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Impact on clinical outcomes of renin-angiotensin system inhibitors against doxorubicin-related toxicity in patients with breast cancer and hypertension: A nationwide cohort study in South Korea.
- Source :
-
PloS one [PLoS One] 2023 Nov 20; Vol. 18 (11), pp. e0294649. Date of Electronic Publication: 2023 Nov 20 (Print Publication: 2023). - Publication Year :
- 2023
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Abstract
- Background: Although doxorubicin (DOX) is a commonly used potent chemotherapeutic agent in patients with breast cancer, its cardiotoxic effect is a concern, particularly in patients with hypertension. Antihypertensive renin-angiotensin system (RAS) inhibitors may potentially play a role in preventing overt heart failure (HF) due to DOX toxicity. This study aimed to evaluate whether the use of RAS inhibitors improves clinical outcomes in patients with hypertension and breast cancer undergoing DOX-containing chemotherapy.<br />Methods: A total of 54,344 female patients who were first diagnosed with breast cancer and initiated into DOX therapy between 2008 and 2015 were recruited from a nationwide Korean cohort. Patients were divided into two groups: with and without hypertension (HT, n = 10,789; non-HT, n = 43,555), and the RAS inhibitor group (n = 1,728) was sub-classified from the HT group. Two propensity score-matched cohorts were constructed to compare the clinical outcomes between non-HT and HT groups and between non-HT and RAS inhibitor groups. The primary outcome was the composite of HF and death.<br />Results: After propensity score matching, the HT group had a higher risk for HF (adjusted hazard ratio [HR] = 1.30, 95% confidence intervals [95% CI] = 1.09-1.55) compared to the non-HT group, but there was no significant difference in primary outcome between the two groups. The RAS inhibitor group had a lower risk for primary outcome (adjusted HR = 0.78, 95% CI = 0.65-0.94) and death (adjusted HR = 0.81, 95% CI = 0.66-0.99) compared to the non-HT group.<br />Conclusions: Hypertension is a risk factor for HF in patients with breast cancer undergoing DOX chemotherapy. However, the RAS inhibitors used to treat hypertension may contribute to decreased mortality and improved clinical outcomes.<br />Competing Interests: The authors have declared that no competing interests exist.<br /> (Copyright: © 2023 Hwang, Lee. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Subjects :
- Humans
Female
Antihypertensive Agents therapeutic use
Angiotensin-Converting Enzyme Inhibitors adverse effects
Renin-Angiotensin System
Cohort Studies
Doxorubicin adverse effects
Enzyme Inhibitors pharmacology
Angiotensin Receptor Antagonists adverse effects
Breast Neoplasms complications
Breast Neoplasms drug therapy
Breast Neoplasms chemically induced
Hypertension chemically induced
Hypertension drug therapy
Heart Failure
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 18
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 37983233
- Full Text :
- https://doi.org/10.1371/journal.pone.0294649