Fitzpatrick A L, Daling J R, Furberg C D, Kronmal R A, Weissfeld J L
Department of Epidemiology, University of Washington, Seattle 98101, USA.
Cancer. 1997 Oct 15;80(8):1438-47. doi: 10.1002/(sici)1097-0142(19971015)80:8<1438::aid-cncr11>3.0.co;2-6.
The use of calcium channel blockers in an elderly population recently was reported to be associated with the incidence of cancer. The Cardiovascular Health Study, a multisite observational cohort study, provided the opportunity to investigate the epidemiologic association between the use of calcium channel blockers and breast carcinoma risk in 3198 women age > or = 65 years.
Standard questionnaires and clinical procedures were administered at four study sites annually from 1989-1990 to 1993-1994. Drug usage was assessed by a medication inventory and hospitalizations for 75 incident invasive breast carcinoma cases were identified using International Classification of Diseases-9 Clinical Modification codes. Time-dependent Cox proportional hazards regression models were used to assess associations between incident breast carcinoma and the use of specific antihypertensive medication including calcium channel blockers.
In adjusted Cox proportional hazards models, an elevated risk of breast carcinoma was associated with use of calcium channel blockers (hazard ratio [HR]: 2.57; 95% confidence interval [CI], 1.47-4.49). This association persisted when the comparison group was users of other antihypertensive medication. No associations between the use of other antihypertensive medication with incident breast carcinoma were found. Associations were enhanced by assessment of high dose at baseline (HR: 4.42; 95% CI, 1.37-14.27) and when calcium channel blockers were combined with estrogen use (HR: 4.48; 95% CI, 1.58-12.75). The association was found to be strongest for the use of estrogens with immediate release calcium channel blockers (HR: 8.48; 95% CI, 2.99-24.08).
Although the number of cases was limited in this observational study, associations found between the use of calcium channel blockers and incident invasive breast carcinoma warrant further investigation. Site specific carcinomas should be included as an outcome of ongoing and planned long term clinical trials using calcium channel blockers.
最近有报道称，老年人群中使用钙通道阻滞剂与癌症发病率有关。心血管健康研究是一项多中心观察性队列研究，为调查3198名年龄≥65岁女性使用钙通道阻滞剂与患乳腺癌风险之间的流行病学关联提供了机会。
1989 - 1990年至1993 - 1994年期间，每年在四个研究地点进行标准问卷调查和临床程序。通过药物清单评估药物使用情况，并使用国际疾病分类第9版临床修订代码确定75例浸润性乳腺癌病例的住院情况。使用时间依赖性Cox比例风险回归模型评估浸润性乳腺癌与包括钙通道阻滞剂在内的特定抗高血压药物使用之间的关联。
在调整后的Cox比例风险模型中，使用钙通道阻滞剂与乳腺癌风险升高相关（风险比[HR]：2.57；95%置信区间[CI]，1.47 - 4.49）。当对照组为其他抗高血压药物使用者时，这种关联仍然存在。未发现使用其他抗高血压药物与浸润性乳腺癌之间存在关联。通过在基线时评估高剂量（HR：4.42；95% CI，1.37 - 14.27）以及当钙通道阻滞剂与雌激素联合使用时（HR：4.48；95% CI，1.58 - 12.75），关联得到增强。发现雌激素与速释钙通道阻滞剂联合使用时关联最强（HR：8.48；95% CI，2.99 - 24.08）。
尽管这项观察性研究中的病例数量有限，但使用钙通道阻滞剂与浸润性乳腺癌之间的关联值得进一步研究。在正在进行和计划中的使用钙通道阻滞剂的长期临床试验中，应将特定部位的癌症作为研究结果纳入。
