Epidemiology. 2018 May;29(3):407-413. doi: 10.1097/EDE.0000000000000814.
There have long been concerns that calcium channel blockers (CCBs), widely used to treat hypertension, may contribute to malignant growth through the evasion of apoptosis and proliferation of cancer cells. Worryingly, a recent cohort study found breast cancer patients who used CCBs had higher death rates, but interpreting these results was difficult as they were based on all-cause mortality and medication use before cancer diagnosis. We used UK population-based data to more robustly investigate the association between CCB use and cancer-specific mortality.
We selected a cohort of patients with breast cancer diagnosed between 1998 and 2012 from English cancer registries. We linked to prescription and clinical records from the Clinical Practice Research Datalink, and to death records from the Office for National Statistics. We used adjusted, time-dependent Cox regression models to calculate hazard ratios (HRs) comparing breast cancer-specific and all-cause mortality between postdiagnostic CCB users and nonusers.
Our cohort included 23,669 breast cancer patients, of whom 5,141 used CCBs and 3,053 died due to their breast cancer during follow-up. After adjustment, CCB users had similar breast cancer-specific mortality to nonusers (HR = 0.98, 95% confidence interval [CI] = 0.88, 1.08). There was no evidence of a dose-response relationship. We found similar associations for specific CCBs, and for all-cause mortality.
In this large population-based breast cancer cohort, we did not find any evidence that CCB use is associated with increased mortality.
长期以来，人们一直担心广泛用于治疗高血压的钙通道阻滞剂 (CCB) 可能通过逃避癌细胞凋亡和增殖而促进恶性生长。令人担忧的是，最近的一项队列研究发现，使用 CCB 的乳腺癌患者死亡率更高，但由于这些结果基于全因死亡率和癌症诊断前的药物使用情况，因此难以解释。我们使用英国基于人群的数据更有力地调查了 CCB 使用与癌症特异性死亡率之间的关联。
我们从英国癌症登记处选择了一组 1998 年至 2012 年间诊断为乳腺癌的患者作为队列。我们与临床实践研究数据链接中的处方和临床记录以及国家统计局的死亡记录进行了链接。我们使用调整后的、时依 Cox 回归模型来计算比较 CCB 使用者和非使用者的乳腺癌特异性死亡率和全因死亡率的风险比 (HR)。
我们的队列包括 23669 名乳腺癌患者，其中 5141 名使用了 CCB，在随访期间有 3053 名死于乳腺癌。调整后，CCB 使用者的乳腺癌特异性死亡率与非使用者相似（HR = 0.98，95%置信区间 [CI] = 0.88, 1.08）。没有证据表明存在剂量反应关系。我们发现特定 CCB 与全因死亡率也存在类似的关联。
在这项大型基于人群的乳腺癌队列研究中，我们没有发现 CCB 使用与死亡率增加相关的任何证据。
