Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women's Health Initiative
Year: 2020
Type: article
Abstract: BACKGROUND: Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard clinical endpoints. Within a prospective study, we examined the risk of heart failure (HF) and coronary heart disease (CHD) events in relation to use of commonly used antihypertensive medications, including ACEis/ARBs, BBs, calcium channel blockers (CCB), and diuretics, comparing women with and without cancer. MATERIALS AND METHODS: In a cohort of 56,997 Women's Health Initiative study participants free of cardiovascular disease who received antihypertensive treatment, we used multivariable-adjusted Cox regression models to calculate the hazard ratios (HRs) of developing CHD, HF, and a composite outcome of cardiac events (combining CHD and HF) in relation to use of ACEis/ARBs, CCBs, or diuretics versus BBs, separately in women with and without cancer. RESULTS: Whereas there was no difference in risk of cardiac events comparing ACEi/ARB with BB use among cancer-free women (HR = 0.99 [0.88-1.12]), among cancer survivors ACEi/ARB users were at a 2.24-fold risk of total cardiac events (1.18-4.24); p-interaction = .06). When investigated in relation to CHD only, an increased risk was similarly observed in ACEi/ARB versus BB use for cancer survivors (HR = 1.87 [0.88-3.95]) but not in cancer-free women (HR = 0.91 [0.79-1.06]; p-interaction = .04). A similar pattern was also seen in relation to HF but did not reach statistical significance (p-interaction = .23). CONCLUSION: These results from this observational study suggest differing risks of cardiac events in relation to antihypertensive medications depending on history of cancer. Although these results require replication before becoming actionable in a clinical setting, they suggest the need for more rigorous examination of the effect of antihypertensive choice on long-term cardiac outcomes in cancer survivors. IMPLICATIONS FOR PRACTICE: Although additional research is needed to replicate these findings, these data from a large, nationally representative sample of postmenopausal women indicate that beta blockers are favorable to angiotensin-converting enzyme inhibitors in reducing the risk of cardiac events among cancer survivors. This differs from the patterns observed in a noncancer cohort, which largely mirrors what is found in the randomized clinical trials in the general population.
Source: The Oncologist
Authors: Kerryn W. Reding, Aaron K. Aragaki, Richard K. Cheng, Ana Barac, Sylvia Wassertheil-Smoller, Jessica Chubak, Marian C. Limacher, W. Gregory Hundley, Ralph D'Agostino, Mara Z. Vitolins, Theodore M. Brasky, Laurel A. Habel, Eric J. Chow, Rebecca D. Jackson, Chu Chen, April Morgenroth, Wendy E. Barrington, Matthew Banegas, Matthew Barnhart, Rowan T. Chlebowski
Institutions: University of Washington, Fred Hutch Cancer Center, MedStar Washington Hospital Center, MedStar Heart & Vascular Institute, Albert Einstein College of Medicine, Kaiser Permanente Washington Health Research Institute, University of Florida Health, University of Florida, Virginia Commonwealth University, Wake Forest University Health Sciences, Wake Forest University, Virginia Commonwealth University Medical Center, The Ohio State University, Kaiser Permanente, Kaiser Permanente Northern California, Seattle Pacific University, Kaiser Permanente Center for Health Research, Stony Brook University, University of California, Los Angeles, Los Angeles Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3014544167