Elevated risk

There is insufficient evidence to unequivocally link nitrosamine exposure to elevated risk for human cancer (159). There are, however, a number of specific cases, especially with respect to the tobacco-related nitrosamines, in which exposure to V/-nitroso compounds is of concern. The strongest evidence in this context is probably that relating to oral cancer rates among habitual users of smokeless tobacco (snuff). Oral cancer rates among this group are significantly elevated over those of nonusers, and /V-nitrosonornicotine, and 4-(methylnitrosamino)-l-(3-pyridinyl)-l-butanone [64091 -91 both of... 

Having multiple first-degree relatives affected has been inconsistently associated with elevated risks. 

Nutritional surveys indicate that children of low-income groups consume less than recommended dietary allowances of calcium and iron. Dietary deficiencies of these two minerals have been shown to potentiate the toxicity of lead (Johnson and Tenuta 1979 Yip et al. 1981 Ziegler et al. 1978). Thus, nutrient deficiencies in conjunction with a developmental predisposition to absorb lead makes this subset of children at a substantially elevated risk. More information on children s susceptibility to lead is presented in Section 2.6. 

Although the effects of chronic exposure of humans to low levels of POPs are difficult to predict, some biological effects have been described. For example, exposure of children to PCBs and PCDD/Fs may be linked to an elevated risk for infectious diseases. Exposure of pregnant women to PCDD/Fs may cause lower fertility in their male offspring. The adverse effects to human health of acute and chronic exposure of high concentrations of POPs, especially among industrial workers exposed to daily intakes of chemicals, are more evident. Elevated concentrations of DDE and TCDD have been associated with the development of cancers such as breast cancer, leukaemia and thyroid cancer. Dioxin exposure may also be associated with immunotoxicity, reproductive diseases and neurotoxicity. Extreme exposure to chlorinated compounds has resulted in death [101]. 

Two of the biggest health problems that overweight individuals face are a greatly elevated risk of heart disease and stroke. The American Heart Association (AHA) has found a direct link between these health conditions and being overweight. Heart disease is now the number-one killer of women in the United States, and the rise of overweight and obesity can be directly correlated to it.2... 

The carcinogenicity of famphur has not been satisfactorily resolved. Studies indicate a significantly elevated risk for leukemias among farmers handling famphur (Brown et al. 1990), but this needs verification. 

It seems, therefore, that men respond to an elevated risk of sperm competition during IPCs by inseminating their long-term partners with more sperm but to an elevated risk during EPCs by inseminating their short-term partners with fewer sperm. Why - and is it in some way due to a link between masturbation and sperm competition ... 

More concerning are the less common but potentially dangerous interactions of the MAOis with certain foods and medications. Because the MAOis permanently disable the MAO enzymes (until the body is able over the course of several weeks to produce a new supply of the enzymes), taking a medication or eating a food that contains one of the substances eliminated by the MAO enzymes can cause toxic accumulation. The result is a so-called hypertensive crisis in which the blood pressure is uncontrollably elevated, risking heart attack, stroke, or death. 

The syndrome is most common in obese males and should be considered when such patients complain of persistent drowsiness. However, the patient s partner provides the key to diagnosis. If the patient s partner reports frequent snoring and gasping for air or has even noticed episodes of apnea, then one should suspect sleep apnea. The final diagnosis is made during a sleep study in which the episodes of apnea can be observed directly. Although obese individuals have an elevated risk for obstructive sleep apnea, there are clearly individuals with sleep apnea who would be considered normal weight. 

As discussed above, obesity is associated with dyslipidemia, a condition where high levels of low-density lipoprotein cholesterol (LDL-C) is common. Elevated LDL-C is strongly associated with an elevated risk of coronary artery disease and for this reason a number of lipid-lowering therapies that target LDL-C have been developed. These include bile-acid sequestrants (BAS), statins (HMG-CoA reductase inhibitors), cholesterol absorption inhibitors, and fibrates. ... 

NIOSH has determined that some workers exposed to asphalt fume are at an elevated risk for lung cancer however, it is uncertain whether this excess is related to asphalt or other carcinogens in the workplace. ... 

A cohort of 1352 male Navy torpedo munition workers exposed to PGDN between 1970 and 1979 had elevated rates and significantly elevated risks of angina pectoris and myocardial infarction. The age-adjusted incidence rate for myocardial infarction was 18/10,000 in PGDN-exposed workers vs. 8/10,000 for a group of nonexposed torpedomen for angina pectoris incidence rates were 9.8/10,000 in exposed workers vs. 2.6/10,000 in nonexposed munitions workers. It was noted that two of the angina cases had no coronary atheromatous... 

Patients with type 1 diabetes (previousiy caiied juveniie or insulin-dependent diabetes) have an absolute deficiency of insulin, which produces chronic hyperglycemia (elevated blood glucose) with elevated risk for ketoacidosis and a variety of long-term complications, including retinopathy, neuropathy, nephropathy, and cardiovascular complications. 

Hypertriacylglycerolemia with secretion of increased VLDL can lead to long-term elevated risk of atherosclerosis, although this is a complicated, multifactorial process. 

A number of disorders have been identified that are primarily caused by the presence of abnormal platelet levels in the blood. Thrombocythaemia is a disease characterized by abnormal megakaryocyte proliferation, leading to elevated blood platelet levels. In many instances, this results in an elevated risk of spontaneous clot formation within blood vessels. In other instances, the platelets produced are defective, which can increase the risk of spontaneous or prolonged bleeding events. 

The familial aggregation of all of the major subtypes of anxiety disorders has been well-established (Merikangas and Herrell 2004). As reviewed in the following section, when taken together, the results of more than a dozen controlled family studies of probands with specific subtypes of anxiety disorders demonstrate a three- to five-fold elevated risk of anxiety disorders among first-degree relatives of affected probands compared to those of controls. The... 

In another study, Lieb et al. (2002) confirmed the cross-aggregation of anxiety disorders and depression by showing that offspring of parents with depressive disorders have not only an elevated risk for depressive disorders but also for anxiety disorders. Considering parental comorbidity, the crossaggregation between parental depression and general anxiety disorder in off-... 

---