Diabetes and the risk of lung cancer.

OBJECTIVE: The incidence of some cancers has been reported to be higher in diabetic patients than in the general population. We estimated the incidence of lung cancer in diabetic patients and investigated the hypothesis that the rate of lung cancer is different in diabetic compared with nondiabetic patients. RESEARCH DESIGN AND METHODS: Diabetic patients and age-, sex-, and general practice-matched nondiabetic control subjects were identified from U.K. computerized general practice records (General Practice Research Database), and these records searched for any incident lung cancer, demographic details, and smoking status. Primary lung cancer incidence was calculated and rates compared between diabetic patients and nondiabetic control subjects using multivariate Cox regression, adjusting for age, sex, and smoking. The comparison was repeated for incident diabetic patients followed from diagnosis and after stratifying by diabetic treatment. RESULTS: The incidence of primary lung cancer in all 66,848 diabetic patients was 1.63 per 1,000 patient-years (95% CI 1.48-1.79) and 2.05 per 1,000 patient-years (1.76-2.38) among diabetic patients followed from diagnosis. When compared with nondiabetic control subjects, the hazard ratio was 0.88 (0.79-0.97) for all diabetic patients and 1.12 (0.95-1.34) for those followed from diagnosis. When observation was truncated to allow for shorter life expectancy, the hazard ratio for the total cohort was 0.98 (0.84-1.13), and no association was found with any treatment group. CONCLUSIONS: No increased risk of lung cancer in diabetes was found. We hypothesize that the lower incidence may be partly due to shorter life expectancy.

Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice.

BACKGROUND: Triptans are widely used to treat migraine but have been associated with stroke, myocardial infarction (MI), and ischemic heart disease (IHD) in case reports. OBJECTIVE: To estimate the incidence of stroke, cardiovascular events, and death in a migraine cohort, stratified by triptan prescription, and investigate whether the risk of these events was increased in those treated with triptans. METHODS: Migraine patients and matched nonmigraine control subjects were identified from the General Practice Research Database. Computerized records were searched for triptan prescriptions, stroke, TIA, MI, IHD, death, arrhythmia, and confounding variables. Incidence rates were calculated and migraine groups compared with controls using a Cox model, adjusting for confounders. RESULTS: Of 63,575 migraine patients, 13,664 were prescribed a triptan. There was no association between triptan prescription and stroke (hazard ratio [HR] 1.13; 95% CI 0.78, 1.65), MI (HR 0.93; 95% CI 0.60, 1.43), or other outcomes studied. The larger group of migraine patients not prescribed a triptan had an increased risk of stroke (HR 1.51; 95% CI 1.26, 1.82) and IHD (HR 1.35; 95% CI 1.18, 1.54) and a decreased risk of all-cause mortality (HR 0.72; 95% CI 0.65, 0.80). CONCLUSIONS: In general practice, triptan treatment in migraine does not increase the risk of stroke, MI, cardiovascular death, IHD, or mortality. Triptans are prescribed to those less at risk of these events.

Myocardial infarction and third generation oral contraceptives: aggregation of recent studies.

BACKGROUND: Arterial cardiovascular and cerebrovascular adverse events associated with oral contraceptives (OC) are a major concern to the clinician. This paper aggregates the findings of seven recent oral contraceptive studies on the risk of acute myocardial infarction (MI) among users of second (2gen) and third (3gen) generation OC. METHODS: Odds ratios (OR) from seven original studies published between 1996 and 2001 underwent meta-analysis. They had accrued 6464 subjects since 1996. In addition, estimates of 22 studies published from 1965 to 1966 were synthesized using medians and ranges as an historical point of reference. RESULTS: Four meta-analyses were performed for each of the relevant comparisons. The point estimates for 3gen versus 2gen OC ranged from 0.44 (0.24-0.80) to 0.62 (0.38-0.99). Compared with non-users, the aggregated OR for 3gen OC was 1.13 (0.66-1.92); for 2gen OC it was 2.18 (1.62-2.94). CONCLUSIONS: This overview of seven controlled observational studies confirms that 3gen OC do not convey harm in regard to MI compared with non-users of OC. The aggregate data and the continuing replication of findings allow interpretation of benefit compared with older combined OC.