Ronald V. Wade, MD Guest Editor From the Division of Education and Research, Carolinas Medical Center, Charlotte, NC Effects of Diet & Exercise on Cholesterol Stefanick ML, Mackey S, Sheehan M, His- worth M, Haskell WL, Wood PD. Effects of diet and exercise in men and postmeno- pausal women with low levels of HDL cho- lesterol and high levels of LDL cholesterol. N Engl J Med 1998;339:12-20. Synopsis: This prospective cohort study addressed the effects of aerobic exercise and the National Cholesterol Education Program step 2 diet on nondiabetic, nonsmoking men and nondiabetic, nonsmoking, postmeno- pausal women who exhibited lipid profiles placing them at risk of coro- nary artery disease. One hundred eighty women and 213 men were assigned randomly to one of three intervention groups and one no-intervention group and were assessed after 1 year. Significant weight loss was ob- served in the diet groups, but there was no influence of exercise on weight loss. High-density lipoprotein (HDL) cholesterol levels and triglyceride lev- els did not change significantly in any of the groups. The low-density li- poprotein (LDL) -HDL ratio did not change in the female subjects but was significantly reduced in men assigned to the diet-plus-exercise group. The serum level of LDL choles- terol was significantly reduced in the diet-plus-aerobic exercise group in men and women when compared with the control group with no inter- vention. There was not a significant change in cholesterol concentration in the diet-only group in either the male or female study subjects. Commentary: In this detailed study, two relevant points are made. The first is that the differences in response to interventions manifested by women compared with men are con- firmed. For years there has been insuf- ficient research performed on women subjects to allow health care providers for women to have objective data as a basis for general medical decision making. The inclusion of a specific study group of postmenopausal women in this study is helpful. Second, diet alone is less effective than diet plus aerobic exercise in cre- ating a more favorable lipid profile. Colorectal Carcinoma & Fecal-Occult Blood Testing Agrez MV, Coory M, Cockburn J. Popula- tion screening for colorectal carcinoma with fetal-occult blood testing: Are we sufliciendy informed? Cancer 1998;82:1803-7. Synopsis: The authors of this article analyzed the results and recommenda- tions of three randomized controlled trials of screening for occult rectal blood to reduce mortality from colo- rectal carcinoma. Two studies that were analyzed depicted a reduction in mortality when study subjects were compared with a control group that was not in- formed about the study and received no intervention. The third study re- vealed an insignificant difference in mortality between the screened and control group, but the control group constituted a health-conscious group of volunteers. The authors questioned the cost of mass screening and if fi- nancial resources would be better spent educating patients about colo- rectal cancer, preventive strategies, and early warning signs. The cost of screening was estimated to be more than $1 billion per annum. The inclusion of colonoscopic polyp surveillance would double that cost. Based on the estimate of 58,000 deaths per year, the cost of screening patients more than 50 years of age in the United States would be between $50,000 and $100,000 per death pre- vented. The authors noted a potential for at least a 30% reduction of risk for colorectal carcinoma if fiber intake was increased by 70% per day. The authors concluded that education might be as effective as routine fecal- occult blood testing. They also as- serted that for a health-conscious group, fecal-occult blood testing could have minimal or no impact on survival rates from colorectal cancer. Commentary: Although the concept of investing in preventive strategies as opposed to screening is intriguing, the authors have little data to support that claim for colorectal cancer. The beneficial effect of smoking cessation education on the incidence of lung cancer is an analogous con- cept. When comparing outcome of cohorts of study patients, the charac- teristics of the control (comparative) population must be defined. This article appropriately points out that life-style modifications cre- ated by patient education may result in a reduction of the incidence of a disease process. Hormone Use & Colorectal Cancer Grodstein F, Martinez ME, Platz EA, Gio- vannucci E, Colditz GA, Kautzky M, et al. Postmenopausal hormone use and risk for colorectal cancer and adenoma. Ann Intern Med 1998;128:705-12. Synopsis: The investigators analyzed the Nurses' Health Study database and addressed the impact of hormone use in the postmenopausal age group in reducing the risk of colorectal can- cer and colorectal adenoma forma- tion. Of 59,000 postmenopausal women studied, 470 developed colo- rectal cancer, and 838 developed dis- tal colorectal adenomas. The data were analyzed as relative risk esti- mates. Use of postmenopausal hor- mones was related to a relative risk of 0.65 (95% confidence interval [CI] 0.50, 0.83) for the development of colorectal cancer. This relative risk in- creased to 0.84 (95% CI 0.67, 1.05) for past users of hormone therapy. Af- ter 5 years of no use, the decreased risk was no longer apparent. gd998 bythe American College of 0bsletricians and gynec010gis*s November/December 1998 * ACOG CLINICAl. REVIEW • 9 ?ublished bV Elsevier Science In¢ 1085-6862,'9875550