Chang Chia-Hsuin, Chiang Chien-Hsieh, Yen Chung-Jen, Wu Li-Chiu, Lin Jou-Wei, Lai Mei-Shu
aDepartment of Internal Medicine, National Taiwan University Hospital and College of Medicine bInstitute of Preventive Medicine, College of Public Health, National Taiwan University cDepartment of Family Medicine, National Taiwan University Hospital and College of Medicine, Taipei dDepartment of Community and Family Medicine eCardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
J Hypertens. 2016 Mar;34(3):558-66; discussion 566. doi: 10.1097/HJH.0000000000000813.
The study aimed to investigate the association of long-term use of different antihypertensive agents with incident breast cancer.
A total of 794 ,533 women aged at least 55 years were identified from Taiwan National Health Insurance claims database during 2001-2011. As of 31 December 2011, incident breast cancer patients were included as cases, and 1 : 4 age-matched controls were selected by risk-set sampling scheme. Logistic regression models were applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer incidence associated with different durations of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and dihydropyridine calcium channel blockers (DHP CCBs). Different restriction rules were applied to reveal the potential effects of confounding by indication.
Among the 9397 incident breast cancer patients and 37 ,588 controls, a significantly elevated risk was found for relatively short-term use of DHP CCBs (<6 years) but not in those observed for more than 6 years. There was no association between either angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or β-blockers use and breast cancer. Although restricting our analyses to those with any prescription of antihypertensive medications in 2001 or those with diagnosis of hypertension, there was no longer a statistically significant association between any use of DHP CCBs and breast cancer (OR: 1.21, 95% CI: 0.88-1.67 for the former, and OR: 1.71, 95% CI: 0.99-2.95 for the latter).
The results demonstrated the potential effect of confounding by indication, and thus, did not suggest any association of the use of antihypertensive medication and breast cancer risk.
本研究旨在调查长期使用不同抗高血压药物与乳腺癌发病之间的关联。
从2001年至2011年台湾国民健康保险理赔数据库中识别出794533名年龄至少55岁的女性。截至2011年12月31日，将乳腺癌发病患者纳入病例组，并通过风险集抽样方案选择1:4年龄匹配的对照组。应用逻辑回归模型估计与使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂和二氢吡啶类钙通道阻滞剂（DHP CCBs）不同时长相关的乳腺癌发病优势比（OR）和95%置信区间（CI）。应用不同的限制规则以揭示指示性混杂的潜在影响。
在9397例乳腺癌发病患者和37588例对照组中，发现短期使用DHP CCBs（<6年）时风险显著升高，但使用超过6年者未发现此情况。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或β受体阻滞剂的使用与乳腺癌之间均无关联。尽管将分析限制在2001年有任何抗高血压药物处方者或已诊断为高血压者中，但DHP CCBs的任何使用与乳腺癌之间不再存在统计学显著关联（前者的OR为1.21，95%CI为0.88 - 1.67；后者的OR为1.71，95%CI为0.99 - 2.95）。
结果显示了指示性混杂的潜在影响，因此，未提示抗高血压药物使用与乳腺癌风险之间存在任何关联。
