目的:抗高血压药物可能影响结直肠癌风险。我们对关联进行了系统回顾和荟萃分析,有结肠直肠癌的风险,五类抗高血压药物:血管紧张素转换酶抑制剂(ACEI),血管紧张素II受体阻滞剂(ARB),β受体阻滞剂(BBs),钙通道阻滞剂(CCB),和利尿剂。
方法:在MEDLINE中进行了系统搜索,Embase,WebofScience,和Cochrane图书馆,以确定评估ACEI关联的相关研究,ARBs,BBs,CCB,和利尿剂与结直肠癌的风险。使用逆方差方法计算荟萃分析风险比(RR)和相应的95%置信区间(95%CIs)。
结果:未观察到与结直肠癌风险的总体显著关联;ACEI(5项研究)RR1.05,95%CI0.91-1.23,ARBs(5项研究)RR0.94,95%CI0.80-1.11,BBs(4项研究)RR1.00,95%CI0.92-1.08,CCB(4项研究)RR1.02,95%CI0.88-1.18,1.研究中存在相当大的异质性,部分原因是研究设计和地点的差异。当按研究地点分层时,亚洲人群中使用ARB的结直肠癌风险显着降低(2项研究,RR0.69,95%CI0.58-0.83)。
结论:ACEI没有显著的结直肠癌风险,BBs,CCB,或观察到利尿剂。在亚洲人群中使用ARB可能与降低结直肠癌的风险有关。尽管需要在不同人群中进行更多的研究以确认关联并帮助理解地理差异的可能原因.
OBJECTIVE: Antihypertensive medications may impact colorectal cancer risk. We conducted a systematic review and meta-analysis of associations, with colorectal cancer risk, of five classes of antihypertensive medications: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and diuretics.
METHODS: A systematic search was conducted in MEDLINE, Embase, Web of Science, and the Cochrane library to identify relevant studies evaluating associations of ACEIs, ARBs, BBs, CCBs, and diuretics with colorectal cancer risk. Meta-analytic risk ratios (RRs) and corresponding 95% confidence intervals (95% CIs) were calculated using the inverse variance method.
RESULTS: No overall significant associations with colorectal cancer risk were observed; ACEIs (5 studies) RR 1.05, 95% CI 0.91-1.23, ARBs (5 studies) RR 0.94, 95% CI 0.80-1.11, BBs (4 studies) RR 1.00, 95% CI 0.92-1.08, CCBs (4 studies) RR 1.02, 95% CI 0.88-1.18, and diuretics (6 studies) RR 1.02, 95% CI 0.90-1.17. There was considerable heterogeneity across studies, partly explained by differences in study design and location. When stratified by study location, there was significantly reduced colorectal cancer risk for ARB use in Asian populations (2 studies, RR 0.69, 95% CI 0.58-0.83).
CONCLUSIONS: No significant colorectal cancer risk with ACEIs, BBs, CCBs, or diuretics was observed. ARB use may be associated with decreased risk of colorectal cancer in Asian populations, although additional studies in diverse populations are needed to confirm associations and help understand possible reasons for geographical differences.