Ischaemic heart disease: calcium channel blockers did not increase cancer.

Clinical bottom line (level 1b)

  1. Patients with coronary artery disease who took calcium channel blockers were not clearly at increased risk of developing cancer or dying compared with patients who did not.
Braun et al: Journal of the American College of Cardiology 1998; 31 (4): 804-808
Expires June 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Israel

11575 patients (aged mean 60 years, ?% male) documented myocardial infarction or typical angina (within two years of enrollment), and a positive exercise test, a positive radionuclear scan or = 60 % stenosis of one major coronary artery

Excluded if
  • acute coronary event or coronary intervention within six months
  • severe congestive heart failure
  • cancer
  • chronic liver or renal failure
  • unable to determine whether alive or dead at end of follow-up


    • calcium-channel; blockers (diltiazem, nifedipine, verapamil or a combination)- 5843 patients had calcium channel blockers and 5543 did not.

    Cox proportional hazards model was used to adjust for age, sex, smoking, COPD, diabetes, peripheral vascular disease and New York Heart Association functional status.


    Outcomes studied:
  • cancer
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cancer ? 246/11575 2.13%
    (1.86% to 2.39%)
    death ? 1570/11575 13.6%
    (12.9% to 14.2%)

    prognostic factor for
    cancer     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    calcium channel blocker use ? 1.07
    (0.83 to 1.37)     		680
    (-280 to 130)

    prognostic factor for
    death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    calcium channel blocker use ? 0.94
    (0.85 to 1.04)     		-125
    (-50 to 190)

    Comments

    1. No individual drug was found to increase the risk of cancer or death.
    2. This study concurs with systematic reviews that show calcium-channel blockers have no clear effect on mortality in patients with coronary artery disease unlikely beta-blockers.

    Citation

    1. Braun S, Boyko V, Behar S, et al: Calcium channel blocking agents and risk of cancer in patients with coronary artery disease. Journal of the American College of Cardiology 1998; 31 (4): 804-808
    Search Terms: nifedip* and cancer in Cochrane
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer:

    Clinical Question.
    Patient angina
    Intervention or Exposure calcium channel blockers
    Outcome cancer and death