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Table 3 Sensitivity analyses for association between ACEIs and ARBS and cancer specific mortality in breast cancer patients

From: Drugs affecting the renin-angiotensin system and survival from cancer: a population based study of breast, colorectal and prostate cancer patient cohorts

 

Cancer specific deaths number

Controls number

OR (95% CI)

P

OR (95% CI)

P

   

ACEI user versus non user

 

ARB user versus non user

 

Breast cancer

  

Main analysis: diagnosis to six months prior to deatha

648

3,193

0.83 (0.63, 1.09)

0.18

0.94 (0.65, 1.37)

0.75

Diagnosis to 1 year prior to deathb

583

2,875

0.87 (0.65, 1.16)

0.33

0.87 (0.58, 1.30)

0.49

Restricted to users of any antihypertensive medicationc prior to cancer diagnosisd

212

994

0.87 (0.60, 1.25)

0.44

1.36 (0.85, 2.16)

0.20

Comparison group restricted to users of any antihypertensive in exposure periodc

361

1,624

0.79 (0.59, 1.05)

0.10

0.92 (0.63, 1.34)

0.67

Additionally adjusting for other antihypertensivese

648

3,193

0.79 (0.60, 1.06)

0.12

0.90 (0.61, 1.33)

0.60

Additionally adjusting for hormone therapy any time after diagnosisf

648

3,193

0.80 (0.60, 1.05)

0.11

0.98 (0.66, 1.44)

0.91

≥730 DDDs versus 0 DDDs (non-user)

648

3,193

1.06 (0.74, 1.52)

0.75

0.99 (0.64, 1.52)

0.95

Restricted to cancer registries with stage data available for over 85% of patients

487

1,911

0.84 (0.59, 1.18)

0.31

1.33 (0.81, 2.17)

0.25

Stage 1 and 2g

469

2,313

0.95 (0.68, 1.32)

0.75

1.14 (0.73, 1.81)

0.56

Stage 3 and 4g

161

531

0.83 (0.46, 1.51)

0.54

2.37 (1.05, 5.35)

0.04

Pre-diagnostic useh

695

3,413

0.86 (0.61, 1.20)

0.37

1.06 (0.65, 1.72)

0.82

Time varying covariate analysisi

656

4,164

    

  ≥1 DDDs versus 0 DDDs (non-user)

  

0.97 (0.77, 1.21)

0.76

1.20 (0.89, 1.62)

0.23

  1to 365 DDDs versus 0 DDDs (non-user)

  

0.90 (0.65, 1.25)

0.52

0.94 (0.55, 1.60)

0.81

  ≥365 DDDs versus 0 DDDs (non-user)

  

1.01 (0.77, 1.32)

0.93

1.35 (0.96, 1.91)

0.09

  1. aExcept where otherwise stated analysis investigates medications from diagnosis to six months prior to death/index date and models include surgery (within six months of diagnosis), chemotherapy (within six months), radiotherapy (within six months), low dose aspirin (during exposure period), statins (during exposure period), comorbidities (pre-diagnosis or during exposure period, including myocardial infarction, cerebrovascular disease, congestive heart disease, chronic pulmonary disease, peripheral vascular disease, renal disease, peptic ulcer disease and diabetes), and smoking (pre-diagnosis, with missing included as a category), tamoxifen (within six months), aromatase inhibitors (within six months), hormone replacement therapy (pre-diagnosis) and stage. bRestricted to individuals surviving more than 1.5 years. cAntihypertensive medications include beta-blockers, diuretics, vasodilator antihypertensive drugs, centrally acting antihypertensive drugs, alpha-adrenoceptor blocking drugs, ACEIs, ARBs, renin inhibitors, and calcium channel blockers. dRestricted to individuals with >1 year of records prior to cancer diagnosis and pre-diagnostic use considered antihypertensive use in that year, excluding deaths in the year after cancer diagnosis. eModels include all variables in aand additionally include calcium channel blockers, diuretics and beta-blockers. fModels include all variables in abut tamoxifen and aromatase inhibitors were determined at any time after diagnosis in the exposure period. gStratified analyses were conducted after re-matching controls to cases within strata; due to non-availability of matches overall numbers in subgroups may not be identical to numbers presented in Table 1. hRestricted to individuals with >1 year of records prior to cancer diagnosis and pre-diagnostic use considered ACEI/ARB use in that year, not excluding deaths in the year after cancer diagnosis. iReported estimates are adjusted hazard ratios and 95% CIs, model includes age at diagnosis, year of diagnosis, surgery (within six months of diagnosis), chemotherapy (within six months), radiotherapy (within six months), statins (during exposure period, as a time varying covariate), comorbidities (pre-diagnosis including, myocardial infarction, cerebrovascular disease, congestive heart disease, chronic pulmonary disease, peripheral vascular disease, renal disease, peptic ulcer disease and diabetes) and stage. ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; CI, confidence interval; DDDs, daily defined doses; OR, odds ratio.