Braun S, Boyko V, Behar S, Reicher-Reiss H, Laniado S, Kaplinsky E, Goldbourt U
Department of Cardiology, Tel Aviv Medical Center, Israel.
J Am Coll Cardiol. 1998 Mar 15;31(4):804-8. doi: 10.1016/s0735-1097(98)00008-4.
This analysis sought to estimate the risk ratio for cancer incidence and cancer-related mortality associated with the use of calcium channel blocking agents (CCBs) in a large group of patients with chronic coronary heart disease (CHD).
Recent publications contend that the use of short-acting CCBs may double the risk of cancer incidence and possibly increase mortality in hypertensive patients.
Cancer incidence data were obtained for 11,575 patients screened for the Bezafibrate Infarction Prevention (BIP) study, one-half of whom were treated at the time of screening with CCBs, over a mean follow-up period of 2.8 years. Cause-specific mortality was available through September 1996 (mean follow-up 5.2 years). The statistical power of detecting an odds ratio > or = 1.5 (given the cancer incidence rate of 2.1 in the nonusers of CCBs) was 0.91. The power declined to 0.77, 0.54 and 0.41, with declining odds ratios of 1.4, 1.3 and 1.25, respectively.
Of 246 incident cancer cases, 129 occurred among the users (2.3%) and 117 among nonusers of CCBs (2.1%). After adjustment for age, gender and smoking, the odds ratio estimates for all cancers combined was 1.07 (95% confidence interval [CI] 0.83 to 1.37) for CCB users relative to nonusers. The adjusted risk ratio for all-cause mortality for age, gender and smoking and pertinent prognostic clinical characteristics was estimated at 0.94 (95% CI 0.85 to 1.04). The adjusted risk ratio for cancer-related mortality was 1.03 (95% CI 0.75 to 1.41).
Patients with CHD treated with CCBs exhibited a similar risk of cancer incidence and total and cancer-related mortality compared with nonusers of CCBs. This analysis provides a certain assurance that CCB use in middle-aged and elderly patients with CHD is not associated with a meaningful difference in cancer incidence and related mortality.
本分析旨在估计一大群慢性冠心病（CHD）患者使用钙通道阻滞剂（CCB）与癌症发病率及癌症相关死亡率的风险比。
近期出版物认为，使用短效CCB可能使高血压患者的癌症发病率风险加倍，并可能增加死亡率。
在平均随访2.8年的时间里，获取了11575名参与苯扎贝特预防心肌梗死（BIP）研究筛查患者的癌症发病率数据，其中一半患者在筛查时接受CCB治疗。截至1996年9月可获取特定病因死亡率数据（平均随访5.2年）。检测比值比≥1.5（鉴于未使用CCB者的癌症发病率为2.1）的统计效能为0.91。当比值比分别降至1.4、1.3和1.25时，效能分别降至0.77、0.54和0.41。
在246例新发癌症病例中，129例发生在CCB使用者中（2.3%），117例发生在未使用CCB者中（2.1%）。在对年龄、性别和吸烟情况进行调整后，CCB使用者相对于未使用者的所有癌症综合比值比估计为1.07（95%置信区间[CI]0.83至1.37）。对年龄、性别、吸烟情况及相关预后临床特征进行调整后的全因死亡率风险比估计为0.94（95%CI0.85至1.04）。癌症相关死亡率的调整风险比为1.03（95%CI0.75至1.41）。
与未使用CCB的患者相比，接受CCB治疗的CHD患者在癌症发病率、全因死亡率及癌症相关死亡率方面表现出相似的风险。该分析提供了一定保证，即中年和老年CHD患者使用CCB与癌症发病率及相关死亡率的显著差异无关。
