The role of metformin for primary prevention in non-elderly diabetic colorectal cancer patients.

406 Background: There is growing evidence for the beneficial effect of metformin in reducing the incidence of colorectal cancer (CRC) in diabetic patients. However, no such studies are done in the US population. We conducted a case control study (N=8,046) in non-elderly diabetic adult US population (age 18-64 years) to investigate the role of metformin for the primary prevention of CRC. Methods: MarketScan claims database was used to identify diabetic patients with CRC using ICD-9 codes. Only incident cases of CRC in diabetic patients were included in the study. Two matched controls (matched for age, sex, and geographical region) were selected per case. The exposure to metformin was assessed from prescriptions in the 12 months prior to the earliest date of CRC diagnosis. The primary objective was to assess the odds of having CRC in metformin users as compared nonusers. Adjusted odds ratios (AOR) were calculated by adjusting for multiple potential confounders using conditional logistic regression. Results: The mean age of CRC patients was 56 years, 60% were males. Metformin was prescribed to 38.13% patients. A total of 37% (995/2,682) patients developed CRC in metformin exposed group compared to 62.9% (1,687/2,682) patients in non-metformin exposed group. In a multivariate model, any metformin use was associated with a statistically significant 12% reduced risk of developing CRC (AOR 0.88, 95% CI, 0.79-0.98, p<0.026). Prescribed NSAIDs were also associated with decreased incidence of CRC (AOR 0.84, 95% CI, 0.73-0.97, p=0.019). Variables associated with increased incidence of CRC in the multivariate model were IBD (AOR 1.94, 95% CI, 1.13-3.33, p<0.015); use of insulin (AOR 1.45, 95% CI, 1.27-1.65, p<0.001); coronary artery disease (AOR 1.66, 95% CI, 1.43-1.93, p<0.001). There was no significant relationship between CRC incidence and obesity (AOR 1.19, 95% CI, 0.93-1.53, p=0.158); polycystic ovary disease (AOR 0.32, 95% CI, 0.03-2.76, p=0.3); sulfonylureas (AOR 1.09, 95% CI, 0.96-1.24, p=0.15); thiazolidinediones (AOR 0.94, 95% CI, 0.82-1.08, p=0.41); statins (AOR 0.914, 95% CI, 0.82-1.01, p=0.108). Conclusions: The use of metformin appears to reduce the incidence of CRC in non-elderly diabetic adult US population.

Download Full-text

The role of statins for primary prevention in non-elderly colorectal cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1513 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1513-1513 ◽

Cited By ~ 1

Author(s):

Amikar Sehdev ◽

Ya-Chen T. Shih ◽

Benjamin Vekhter ◽

Christopher Lyttle ◽

Blase N. Polite

Keyword(s):

Colorectal Cancer ◽

Primary Prevention ◽

Controlled Trial ◽

Conditional Logistic Regression ◽

Primary Objective ◽

Multivariate Model ◽

Exposed Group ◽

Elderly Adult ◽

Colorectal Cancer Patients

1513 Background: There is conflicting evidence for the effect of statins in primary prevention of colorectal cancer (CRC). We conducted a case control study (N=357,702) in non-elderly adult US population (age 18-64 years) to investigate the role of statins in primary prevention of CRC. Methods: We used MarketScan claims database to identify patients with CRC using ICD-9 codes. A case was defined as having an incident diagnosis of CRC. Up to ten controls (matched for age, sex, and geographical region) were selected per case. Statins exposure was assessed from prescriptions in the 12 months prior to the earliest date of CRC diagnosis. The primary objective was to assess the incidence of CRC in statin users and nonusers. Conditional logistic regression was used to adjust for multiple potential confounders and calculate adjusted odds ratios (AOR). Results: The mean age of CRC patients was 54 years, 52% were males.Statins were prescribed to 19.1% (68,461/357,702) patients.A total of 8.3% (5,704/68,461) patients developed CRC in statin exposed group compared to 9.3% (26,912/289,241) patients in non-statin exposed group. In a multivariate model, any statin use was associated with 25% reduced risk of CRC (AOR 0.75, 95% CI, 0.73-0.78, p<0.001). An age-stratified analysis showed more benefit in patients aged 55 years or less than those above age 56 years (AOR 0.68 and AOR 0.79 respectively; p<0.001 for interaction between age group and statin exposure). Variables associated with increased incidence of CRC in the multivariate model were obesity (AOR 1.3, 95% CI, 1.2-1.4, p<0.001); DM (AOR 1.2, 95% CI, 1.1-1.2, p<0.001); IBD (AOR 3.1, 95% CI, 2.8-3.5, p<0.001); use of insulin (AOR 1.2, 95% CI, 1.1-1.3, p<0.001) and sulfonylureas (AOR 1.2, 95% CI, 1.1-1.3, p<0.001). Prescribed NSAIDs showed modest reduction in CRC incidence (AOR 0.94, 95% CI, 0.91-0.97, p=0.002). There was no significant relationship between CRC incidence and other oral hypoglycemic drugs. Conclusions: Statins appears to reduce the incidence of CRC in non-elderly adult US population. A randomized controlled trial is needed to validate this finding.

Download Full-text

Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

10.22541/au.162247344.43377091/v1 ◽

2021 ◽

Author(s):

Hua Ma ◽

QIng Gu ◽

Huining Niu ◽

Xiaohua Li ◽

Rong Wang

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

Meta Analysis ◽

Significant Risk ◽

Diabetic Patients ◽

Primary Endpoints ◽

All Cause Mortality ◽

Patients With Diabetes ◽

Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

Download Full-text

Possible role of chondroitin sulphate and glucosamine for primary prevention of colorectal cancer. Results from the MCC-Spain study

Scientific Reports ◽

10.1038/s41598-018-20349-6 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Gemma Ibáñez-Sanz ◽

Anna Díez-Villanueva ◽

Laura Vilorio-Marqués ◽

Esther Gracia ◽

Nuria Aragonés ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Prevention ◽

Chondroitin Sulphate

Download Full-text

Microbial Hydroxysteroid Dehydrogenases: From Alpha to Omega

Microorganisms ◽

10.3390/microorganisms9030469 ◽

2021 ◽

Vol 9 (3) ◽

pp. 469

Author(s):

Heidi L. Doden ◽

Jason M. Ridlon

Keyword(s):

Prostate Cancer ◽

Colorectal Cancer ◽

Therapeutic Potential ◽

Polycystic Ovary ◽

Hydroxyl Groups ◽

Ovary Syndrome ◽

Hydroxysteroid Dehydrogenases ◽

Fecal Water ◽

Druggable Targets

Bile acids (BAs) and glucocorticoids are steroid hormones derived from cholesterol that are important signaling molecules in humans and other vertebrates. Hydroxysteroid dehydrogenases (HSDHs) are encoded both by the host and by their resident gut microbiota, and they reversibly convert steroid hydroxyl groups to keto groups. Pairs of HSDHs can reversibly epimerize steroids from α-hydroxy conformations to β-hydroxy, or β-hydroxy to ω-hydroxy in the case of ω-muricholic acid. These reactions often result in products with drastically different physicochemical properties than their precursors, which can result in steroids being activators or inhibitors of host receptors, can affect solubility in fecal water, and can modulate toxicity. Microbial HSDHs modulate sterols associated with diseases such as colorectal cancer, liver cancer, prostate cancer, and polycystic ovary syndrome. Although the role of microbial HSDHs is not yet fully elucidated, they may have therapeutic potential as steroid pool modulators or druggable targets in the future. In this review, we explore metabolism of BAs and glucocorticoids with a focus on biotransformation by microbial HSDHs.

Download Full-text

Prognostic role of metformin intake in diabetic patients with colorectal cancer: An updated qualitative evidence of cohort studies

Oncotarget ◽

10.18632/oncotarget.14688 ◽

2017 ◽

Vol 8 (16) ◽

pp. 26448-26459 ◽

Cited By ~ 12

Author(s):

Lili Du ◽

Mingli Wang ◽

Yingying Kang ◽

Bo Li ◽

Min Guo ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Studies ◽

Diabetic Patients ◽

Prognostic Role ◽

Qualitative Evidence

Download Full-text

The patients knowledge about the role of calcium in the primary prevention of colorectal cancer

Współczesna Onkologia ◽

10.5114/wo.2012.31776 ◽

2012 ◽

Vol 5 ◽

pp. 440-443 ◽

Cited By ~ 1

Author(s):

Konrad Wroński ◽

Roman Bocian

Keyword(s):

Colorectal Cancer ◽

Primary Prevention

Download Full-text

The role of vitamin D in metabolic and reproductive disturbances of polycystic ovary syndrome: A narrative mini-review

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000691 ◽

2020 ◽

pp. 1-8

Author(s):

Daniela Menichini ◽

Gianpiero Forte ◽

Beatrice Orrù ◽

Giuseppe Gullo ◽

Vittorio Unfer ◽

...

Keyword(s):

Vitamin D ◽

Polycystic Ovary Syndrome ◽

Embryo Quality ◽

Polycystic Ovary ◽

Vitamin D Supplementation ◽

Endometrial Receptivity ◽

Metabolic Disturbances ◽

Ovary Syndrome ◽

Beneficial Role

Abstract. Vitamin D is a secosteroid hormone that plays a pivotal role in several metabolic and reproductive pathways in humans. Increasing evidence supports the role of vitamin D deficiency in metabolic disturbances and infertility in women with polycystic ovary syndrome (PCOS). Indeed, supplementation with vitamin D seems to have a beneficial role on insulin resistance and endometrial receptivity. On the other hand, exceedingly high levels of vitamin D appear to play a detrimental role on oocytes development and embryo quality. In the current review, we summarize the available evidence about the topic, aiming to suggest the best supplementation strategy in women with PCOS or, more generally, in those with metabolic disturbances and infertility. Based on the retrieved data, vitamin D seems to have a beneficial role on IR, insulin sensitivity and endometrial receptivity, but high levels and incorrect timing of administration seem to have a detrimental role on oocytes development and embryo quality. Therefore, we encourage a low dose supplementation (400–800 IU/day) particularly in vitamin D deficient women that present metabolic disturbances like PCOS. As far as the reproductive health, we advise vitamin D supplementation in selected populations, only during specific moments of the ovarian cycle, to support the luteal phase. However, ambiguities about dosage and timing of the supplementation still emerge from the clinical studies published to date and further studies are required.

Download Full-text

The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

Digestive Disease Interventions ◽

10.1055/s-0040-1715816 ◽

2020 ◽

Vol 04 (03) ◽

pp. 291-302

Author(s):

Mariam F. Eskander ◽

Christopher T. Aquina ◽

Aslam Ejaz ◽

Timothy M. Pawlik

Keyword(s):

Colorectal Cancer ◽

Portal Vein ◽

Surgical Oncology ◽

Portal Vein Ligation ◽

Safe Alternative ◽

Colorectal Cancer Liver Metastases ◽

Liver Remnant ◽

New Era ◽

Ablation Therapy

AbstractAdvances in the field of surgical oncology have turned metastatic colorectal cancer of the liver from a lethal disease to a chronic disease and have ushered in a new era of multimodal therapy for this challenging illness. A better understanding of tumor behavior and more effective systemic therapy have led to the increased use of neoadjuvant therapy. Surgical resection remains the gold standard for treatment but without the size, distribution, and margin restrictions of the past. Lesions are considered resectable if they can safely be removed with tumor-free margins and a sufficient liver remnant. Minimally invasive liver resections are a safe alternative to open surgery and may offer some advantages. Techniques such as portal vein embolization, association of liver partition with portal vein ligation for staged hepatectomy, and radioembolization can be used to grow the liver remnant and allow for resection. If resection is not possible, nonresectional ablation therapy, including radiofrequency and microwave ablation, can be performed alone or in conjunction with resection. This article presents the most up-to-date literature on resection and ablation, with a discussion of current controversies and future directions.

Download Full-text