Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Apr;83(4):377-381. doi: 10.1097/JCMA.0000000000000288.
In vitro studies have confirmed that cardiac glycosides can induce apoptosis in both hormone-dependent and -independent prostate cancer (PCa) cell lines. The aim of this study was to investigate the incidence of PCa among patients treated with and without digoxin using a nationwide population-based database in Taiwan.
We retrieved data of men aged 30 years or older who were newly diagnosed with heart failure between January 1998 and December 2003 from the National Health Insurance program database in Taiwan. We divided the patients into digoxin users and non-digoxin users. Kaplan-Meier curves and Cox proportional hazard analysis were used to examine the risk of subsequent PCa between the digoxin and non-digoxin groups.
The mean ± SD follow-up (years) periods in the digoxin and non-digoxin groups were 8.6 ± 1.78 and 8.3 ± 1.75, respectively. The cumulative incidence of PCa during the follow-up period was 3.5% (147/4233) in the non-digoxin group compared with 3.0% (65/2154) in the digoxin group. The log-rank test revealed that the digoxin group had a similar incidence of PCa to the non-digoxin group (p = 0.18). After adjusting for age, benign prostatic hyperplasia, and comorbidities, Cox proportional hazard regression analysis showed that digoxin was associated with a significantly decreased risk of developing PCa (hazard ratio, 0.74; 95% CI, 0.548-0.993; p = 0.045). Moreover, logistic regression analysis showed that the risk of PCa decreased with a longer duration of digoxin use during the study period compared to those who had never used digoxin (p = 0.043).
The cardiac glycoside digoxin had significant effects on reducing the incidence of PCa in a time-dependent manner. Our findings may imply the potential application of cardiac glycosides in the prevention and management of PCa.
体外研究已经证实，强心苷可诱导激素依赖性和非依赖性前列腺癌（PCa）细胞系凋亡。本研究旨在利用台湾全国人群数据库调查使用和未使用地高辛的患者中 PCa 的发病率。
我们从台湾全民健康保险计划数据库中检索了 1998 年 1 月至 2003 年 12 月期间年龄在 30 岁或以上新诊断为心力衰竭的男性患者的数据。我们将患者分为地高辛使用者和非地高辛使用者。采用 Kaplan-Meier 曲线和 Cox 比例风险分析比较地高辛组和非地高辛组之间随后发生 PCa 的风险。
地高辛组和非地高辛组的平均随访（年）时间分别为 8.6 ± 1.78 和 8.3 ± 1.75。在随访期间，非地高辛组的 PCa 累积发生率为 3.5%（147/4233），而地高辛组为 3.0%（65/2154）。对数秩检验显示，地高辛组与非地高辛组的 PCa 发生率相似（p = 0.18）。在校正年龄、良性前列腺增生和合并症后，Cox 比例风险回归分析显示，地高辛与 PCa 发病风险显著降低相关（风险比，0.74；95%CI，0.548-0.993；p = 0.045）。此外，逻辑回归分析显示，与从未使用地高辛相比，在研究期间使用地高辛时间较长的患者 PCa 风险降低（p = 0.043）。
强心苷地高辛对降低 PCa 的发病率具有显著的时间依赖性效应。我们的发现可能意味着强心苷类药物在 PCa 的预防和管理中有潜在的应用价值。
