Calcium channel blocker use not associated with increased risk of cancer

1. In a population-based study of over 800 000 patients, calcium channel blocker (CCB) use was not associated with an increased risk of cancer compared to patients with no CCB exposure or patients on other anti-hypertensive medications.

Evidence Rating Level: 3 (Average)

Study Rundown: CCBs are one of the most widely prescribed medications worldwide for the management of angina, hypertension, and other cardiovascular diseases. However, previous studies have suggested that CCB exposure may interfere with apoptosis resulting in a potential increased risk of cancer. Previous retrospective reviews have demonstrated conflicting results regarding the association between CCB use and cancer. The purpose of this large, population-based study was to investigate the relationship between CCB use and the incidence of cancer.

The study reviewed medication use and health record data from over 800 000 patients in 2 national patient databases in the United Kingdom (UK) and compared the incidence of cancer between patients exposed to CCBs, patients with no exposure to CCB (non-CCB), and patients not exposed to CCB, but with exposure to an alternative antihypertensive medication (AHT). At the conclusion of the trial, CCB treatment was not associated with an increased incidence of cancer compared to those treated with non-CCB or AHT. This association was consistent across multiple cancer types, including breast, colon, and prostate. The results of this study support the hypothesis that CCB exposure is not associated with increased risk of cancer. The study was strengthened by a large sample size and a long follow-up period. However, the patient database is only representative of the UK population, which limits the generalizability to ethnically diverse populations.

Click to read the study in BMJ Open

Relevant Reading: Calcium channel blockers, apoptosis and cancer: is there a biologic relationship?

In-Depth [retrospective cohort]: This study reviewed medication use data and patient outcomes of all adults aged 18 to 79 from the Clinical Practice Research Datalink (CPRD) and the National Cancer Registration System (NCRS) for the study period of 1996 to 2009. Overall, 865 647 patients were included and divided into 3 groups based on medication exposure: 1) patients exposed to CCB (n =150 750), 2) no exposure to CCB (n = 557 931), and 3) exposure to AHT (n = 156 966). CCB and AHT exposures were defined as having at least 1 prescription during the study time period. The primary outcome was the incidence of primary cancer and carcinoma in situ of known origin. At the conclusion of the trial, there were no significant differences between the incidence of cancer in the CCB cohort compared to the non-CCB or AHT groups. The adjusted hazard ratio (HR) for all cancers for the CCB group compared to the non-CCB and AHT groups were 0.88 (95% CI: 0.86 to 0.89) and 1.01 (95% CI: 0.98 to 1.04), respectively. In subgroup analysis, no significant differences were seen in the incidence of breast, colon, and prostate cancers between the CCB and AHT group.

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