RESUMO
When patients survive cancer, they eventually come back to their primary care physicians. This group has special needs, including surveillance for recurrent and new cancer, health promotion, and interventions to mitigate the lingering effects of the cancer and the adverse effects of its treatment.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias do Colo/diagnóstico , Promoção da Saúde , Papel do Médico , Vigilância da População/métodos , Atenção Primária à Saúde , Neoplasias da Próstata/diagnóstico , Neoplasias da Mama/complicações , Sobreviventes de Câncer , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Neoplasias do Colo/complicações , Fadiga/etiologia , Fadiga/terapia , Feminino , Humanos , Masculino , Osteoporose/etiologia , Osteoporose/terapia , Neoplasias da Próstata/complicações , Recidiva , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapiaRESUMO
BACKGROUND: Angioedema is a rare adverse effect of angiotensin-converting enzyme (ACE) inhibitors, which occurs more commonly in women and black Americans. Angioedema is thought to result from decreased degradation of vasoactive peptides. During ACE inhibition, bradykinin is primarily inactivated by aminopeptidase P (APP). Earlier studies have provided conflicting data with regard to serum APP activity in patients with a history of ACE inhibitor-associated angioedema. A single nucleotide polymorphism, -2399C>A (rs3788853, C-2399A), in XPNPEP2, the X-linked gene that encodes membranous APP, has been reported to associate with APP activity. OBJECTIVE: To test the hypothesis that the relationship between XPNPEP2 C-2399A genotype and APP activity or ACE inhibitor-associated angioedema is sex-dependent and race-dependent. METHODS: We compared C-2399A genotype frequencies in 169 cases with a history of ACE inhibitor-associated angioedema and 397 ACE inhibitor-exposed controls. Controls were prespecified to be 50% white, 50% black, and 50% women. Cases and controls were group matched for age and smoking. RESULTS: XPNPEP2 C-2399A genotype associated with serum APP activity in both men and women. Serum APP activity was lower in men than in women, independent of genotype. XPNPEP2 -2399 A/ genotype was associated with an increased risk of angioedema in men [odds ratio 2.17 (1.09-4.32), P=0.03] in multivariate analysis. The A/ genotype was associated with angioedema in black men (P=0.03) but not in white men. CONCLUSION: APP activity is lower in men and the XPNPEP2 C-2399A polymorphism associates with ACE inhibitor-associated angioedema in men but not women.