Among female survivors of cancer, the risk of cardiac events may be higher with some antihypertensive medications, according to a new study published in The Oncologist.1

This prospective study examined a population of 56,997 women participating in the Women’s Health Initiative to assess cardiac outcomes with antihypertensive medications in women with or without cancer. Cardiac outcomes included heart failure, coronary heart disease, and total cardiac events, which was a composite of the other outcomes.

Within each patient group, cardiac outcomes with angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics were compared with outcomes with beta blockers (BBs). Outcomes with these treatments were also compared between groups based on cancer history.

The mean age of participants at the start of this study was 64.6 years. Among the women without cancer, no difference in total cardiac events was seen between those using BBs and those using ACE inhibitors/ARBs (hazard ratio [HR], 0.99; 95% CI, 0.88-1.12). However, the risk of total cardiac events was twice as high for cancer survivors using ACE inhibitors/ARBs compared with survivors using BBs (HR, 2.24; 95% CI, 1.18-4.24). The HR for a comparison of these outcomes based on cancer history was 2.25 (95% CI, 1.17-4.32; P =.06 for interaction).


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Cancer survivors trended toward a greater risk of coronary heart disease with the use of ACE inhibitors/ARBs compared with BBs, whereas women without a cancer history did not (P =.04 for interaction). Heart failure showed similar results but without a significant difference between groups by cancer history.

“In this prospective cohort study, our findings suggest that in cancer survivors, BB use is favorable for reducing cardiac events relative to [ACE inhibitor/ARB] use, which contrasted with the findings in cancer-free women,” the researchers wrote in their report.

Reference

Reding KW, Aragaki AK, Cheng RK, et al. Cardiovascular outcomes in relation to antihypertensive medication use in women with and without cancer: results from the Women’s Health Initiative [published online April 6, 2020]. Oncologist. doi:10.1634/theoncologist.2019-0977