Du Xianglin L, Li Zhuoyun, Schulz Paul E
Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Front Cardiovasc Med. 2023 May 5;10:1136475. doi: 10.3389/fcvm.2023.1136475. eCollection 2023.
Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors.
To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016.
We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs.
Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk.
The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.
先前的多项研究表明，服用血管紧张素II刺激类降压药物的患者痴呆发病率低于服用血管紧张素II抑制类降压药物的患者，但尚未在长期癌症幸存者中开展相关研究。
确定2007 - 2015年一大群结直肠癌幸存者中，与降压药物类型相关的阿尔茨海默病（AD）及相关痴呆（ADRD）风险，随访时间为2007年至2016年。
我们从2007 - 2015年17个监测、流行病学和最终结果（SEER）地区的SEER - 医疗保险关联数据库中，识别出58699名年龄在65岁及以上的结直肠癌男性和女性，随访至2016年，这些患者在基线时（结直肠癌诊断日期前12个月内及诊断后12个月内）未患任何已确诊的ADRD。所有通过ICD诊断代码定义为患有高血压或在此基线2年期间接受降压药物治疗的患者，根据是否接受血管紧张素II刺激或抑制类降压药物分为6组。
服用血管紧张素II刺激类降压药物的患者（4.3%和21.7%）与服用血管紧张素II抑制类降压药物的患者（4.2%和23.5%）的AD和ADRD粗累积发病率相似。与服用血管紧张素II刺激类降压药物的患者相比，服用血管紧张素II抑制类降压药物的患者在调整潜在混杂因素后，发生AD（调整后风险比：1.15，95%置信区间：1.01 - 1.32）、血管性痴呆（1.27，1.06 - 1.53）和总ADRD（1.21，1.14 - 1.28）的可能性显著更高。在调整药物依从性并将死亡视为竞争风险后，这些结果仍然相似。
在结直肠癌患者中，服用血管紧张素II抑制类降压药物的高血压患者发生AD和ADRD的风险高于服用血管紧张素II刺激类降压药物的患者。
