Post-diagnosis use of antihypertensive medications and the risk of death from ovarian cancer

Harding, Barbara N; Delaney, Joseph A.; Urban, Renata R.; Weiss, Noel S.

doi:10.1016/j.ygyno.2019.05.030

Cited by 13 publications

(21 citation statements)

References 35 publications

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“…One previous study has reported a decreased risk of OC death among post-diagnostic ACE-inhibitor users [ 12 ]. Previous investigators have also reported better OC survival among beta-blocker users [ 10 , 11 , 12 , 13 ]. The follow-up times in these studies have varied between 6 and 15 years with no restrictions for follow-up time or separate analyses for 5-year mortality being applied.…”

Section: Discussionmentioning

confidence: 99%

“…Antihypertensive (anti-HT) drugs may be beneficial in OC either via the systemic control of hypertension or other cardiovascular diseases or by some unknown beneficial mechanism of action directly against cancer cells. Beta-blockers and especially non-selective beta-blockers have been associated with better OC specific and overall survival [ 10 , 11 , 12 , 13 ], though not all investigators have been able to confirm this association [ 14 , 15 , 16 ]. According to one report, angiotensin-converting enzyme (ACE)-inhibitors, another anti-HT drug group with a different mechanism of action, might improve OC survival [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Santala

Artama

Pukkala

et al. 2021

Cancers

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Ovarian cancer (OC) has a poor prognosis. Hypertension may be a prognostic factor for OC, but it is unclear whether antihypertensive (anti-HT) drug use of modifies OC prognosis. We performed a population-based analysis assessing the effect of anti-HT drug use on OC mortality. A cohort of 12,122 women identified from the Finnish Cancer Registry with OC in 1995–2013 was combined with information on their anti-HT drug use during the same time period. Use of each anti-HT drug was analysed as a time-dependent variable. Analyses were run for five, ten and full follow-up (19-year) mortality with cardiovascular morbidity risk evaluated in competing risk analysis. No anti-HT drug group was associated with OC survival within five years after OC diagnosis. At ten years, a dose-dependent association was observed between pre-diagnostic ACE-inhibitor use and improved OC survival. With full follow-up, post-diagnostic high-intensity use associated with reduced OC death risk for multiple anti-HT drug groups. In competing risk analysis, only the post-diagnostic use of ACE-inhibitors associated with increased OC survival. Anti-HT drugs were not associated with survival benefits within five years after OC diagnosis. ACE-inhibitors may confer survival benefits in women with OC, but further confirmatory studies are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Santala

Artama

Pukkala

et al. 2021

Cancers

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“…During the last 2 years, many of high-quality studies with additional potential confounder adjustments have been published (22)(23)(24)(25). Several studies have indicated that post-diagnostic beta blocker use increased OC mortality (22,25), while other studies did not show an association (23,24). In 2020, a large prognostic cohort study with 6,197 OC patients showed that post-diagnostic beta blocker use increased mortality (25).…”

Section: Introductionmentioning

confidence: 99%

Post-Diagnostic Beta Blocker Use and Prognosis of Ovarian Cancer: A Systematic Review and Meta-Analysis of 11 Cohort Studies With 20,274 Patients

et al. 2021

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ObjectivesPrevious experimental studies have indicated that exposure to beta blocker provides protective effects against ovarian cancer (OC). However, findings from epidemiologic studies have still been controversial. Therefore, we carried out a meta-analysis to update and quantify the correlation between post-diagnostic beta blocker usage and OC prognosis.MethodsThe meta-analysis had been registered at PROSPEPO. The number of registration is CRD42020188806. A comprehensive search of available literatures in English prior to April 16, 2020, was conducted in PubMed, EMBASE, and the Web of Science databases. Random-effects models were used to calculate overall hazard ratios (HRs) and 95% confidence intervals (CIs). Publication bias assessments, and subgroup, sensitivity, and meta-regression analyses were also performed.ResultsOf the 637 initially identified articles, 11 retrospective cohort studies with 20,274 OC patients were included. The summary HRs did not reveal any statistically significant associations between post-diagnostic beta blocker use and OC prognosis characteristics, such as total mortality (HR = 1.08, 95% CI = 0.92–1.27, I2 = 76.5%, n = 9), cancer-specific mortality (HR = 1.22, 95% CI = 0.89–1.67, I2 = 88.1%, n=3), and progression-free survival (HR = 0.88, 95% CI = 0.75–1.05, I2 = 0, n = 4). No evidence of publication bias was observed in current analysis. In our subgroup analyses, the majority of results were consistent with the main findings. However, several positive correlations were detected in studies with ≥800 cases (HR = 1.20, 95% CI = 1.05–1.37), no immortal time bias (HR = 1.28, 95% CI = 1.10–1.49), and adjustment for comorbidity (HR = 1.20, 95% CI = 1.05–1.37). In the meta-regression analysis, no evidence of heterogeneity was detected in the subgroups according to study characteristics and confounding factors.ConclusionsPost-diagnostic beta blocker use has no statistical correlation with OC prognosis. More prospective cohort studies are necessary to further verify our results.Systematic Review RegistrationIdentifier (CRD42020188806).

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“…In some of those studies, only non-selective beta blockers (NSBB) were proved to be effective for prolonging EOC survival [14,16]. Meanwhile, data on the impact of other antihypertensive agents, including calcium channel blockers (CCBs) and thiazide diuretics (TDs), on EOC survival rate is sparse [17].…”

Section: Introductionmentioning

confidence: 99%

“…However, only a few clinical investigations to date have investigated the potential effect of ARBs for survival outcomes of ovarian cancer patients [9]. Also, there are not many studies for comparison between different types of blood pressure medications [9,17]. Given the potential role of ARBs in the treatment of patients with EOC, clinical data on the impact of ARB use in ovarian cancer is important.…”

Section: Introductionmentioning

confidence: 99%

Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients

et al. 2020

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PurposeWe investigated the impact of four types of antihypertensive medications, angiotensin receptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calcium channel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovarian cancer (EOC).Materials and MethodsA single-institutional retrospective chart review of 878 patients with EOC was performed. Survival was compared according to use of the four antihypertensive medications during primary treatment. Propensity score matching (ratio 1:3) was performed to control possible associated covariates, such as age, International Federation of Gynecology and Obstetrics stage, residual status after primary debulking surgery, and co-morbidity.ResultsAmong 878 patients, 56 patients (6.4%) were ARB users, 62 (7.1%) were BB users, 107 (12.2%) were CCBs users and 32 (3.6%) used TDs. Median progression-free survival (PFS) for ARB, BB, and CCB users was 37.8, 27.2, and 23.6 months compared with 33.6 months for non-users. ARB was associated with 35% decreased risk of disease progression (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.42 to 0.99; p=0.046) in multivariate analysis. After propensity score matching, median PFS for ARB users was 37.8 months and ARB use remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariate analysis (HR, 0.60; 95% CI, 0.39 to 0.93; p=0.022).ConclusionIn this study, ARBs use during primary treatment is associated with lower recurrence in EOC patients. However, CCBs, BBs, and TDs did not show beneficial impact.

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Post-diagnosis use of antihypertensive medications and the risk of death from ovarian cancer

Cited by 13 publications

References 35 publications

Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Post-Diagnostic Beta Blocker Use and Prognosis of Ovarian Cancer: A Systematic Review and Meta-Analysis of 11 Cohort Studies With 20,274 Patients

Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients

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