Renin angiotensin system inhibitors may attenuate low LDL cholesterol-related cancer risk in type 2 diabetes
Corresponding Author
Xilin Yang
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
Correspondence to: Xilin Yang, P.O. Box 154, Tianjin Medical University, Heping District, Tianjin 300070, China.
E-mail: [email protected]
Juliana C. N. Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
E-mail: [email protected]
Search for more papers by this authorRonald C. W. Ma
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorWing Yee So
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorYing Wang
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorAlice P. S. Kong
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorRisa Ozaki
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorGang Xu
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorCorresponding Author
Juliana C. N. Chan
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Correspondence to: Xilin Yang, P.O. Box 154, Tianjin Medical University, Heping District, Tianjin 300070, China.
E-mail: [email protected]
Juliana C. N. Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
E-mail: [email protected]
Search for more papers by this authorCorresponding Author
Xilin Yang
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
Correspondence to: Xilin Yang, P.O. Box 154, Tianjin Medical University, Heping District, Tianjin 300070, China.
E-mail: [email protected]
Juliana C. N. Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
E-mail: [email protected]
Search for more papers by this authorRonald C. W. Ma
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorWing Yee So
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorYing Wang
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorAlice P. S. Kong
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorRisa Ozaki
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorGang Xu
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorCorresponding Author
Juliana C. N. Chan
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Correspondence to: Xilin Yang, P.O. Box 154, Tianjin Medical University, Heping District, Tianjin 300070, China.
E-mail: [email protected]
Juliana C. N. Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
E-mail: [email protected]
Search for more papers by this authorAbstract
Background
In type 2 diabetes (T2D), copresence of low-density lipoprotein cholesterol (LDL-C) <2.8 mmol/L with triglyceride <1.7 mmol/L or with albuminuria synergistically increased cancer risk. We tested whether use of renin angiotensin system inhibitors attenuated the increased cancer risk associated with these two risk subphenotypes.
Methods
A prospective cohort of 4307 patients with T2D enrolled from December 1996 to January 2005 was analysed using a new user cohort design. Cox model analysis was used to obtain hazard ratios and 95% confidence intervals. The study measured additive interactions between nonuse of renin angiotensin system inhibitors and low LDL-C plus low triglyceride or albuminuria for the risk of cancer. A positive interaction suggests a specific drug effect on the low LDL-C-related cancer risk.
Results
During 18 769 person years of follow-up (median follow-up years: 4.44), 4.48% (n = 193) of patients developed cancer. Use of renin angiotensin system inhibitors was associated with reduced cancer risk among patients with copresence of low LDL-C plus low triglyceride or low LDL-C plus albuminuria but not in patients without these subphenotypes. In multivariable analysis, renin angiotensin system inhibitor usage attenuated the hazard ratio of copresence of low LDL-C plus low triglyceride versus lack of this subphenotype for cancer from 2.08 (95% CI: 1.25–3.47) to 1.13 (0.61–2.11) with significant additive interaction (p = 0.0225). Similarly, RAS inhibitor usage attenuated the hazard ratio of copresence of low LDL-C plus albuminuria versus lack of this subphenotype for cancer from 1.99 (95% CI: 1.12–3.56) to 0.82 (0.43–1.54) with significant additive interaction (p = 0.0009).
Conclusion
In T2D, renin angiotensin system inhibitor usage may specifically attenuate the low LDL-C-related cancer risk. Copyright © 2013 John Wiley & Sons, Ltd.
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