Pahor M, Guralnik J M, Ferrucci L, Corti M C, Salive M E, Cerhan J R, Wallace R B, Havlik R J
Department of Internal Medicine and Geriatrics, Catholic University, Rome, Italy.
Lancet. 1996 Aug 24;348(9026):493-7. doi: 10.1016/S0140-6736(96)04277-8.
Calcium-channel blockers can alter apoptosis, a mechanism for destruction of cancer cells. We examined whether the long-term use of calcium-channel blockers is associated with an increased risk of cancer.
Between 1988 and 1992 we carried out a prospective cohort study of 5052 people aged 71 years or more and who lived in three regions of Massachusetts, Iowa, and Connecticut USA. Those taking calcium-channel blockers (n = 451) were compared with all other participants (n = 4601). The incidence of cancer was assessed by survey of hospital discharge diagnoses and causes of death. These outcomes were validated by the cancer registry in the one region where it was available. Demographic variables, disability, cigarette smoking, alcohol consumption, blood pressure, body-mass index, use of other drugs, hospital admissions for other causes, and comorbidity were all assessed as possible confounding factors.
The hazard ratio for cancer associated with calcium-channel blockers (1549 person-years, 47 events) compared with those not taking calcium-channel blockers (17225 person-years, 373 events) was 1.72 (95% CI 1.27-2.34, p = 0.0005), after adjustment for confounding factors. A significant dose-response gradient was found. Hazard ratios associated with verapamil, diltiazem, and nifedipine did not differ significantly from each other. The results remained unchanged in community-specific analyses. The association between calcium-channel blockers and cancer was found with most of the common cancers.
Calcium-channel blockers were associated with a general increased risk of cancer in the study populations, which suggested a common mechanism. These observational findings should be confirmed by other studies.
钙通道阻滞剂可改变细胞凋亡，这是一种癌细胞破坏机制。我们研究了长期使用钙通道阻滞剂是否与癌症风险增加有关。
1988年至1992年间，我们对美国马萨诸塞州、爱荷华州和康涅狄格州三个地区的5052名71岁及以上的人群进行了一项前瞻性队列研究。将服用钙通道阻滞剂的人群（n = 451）与所有其他参与者（n = 4601）进行比较。通过调查医院出院诊断和死亡原因来评估癌症发病率。在有癌症登记处的一个地区，这些结果得到了癌症登记处的验证。人口统计学变量、残疾情况、吸烟、饮酒、血压、体重指数、其他药物的使用、因其他原因住院以及合并症均作为可能的混杂因素进行评估。
在调整混杂因素后，与未服用钙通道阻滞剂的人群（17225人年，373例事件）相比，服用钙通道阻滞剂的人群（1549人年，47例事件）患癌症的风险比为1.72（95%可信区间1.27 - 2.34，p = 0.0005）。发现了显著的剂量反应梯度。维拉帕米、地尔硫䓬和硝苯地平的风险比彼此之间无显著差异。在社区特异性分析中，结果保持不变。在大多数常见癌症中都发现了钙通道阻滞剂与癌症之间的关联。
在研究人群中，钙通道阻滞剂与总体癌症风险增加有关，这提示了一种共同机制。这些观察结果应由其他研究加以证实。
