Prescription diuretic use and risk of basal cell carcinoma in the nationwide U.S. radiologic technologists cohort.
Prescription diuretic use and risk of basal cell carcinoma in the nationwide U.S. radiologic technologists cohort.
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DOI：
10.1158/1055-9965.epi-14-0251
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发表时间：
2014-08
期刊：
影响因子：
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通讯作者：
Cahoon EK
中科院分区：
文献类型：
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作者：
McDonald E;Freedman DM;Alexander BH;Doody MM;Tucker MA;Linet MS;Cahoon EK
紫外线辐射（UVR）暴露是基底细胞癌（BCC）的主要危险因素。虽然处方利尿剂具有光敏特性，但利尿剂使用与BCC之间的关系仍不清楚。使用来自美国放射技术人员研究的数据，一个大型的，全国性的前瞻性队列，我们评估了利尿剂的使用和第一次原发性BCC之间的关系，同时考虑到阳光照射史，体质特征，生活方式因素，以及地理上分散的个人暴露于广泛的环境UVR的人体测量。调整潜在混杂因素后，我们发现与利尿剂使用相关的BCC风险显著增加（风险比（HR）=1.22，95%CI：1.07-1.38）。这种关系被体重指数（BMI）（p=0.019）修正，因此超重（HR=1.43，95% CI：1.16-1.76）和肥胖个体（HR= 1.43，95% CI：1.09-1.88）使用利尿剂会增加BCC风险，但正常体重个体（HR=0.99，95% CI：0.81-1.21）则不会。在超重和肥胖的参与者中，与利尿剂使用相关的BCC风险增加可能与更高的剂量、更长的药物使用持续时间、药物代谢降低或药物相互作用有关。未来的队列研究应该获得更详细的药物使用信息，考虑影响药物代谢的因素，并测量中间终点，如光敏反应。
Ultraviolet radiation (UVR) exposure is the primary risk factor for basal cell carcinoma (BCC). While prescription diuretics have photosensitizing properties, the relationship between diuretic use and BCC remains unclear. Using data from the United States Radiologic Technologists Study, a large, nationwide prospective cohort, we assessed the relationship between diuretic use and first primary BCC while accounting for sun exposure history, constitutional characteristics, lifestyle factors, and anthropometric measurements for geographically-dispersed individuals exposed to a wide range of ambient UVR. After adjustment for potential confounders, we found a significantly increased risk of BCC associated with diuretic use (hazard ratio (HR) =1.22, 95% CI: 1.07–1.38). This relationship was modified by body mass index (BMI) (p=0.019), such that BCC risk was increased with diuretic use in overweight (HR=1.43, 95% CI: 1.16–1.76) and obese individuals (HR=1.43, 95% CI: 1.09–1.88), but not in normal weight individuals (HR=0.99, 95% CI: 0.81–1.21). Increased risk of BCC associated with diuretic use in overweight and obese participants may be related to higher dosages, longer duration of medication use, reduced drug metabolism, or drug interactions. Future cohort studies should obtain more detailed information on medication use, consider factors that affect drug metabolism, and measure intermediate endpoints such as photosensitivity reactions.