Dihydropyridine Calcium Channel Blockers do not increase risk of pancreatic cancer

Canadian Researchers found that dihydropyridine calcium channel blockers (dCCBs) do not increase the risk of pancreatic cancer when compared with thiazide diuretics. The study results were published in the Journal of the American Heart Association.  

Dihydropyridine calcium channel blockers (dCCBs) are the most frequently prescribed, first‐line treatment of antihypertensive drugs in primary health care practices. They have good cardiovascular safety profiles, but recent literature showed an increased risk of pancreatic cancer. Due to the limited and conflicting evidence, Canadian researchers conducted a study to determine if dCCBs are associated with an increased risk of pancreatic cancer compared with thiazide diuretics. 

Using the UK Clinical Practice Research Datalink, a new user, active comparator, and population‐based cohort study was conducted. The new users of dCCBs and new users of thiazide diuretics between 1990 and 2018 were identified, with follow‐up until 2019. Estimation of hazard ratios (HRs) with 95% CIs for pancreatic cancer, comparing dCCBs with thiazide diuretics was done using the cox proportional hazards models. Based on calendar time‐specific propensity scores, models were weighted using standardized morbidity ratio weights. Secondary analyses were conducted by the cumulative duration of use, time since initiation, and individual drugs and assessed for the presence of effect modification by age, sex, smoking status, body mass index, history of chronic pancreatitis, and diabetes.

Findings of the study:

• 3,44,480 initiators of dCCBs and 3,57,968 initiators of thiazide diuretics, generating 33,60 745 person‐years of follow‐up were included in the study.
• The weighted incidence rate per 100 000 person‐years was 37.2 (95% CI, 34.1–40.4) for dCCBs and 39.4 (95% CI, 36.1–42.9) for thiazide diuretics after a median follow-up of 4.5 years. 
• There was no observed increased risk of pancreatic cancer with dCCBs (weighted HR, 0.93; 95% CI, 0.80–1.09).
• Secondary analyses also showed similar results.

Thus, this large population-based study showed that dCCBs have long-term pancreatic cancer safety profiles and are not associated with an increased risk of pancreatic cancer. 

Further reading: Rouette J, McDonald EG, Schuster T, Brophy JM, Azoulay L. Dihydropyridine Calcium Channel Blockers and Risk of Pancreatic Cancer: A Population-Based Cohort Study [published online ahead of print, 2022 Dec 14]. J Am Heart Assoc. 2022;e026789. doi: 10.1161/JAHA.122.026789