Welsh, Judith A.

SUMMARY Aim To evaluate the risks of restrictive red blood cell transfusion strategies (haemoglobin 7–8 g dL −1 ) in patients with and without known cardiovascular disease (CVD). Background Recent guidelines recommend restrictive strategies for CVD patients hospitalised for non‐CVD indications, patients without known CVD and patients hospitalised for CVD corrective procedures. Methods/Materials Database searches were conducted through December 2017 for randomised clinical trials that enrolled patients with and without known CVD, hospitalised either for CVD‐corrective procedures or non‐cardiac indications, comparing effects of liberal with restrictive strategies on major adverse coronary events (MACE) and death. Results In CVD patients not undergoing cardiac interventions, a liberal strategy decreased ( P = 0·01) the relative risk (95% CI) (RR) of MACE [0·50 (0·29–0·86)] ( I 2 = 0%). Among patients without known CVD, the incidence of MACE was lower (1·7 vs 3·9%), and the effect of a liberal strategy on MACE [0·79, (0·39–1·58)] was smaller and non‐significant but not different from CVD patients ( P = 0·30). Combining all CVD and non‐CVD patients, a liberal strategy decreased MACE [0·59, (0·39–0·91); P = 0·02]. Conversely, among studies reporting mortality, a liberal strategy decreased mortality in CVD patients (11·7% vs·13·3%) but increased mortality (19·2% vs 18·0%) in patients without known CVD [interaction P = 0·05; ratio of RR 0·73, (0·53–1·00)]. A liberal strategy also did not benefit patients undergoing cardiac surgery; data were insufficient for percutaneous cardiac procedures. Conclusions In patients hospitalised for non‐cardiac indications, liberal transfusion strategies are associated with a decreased risk of MACE in both those with and without known CVD. However, this only provides a survival benefit to CVD patients not admitted for CVD‐corrective procedures.

Abstract Background: Patients with lung cancer with mutations in EGF receptor (EGFR) tyrosine kinase have improved prognosis when treated with EGFR inhibitors. We hypothesized that EGFR mutations may be related to residential radon or passive tobacco smoke. Methods: This hypothesis was investigated by analyzing EGFR mutations in 70 lung tumors from a population of never and long-term former female smokers from Missouri with detailed exposure assessments. The relationship with passive smoking was also examined in never-smoking female lung cancer cases from the Mayo clinic. Results: Overall, the frequency of EGFR mutation was 41% [95% confidence interval (CI), 32%–49%]. Neither radon nor passive-smoking exposure was consistently associated with EGFR mutations in lung tumors. Conclusions: The results suggest that EGFR mutations are common in female, never-smoking lung cancer cases from the United States, and EGFR mutations are unlikely due to exposure to radon or passive smoking. Cancer Epidemiol Biomarkers Prev; 21(6); 988–92. ©2012 AACR.