Spironolactone use and risk of incident cancers: a retrospective, matched cohort study
Aims Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim...
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| Published in: | British journal of clinical pharmacology Vol. 83; no. 3; pp. 653 - 663 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
John Wiley and Sons Inc
01.03.2017
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| Subjects: | |
| ISSN: | 0306-5251, 1365-2125, 1365-2125 |
| Online Access: | Get full text |
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| Abstract | Aims
Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim of this study was to assess the effect of spironolactone exposure on cancer incidence.
Methods
A pharmacoepidemiological propensity score‐matched cohort study was performed to assess the effect of spironolactone exposure on cancer incidence. Cox proportional hazards models were used to analyse time to first diagnosis of each prespecified cancer and hazard ratios for spironolactone exposure are presented. The setting for the study was UK primary care using the Clinical Practice Research Datalink. The participants were 74 272 patients exposed to spironolactone between 1986 and 2013, matched 1:2 with unexposed controls. The prespecified primary outcomes were the first incidence of ovarian, endometrial, pancreatic, colorectal, prostate, renal cell, pharyngeal and thyroid cancers, and myelomonoblastic/‐cytic leukaemias. Secondary outcomes were the remaining 27 types of cancer.
Results
There was no evidence of an increased risk of any cancer associated with spironolactone use. Spironolactone use was associated with a significantly lower risk of prostate cancer (hazard ratio 0.69; 95% confidence interval 0.60–0.80, P < 0.001).
Conclusions
In this study, spironolactone use was associated with a lower incidence of prostate cancer, the most common cancer in men in the UK. The possible mechanisms and clinical implications merit further investigation. |
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| AbstractList | Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim of this study was to assess the effect of spironolactone exposure on cancer incidence.AIMSSpironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim of this study was to assess the effect of spironolactone exposure on cancer incidence.A pharmacoepidemiological propensity score-matched cohort study was performed to assess the effect of spironolactone exposure on cancer incidence. Cox proportional hazards models were used to analyse time to first diagnosis of each prespecified cancer and hazard ratios for spironolactone exposure are presented. The setting for the study was UK primary care using the Clinical Practice Research Datalink. The participants were 74 272 patients exposed to spironolactone between 1986 and 2013, matched 1:2 with unexposed controls. The prespecified primary outcomes were the first incidence of ovarian, endometrial, pancreatic, colorectal, prostate, renal cell, pharyngeal and thyroid cancers, and myelomonoblastic/-cytic leukaemias. Secondary outcomes were the remaining 27 types of cancer.METHODSA pharmacoepidemiological propensity score-matched cohort study was performed to assess the effect of spironolactone exposure on cancer incidence. Cox proportional hazards models were used to analyse time to first diagnosis of each prespecified cancer and hazard ratios for spironolactone exposure are presented. The setting for the study was UK primary care using the Clinical Practice Research Datalink. The participants were 74 272 patients exposed to spironolactone between 1986 and 2013, matched 1:2 with unexposed controls. The prespecified primary outcomes were the first incidence of ovarian, endometrial, pancreatic, colorectal, prostate, renal cell, pharyngeal and thyroid cancers, and myelomonoblastic/-cytic leukaemias. Secondary outcomes were the remaining 27 types of cancer.There was no evidence of an increased risk of any cancer associated with spironolactone use. Spironolactone use was associated with a significantly lower risk of prostate cancer (hazard ratio 0.69; 95% confidence interval 0.60-0.80, P < 0.001).RESULTSThere was no evidence of an increased risk of any cancer associated with spironolactone use. Spironolactone use was associated with a significantly lower risk of prostate cancer (hazard ratio 0.69; 95% confidence interval 0.60-0.80, P < 0.001).In this study, spironolactone use was associated with a lower incidence of prostate cancer, the most common cancer in men in the UK. The possible mechanisms and clinical implications merit further investigation.CONCLUSIONSIn this study, spironolactone use was associated with a lower incidence of prostate cancer, the most common cancer in men in the UK. The possible mechanisms and clinical implications merit further investigation. Aims Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim of this study was to assess the effect of spironolactone exposure on cancer incidence. Methods A pharmacoepidemiological propensity score‐matched cohort study was performed to assess the effect of spironolactone exposure on cancer incidence. Cox proportional hazards models were used to analyse time to first diagnosis of each prespecified cancer and hazard ratios for spironolactone exposure are presented. The setting for the study was UK primary care using the Clinical Practice Research Datalink. The participants were 74 272 patients exposed to spironolactone between 1986 and 2013, matched 1:2 with unexposed controls. The prespecified primary outcomes were the first incidence of ovarian, endometrial, pancreatic, colorectal, prostate, renal cell, pharyngeal and thyroid cancers, and myelomonoblastic/‐cytic leukaemias. Secondary outcomes were the remaining 27 types of cancer. Results There was no evidence of an increased risk of any cancer associated with spironolactone use. Spironolactone use was associated with a significantly lower risk of prostate cancer (hazard ratio 0.69; 95% confidence interval 0.60–0.80, P < 0.001). Conclusions In this study, spironolactone use was associated with a lower incidence of prostate cancer, the most common cancer in men in the UK. The possible mechanisms and clinical implications merit further investigation. Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects that could influence cancer risks and historical reports suggest possible links with increased risk of certain types of cancer. The aim of this study was to assess the effect of spironolactone exposure on cancer incidence. A pharmacoepidemiological propensity score-matched cohort study was performed to assess the effect of spironolactone exposure on cancer incidence. Cox proportional hazards models were used to analyse time to first diagnosis of each prespecified cancer and hazard ratios for spironolactone exposure are presented. The setting for the study was UK primary care using the Clinical Practice Research Datalink. The participants were 74 272 patients exposed to spironolactone between 1986 and 2013, matched 1:2 with unexposed controls. The prespecified primary outcomes were the first incidence of ovarian, endometrial, pancreatic, colorectal, prostate, renal cell, pharyngeal and thyroid cancers, and myelomonoblastic/-cytic leukaemias. Secondary outcomes were the remaining 27 types of cancer. There was no evidence of an increased risk of any cancer associated with spironolactone use. Spironolactone use was associated with a significantly lower risk of prostate cancer (hazard ratio 0.69; 95% confidence interval 0.60-0.80, P < 0.001). In this study, spironolactone use was associated with a lower incidence of prostate cancer, the most common cancer in men in the UK. The possible mechanisms and clinical implications merit further investigation. |
| Author | MacDonald, Thomas M. Mackenzie, Isla S. Thompson, Alastair M. Morant, Steven V. Wei, Li |
| AuthorAffiliation | 2 School of Pharmacy University College London Gower Street London WC1E 6BT UK 3 Department of Breast Surgical Oncology, FCT7.6092 University of Texas MD Anderson Cancer Center 1400 Pressler Street Houston Texas 77030 USA 1 Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine University of Dundee Dundee DD1 9SY UK |
| AuthorAffiliation_xml | – name: 2 School of Pharmacy University College London Gower Street London WC1E 6BT UK – name: 1 Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine University of Dundee Dundee DD1 9SY UK – name: 3 Department of Breast Surgical Oncology, FCT7.6092 University of Texas MD Anderson Cancer Center 1400 Pressler Street Houston Texas 77030 USA |
| Author_xml | – sequence: 1 givenname: Isla S. surname: Mackenzie fullname: Mackenzie, Isla S. email: i.s.mackenzie@dundee.ac.uk organization: University of Dundee – sequence: 2 givenname: Steven V. surname: Morant fullname: Morant, Steven V. organization: University of Dundee – sequence: 3 givenname: Li surname: Wei fullname: Wei, Li organization: University College London – sequence: 4 givenname: Alastair M. surname: Thompson fullname: Thompson, Alastair M. organization: University of Texas MD Anderson Cancer Center – sequence: 5 givenname: Thomas M. surname: MacDonald fullname: MacDonald, Thomas M. organization: University of Dundee |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27735065$$D View this record in MEDLINE/PubMed |
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| Keywords | cancer prostate cohort study spironolactone pharmacoepidemiology |
| Language | English |
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Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine... Spironolactone is widely used to treat heart failure, hypertension and liver disease with increased usage in recent years. Spironolactone has endocrine effects... |
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| SubjectTerms | Adult Aged Aged, 80 and over cancer Case-Control Studies cohort study Female Humans Incidence Male Middle Aged Neoplasms - chemically induced Neoplasms - epidemiology Pharmacoepidemiology Proportional Hazards Models prostate Retrospective Studies Risk Factors spironolactone Spironolactone - adverse effects United Kingdom - epidemiology Young Adult |
| Title | Spironolactone use and risk of incident cancers: a retrospective, matched cohort study |
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