992) 340, 1500
Conclusion - Steroids are frequently prescribed for cancer patients. Communication concerning the rationale for their use and the planned regime is often deficient both between doctors, and between doctor and patient. The frequent lack of perceived benefit and the possibility of adverse effects suggests the need to monitor closely the response to steroids in patients with advanced cancer. RF Lennard (2) Manorlands Hospice, West Yorks BD 22 9HJ, UK Lipoprotein (a) and risk for the development artery disease in transplant recipients.
High concentrations of serum lipoprotein (a) (Lp(a)) are associated with an increased risk of atherosclerotic vascular disease in the non-transplanted population. However, its relation with accelerated coronary artery disease (CAD) in cardiac transplant recipients has not been reported. We measured serum Lp(a) in 130 cardiac transplant recipients undergoing routine follow-up, which included annual coronary angiography. The median Lp(a) concentration in 33 patients with CAD was 71 mg/dl, which was significantly higher than the corresponding value of 22 mg/dL in the 97 patients without CAD (P = 0.0006). Multivariant analysis showed the serum Lp(a) value to be a higher significant risk factor for CAD irrespective of the other factors included in the regression analysis. Thus, a high concentration of serum Lp(a) is an important, independent risk factor for the development of accelerated CAD in transplant recipients. M Barbir (3) Hamfield Hospital, Harefield, Middlesex UB9 6JH, UK
Steroids and cancer. Design - Survey of 100 consecutive patients with advanced cancer admitted to a hospice. Main’ Outcome Measures - Incidence, rationale and duration of steroid use; patients’ knowledge of their steroid medication; patients’ perception of benefit. Results - 33 patients were taking steroids at the time of admission, with a wide range in duration of use. Only two of the 23 patients admitted via their GP or hospital doctor were accompanied by documentation giving adequate information about their steroid medication. In four, the reason for steroid prescription could not be identified. The commonest reason for use was weakness/anorexia. Only 29% of patients felt the steroids had been beneficial. Eighteen percent of patients had distressing side effects attributable to prolonged steroid use. Only 29% knew that stopping steroids might suddenly be dangerous. (1) Lancer (1993) 341, 392
of coronary
Corticosteroid
osteoporosis:
prevention.
Treatment with calcium and calcitrial reduces bone loss in the lumbar spine in patients receiving therapy, suggesting that the incidence of vertebral fractures related to steroid treatment can be reduced. In a 2-year study conducted at St Vincent’s Hospital, Sydney, Australia, 92 patients who had recently begun treatment with corticosteroids (mean dose 13.5 mglday) for the treatment of rheumatic immunological or respiratory diseases were randomised to either calcium, calcium and calcitrial or calcium, calcitrial and calcitonin. Bone loss occurred in the lumbar spine in the group receiving calcium alone but was prevented or reduced in the other two groups. There was no apparent advantage in the group which received calcitonin in addition to the cal(2) BMJ (1992) 305, 999 (3) Lancer (1992) 340, 1500