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Article Review/Hyperlink
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Pahor M, Guralnik JM, Ferrucci L, Corti M-C, Salive ME,
Cerhan JR, Wallace RB, Havlik RJ
Calcium channel blockade and the incidence of cancer in
aged populations
Lancet
(Aug) 348:494-498 1996

It seems to be open season on calcium chanel blockers. With case
control studies suggesting that short-acting dihydropyridine CCBs
increase the risk of death (Furberg et al), and
another study suggesting an increased incidence of GI bleeding with
CCBs (Pahor et
al), this new study (by the same Pahor et al who did the GI
bleeding study) suggests that the risk of cancer may be increased in
patients taking short acting CCBs. There were 451 elderly patients taking
CCBs and 4601 who were not. Patients using CCBs had
a 70% increased risk of developing cancer over a 5 year follow up period, and
the risk appeared to
rise with higher doses of the CCBs.
Comment: This is an observational study, and such studies are
notorious for coming up with conclusions not found in subsequent studies.
For
example, the Furberg study, which was a meta-analysis that claimed to
demonstrate increased
mortality with CCBs, the relationship apparently could not be confirmed when
the original
data were reanalyzed by
Messerli et al. Also, a large Israeli study by
Braun et al also found no increased risk of death with CCBs.
At the same time Pahor's latest study was being announced, Dr. Shimon Braun
issued a press release
stating that in his as yet unpublished data, which involved a large number of
patients, and
analyzed previously with regard to
mortality, he could find no association between cancer and CCBs
(as reported in the New York Times 8/22/96).
Comment: It seems that the limitations of case-control and
observational studies of many kinds have not been sufficiently
appreciated. This is not to say that the results of the
present study are wrong. There is at least a proposed biologic
mechanism: CCBs in certain vitro models can block apoptosis. But data
from such papers should be used only to generate hypotheses, and not
to infer causality. This is always stated by the article authors,
but then promptly forgotten in the brouhaha which follows the
article's release. (John T. Daugirdas, M.D., University of Illinois at
Chicago)
The full text of an editorial describing the Pahor study is available
at the Lancet site (the abstract is not available). The first time
you access the Lancet site, you will need to register
to get a login ID and password. Click on the links below after you have
registered.
Lancet Press Release--
Editorial.
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