Use of Antihypertensive Medications and Risk of Adverse Breast Cancer Outcomes in a SEER-Medicare Population.
Use of Antihypertensive Medications and Risk of Adverse Breast Cancer Outcomes in a SEER-Medicare Population.
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DOI：
10.1158/1055-9965.epi-17-0346
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Li CI
中科院分区：
文献类型：
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作者：
Chen L;Chubak J;Boudreau DM;Barlow WE;Weiss NS;Li CI
目前尚不清楚常见抗高血压药物的使用是否会影响乳腺癌不良结局的风险。利用关联的监测、流行病学和最终结果 (SEER)-医疗保险数据库，我们确定了 2007 年至 2011 年间诊断患有 I/II 期乳腺癌的 14,766 名 66 岁至 80 岁女性。获得医疗保险 D 部分数据来描述女性癌症后使用各种抗高血压药物的情况。结果包括第二次乳腺癌事件（SBCE，一种复合结果，定义为第一次复发或第二次对侧原发性乳腺癌）、乳腺癌复发和乳腺癌特异性死亡率。使用时变 Cox 比例风险模型来估计风险比 (HR) 及其相关的 95% 置信区间 (CI)。在中位随访 3 年中，发现了 791 例 SBCE、627 例乳腺癌复发和 237 例乳腺癌死亡。乳腺癌诊断后使用利尿剂 (n=8,517) 与 SBCE、复发和乳腺癌死亡风险分别增加 29% (95% CI: 1.10–1.51)、36% (95% CI: 1.14–1.63) 和 51% (95% CI: 1.11–2.04) 相关。与非使用者相比，β受体阻滞剂使用者 (n=7,145) 的乳腺癌死亡风险高出 41% (95% CI: 1.07–1.84)。使用血管紧张素 II 受体阻滞剂、钙通道阻滞剂和血管紧张素转换酶抑制剂与乳腺癌结局风险无关。使用利尿剂和β受体阻滞剂可能会增加老年女性患乳腺癌的风险。大多数抗高血压药物对于乳腺癌结局来说是安全的，但利尿剂和β受体阻滞剂还需要更多的研究。
It is unclear if use of common antihypertensive medications influences the risk of adverse breast cancer outcomes. Using the linked Surveillance, Epidemiology and End-Results (SEER)-Medicare database, we identified 14,766 women between ages 66 and 80 years diagnosed with incident stage I/II breast cancer between 2007–2011. Medicare Part D data were obtained to characterize women’s post-cancer use of various antihypertensive medications. Outcomes included a second breast cancer event (SBCE, a composite outcome defined as the first of a recurrence or a second contralateral primary breast cancer), breast cancer recurrence, and breast-cancer specific mortality. Time-varying Cox proportional hazard models were used to estimate hazard ratios (HRs) and their associated 95% confidence intervals (CIs). There were 791 SBCEs, 627 breast cancer recurrences, and 237 breast cancer deaths identified over a median follow-up of 3 years. Use of diuretics (n=8,517) after breast cancer diagnosis was associated with 29% (95% CI: 1.10–1.51), 36% (95% CI: 1.14–1.63) and 51% (95% CI: 1.11–2.04) higher risks of a SBCE, recurrence, and breast cancer death, respectively. Compared to nonusers, β-blockers users (n=7,145) had a 41% (95% CI: 1.07–1.84) higher risk of breast cancer death. Use of angiotensin II receptor blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors were not associated with risks of breast cancer outcomes. Use of diuretics and β-blockers may be associated with increased risk of breast cancer outcomes among older women. Most antihypertensive medications are safe with respect to breast cancer outcomes, but more research is needed for diuretics and β-blockers.