Phlebotomy decreased cancer risk in patients with PAD

General

Clinical Question:
Is phlebotomy associated with reduced cancer risk in patients with peripheral artery disease?

Bottom Line:
In this secondary analysis, patients with stable peripheral artery disease undergoing phlebotomy were less likely to develop cancer than control patients. But, remember: Although results of secondary analyses are great for generating hypotheses for additional studies, they are generally not ready for prime time. (LOE = 2c)

Reference:
Zacharski LR, Chow BK, Howes PS, et al. Decreased cancer risk after iron reduction in patients with peripheral arterial disease: results from a randomized trial. J Natl Cancer Inst 2008;100(14):996-1002.  [PMID:18612130]

Study Design:
Randomized controlled trial (single-blinded)

Allocation:
Concealed

Setting:
Outpatient (any)

Synopsis:
This study was originally designed to study whether phlebotomy would improve cardiovascular outcomes in patients with stable peripheral artery disease. Patients were randomized to receive phlebotomy every 6 months (n = 636) or no phlebotomy (n = 641). The investigators assessed ferritin as a marker of whether phlebotomy was effective in reducing iron stores. The outcome of interest in this secondary analysis was the development of solid visceral cancers, assessed by a researcher unaware of treatment. After an average of 4.5 years of follow up, 38 (6%) patients undergoing phlebotomy developed cancers compared with 60 (9%) patients in the control. The authors report that the mean ferritin levels were lower in patients who did not develop cancer than in those who did.

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