Evidence map›Paper›PMID 32250503›Full record

Observational studyThe oncologist2020

Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women's Health Initiative.

Kerryn W Reding, Aaron K Aragaki, Richard K Cheng, Ana Barac, Sylvia Wassertheil-Smoller, Jessica Chubak, Marian C Limacher, W Gregory Hundley, Ralph D'Agostino, Mara Z Vitolins and 10 more

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The oncologist, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.3field-weighted citation impact, top 40% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 14 institutions in 1 country.

Kerryn W RedingUniversity of Washington School of Nursing, Seattle, Washington, USA.ORCID 0000-0001-5179-8559
Aaron K AragakiFred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA.
Richard K ChengUniversity of Washington School of Medicine, Seattle, Washington, USA.
Ana BaracMedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
Sylvia Wassertheil-SmollerAlbert Einstein College of Medicine, New York, New York, USA.
Jessica ChubakKaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Marian C LimacherUniversity of Florida College of Medicine, Gainesville, Florida, USA.
W Gregory HundleyVirginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA.
Ralph D'AgostinoWake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Mara Z VitolinsWake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Theodore M BraskyThe Ohio State University College of Medicine, Columbus, Ohio, USA.
Laurel A HabelKaiser Permanente Northern California Division of Research, Oakland, California, USA.
Eric J ChowFred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA.
Rebecca D JacksonThe Ohio State University Department of Medicine, Columbus, Ohio, USA.
Chu ChenFred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA.
April MorgenrothSeattle Pacific University College of Nursing, Seattle, Washington, USA.
Wendy E BarringtonUniversity of Washington School of Nursing, Seattle, Washington, USA.
Matthew BanegasKaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA.
Matthew BarnhartStony Brook University School of Medicine, Stony Brook, New York, USA.
Rowan T ChlebowskiHarbor-University of California Los Angeles Medical Center, Los Angeles, California, USA.
Fred Hutch Cancer Center · USUniversity of Washington · USThe Ohio State University · USWake Forest University · USAlbert Einstein College of Medicine · USKaiser Permanente · USKaiser Permanente Center for Health Research · USKaiser Permanente Washington Health Research Institute · USMedStar Washington Hospital Center · USSeattle Pacific University · USStony Brook University · USUniversity of California, Los Angeles · USUniversity of Florida · USVirginia Commonwealth University · US

Funding

NHLBI NIH HHS HHSN268201600001CNHLBI NIH HHS HHSN268201600002CNHLBI NIH HHS HHSN268201600003CNHLBI NIH HHS HHSN268201600004CNHLBI NIH HHS HHSN268201600018C
6 · The paper itself

Abstract

backgroundRecent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard clinical endpoints. Within a prospective study, we examined the risk of heart failure (HF) and coronary heart disease (CHD) events in relation to use of commonly used antihypertensive medications, including ACEis/ARBs, BBs, calcium channel blockers (CCB), and diuretics, comparing women with and without cancer. MATERIALS AND

methodsIn a cohort of 56,997 Women's Health Initiative study participants free of cardiovascular disease who received antihypertensive treatment, we used multivariable-adjusted Cox regression models to calculate the hazard ratios (HRs) of developing CHD, HF, and a composite outcome of cardiac events (combining CHD and HF) in relation to use of ACEis/ARBs, CCBs, or diuretics versus BBs, separately in women with and without cancer.

resultsWhereas there was no difference in risk of cardiac events comparing ACEi/ARB with BB use among cancer-free women (HR = 0.99 [0.88-1.12]), among cancer survivors ACEi/ARB users were at a 2.24-fold risk of total cardiac events (1.18-4.24); p-interaction = .06). When investigated in relation to CHD only, an increased risk was similarly observed in ACEi/ARB versus BB use for cancer survivors (HR = 1.87 [0.88-3.95]) but not in cancer-free women (HR = 0.91 [0.79-1.06]; p-interaction = .04). A similar pattern was also seen in relation to HF but did not reach statistical significance (p-interaction = .23).

conclusionThese results from this observational study suggest differing risks of cardiac events in relation to antihypertensive medications depending on history of cancer. Although these results require replication before becoming actionable in a clinical setting, they suggest the need for more rigorous examination of the effect of antihypertensive choice on long-term cardiac outcomes in cancer survivors. IMPLICATIONS FOR PRACTICE: Although additional research is needed to replicate these findings, these data from a large, nationally representative sample of postmenopausal women indicate that beta blockers are favorable to angiotensin-converting enzyme inhibitors in reducing the risk of cardiac events among cancer survivors. This differs from the patterns observed in a noncancer cohort, which largely mirrors what is found in the randomized clinical trials in the general population.

Indexed as

HypertensionNeoplasmsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsFemaleHumansProspective StudiesTreatment OutcomeWomen's HealthAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsAntihypertensive medicationsCancer survivorsCardiovascular diseaseCoronary heart diseaseHeart failure

Identifiers

PMID32250503
PMCPMC7418354
OpenAlexW3014544167

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.