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VA RESEARCH: BLOOD PRESSURE DRUGS MAY PROTECT
FROM SOME SKIN CANCERS -- Two classes of commonly
used hypertension agents have been associated
with a
reduced risk of non-melanoma skin cancers in
older veterans.
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Story here...
http://www.medpageto
day.com/Dermatology/SkinCancer/tb/10677
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-------------------------
Blood Pressure Drugs Linked to
Protection Against Non-Melanoma Skin Cancer
By Judith Groch
Contributing Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San Francisco Earn CME/CE
PROVIDENCE, R.I., -- Two classes
of commonly used hypertension agents have been associated with a reduced
risk of non-melanoma skin cancers in older U.S. veterans.
ACE inhibitors and angiotensin receptor blockers were associated with a
33% to almost 40% reduced risk of basal-cell or squamous- cell carcinoma
in high-risk U.S. veterans, Jennifer B. Christian, Pharm.D., Ph.D., of
Brown University here, and colleagues reported in the Aug. 26 online issue
of the Journal of the National Cancer Institute.
Results of animal and in vitro studies have shown that angiotensin II may
promote angiogenesis in cancer cells and, in turn, tumorigenesis. These
observations suggested that blocking its effects could reduce the
occurrence of skin cancer, the investigators wrote.
The researchers evaluated associations between ACE inhibitors or
angiotensin receptor blockers and keratinocyte cancer among 1,051 veterans
(mean age 71) participating in the randomized VA Topical Tretinoin
Chemoprevention (VATTC) Trial.
 Of
the participants, 532 had taken the drugs and 519 were nonusers. All the
participants were at increased risk of basal-cell or squamous-cell
carcinoma, having had at least two keratinocyte cancers in the five years
preceding the study.
They came from six VA clinical centers in Chicago; Long Beach, Calif.;
Phoenix; Oklahoma City; Miami; and Durham, N.C.
The veterans (mainly white non-Hispanic men) were followed from enrollment
(November 1998 through January 2003) until the first basal-cell or
squamous-cell lesion.
Participants were examined every six months by a study dermatologist, and
biopsies were taken for all suspicious lesions. VA pharmacy records were
used to determine use of the drugs.
During a median follow-up of 3.4 years, there were 472 incident basal-cell
carcinomas, 309 squamous-cell cancers, and 200 deaths from any cause.
Compared with nonusers, users of the hypertension drugs had a
statistically significantly 39% reduced risk of basal-cell cancer
(incident rate ratio [IRR]=0.61, 95% CI 0.50 to 0.76) and a 33% relative
reduction in squamous-cell cancer (IRR=0.67, 95% CI 0.52 to 0.87).
The combined absolute incidence rates for the two cancers were 237 per
1,000 person-years among users of the hypertension drugs and 374 per 1,000
person-years among nonusers.
The greatest reduction in keratinocyte cancer was seen among people who
started use of ACE inhibitors or angiotensin receptor blockers during the
study period (IRR basal-cell=0.45, 95% CI 0.34 to 0.59; IRR squamous-cell=0.48,
95% CI 0.35 to 0.67).
The more pronounced reduction among those who initiated use during the
study may indicate an immediate effect, the researchers said.
The investigators said they were surprised to find such a pronounced
reduction in the skin cancers among these high-risk individuals over a
short amount of time. However, they added, because individuals at normal
risk of keratinocyte cancer were not included in the study, the extent to
which these results might apply to normal-risk individuals is not known.
When three other classes of antihypertensive drugs -- calcium-channel
blockers, beta-blockers, and diuretics -- were studied, the researchers
found no association with the skin-cancer incidence. This suggests, they
said, that the association reflects the specific biologic mechanisms of
ACE inhibitors and ARBs and not their general antihypertensive effects.
Given similar reductions in keratinocyte cancer deaths with ACE inhibitors
or ARBs compared with nonuse, the researchers suggested that the
chemopreventive effects of these agents may reflect inhibition of growth
factor activity of angiotensin II rather than prevention of
neovascularization or an antihypertensive effect.
Study limitations included findings limited to high-risk individuals, and
a potential misclassification of use of the drugs before the event. Many
of these individuals could have stopped taking their drug before their
diagnosis of skin cancer, thus being classified as users when they
actually were not.
Misclassification could also have occurred if nonusers filled a drug
prescription outside of the VA system.
Should the results for these two drug classes and keratinocyte cancer turn
out to be causal, there could be a marked reduction in the combined
incidence for these two skin cancers, the investigators said. However,
they added, further research is needed to understand the mechanism of
action.
"If these novel findings are confirmed in a randomized controlled trial,
they may lead to prevention of these very common cancers, at least among
individuals at very high risk," they concluded.
This study was funded by the VA Cooperative Studies Program, Office of
Research and Development, Department of Veterans Affairs; the American
Cancer Society.
Primary source: Journal of the National Cancer Institute
-------------------------
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