Ju, Chengsheng; (2024) The use of cardiovascular medications and cancer diagnosis in patients with heart failure: Applications of pharmacoepidemiological methods. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Cancer diagnosis is common in patients with heart failure (HF). However, little research is centred around the use of cardiovascular medications for HF management in relation to cancer diagnosis. In this thesis, I applied advanced pharmacoepidemiological methods and leveraged large electronic health records from primary care databases in the UK to investigate (1) in patients with HF without cancer, the use of cardiovascular medications and the risk of developing incident cancer, and (2) in patients with HF who developed cancer, the change in use of cardiovascular medications for HF treatment after a cancer diagnosis. Firstly, I conducted a systematic review and meta-analysis to evaluate the risk of cancer diagnosis associated with spironolactone use. It suggested spironolactone use was not associated with an increased risk of any cancers, but a possible lower risk of prostate cancer in men. Following this, I conducted a population-based cohort study and showed that the use of mineralocorticoid receptor antagonists (MRAs), including spironolactone and eplerenone, was associated with a lower risk of prostate cancer in men with HF. Secondly, I conducted a population-based cohort study to compare the effect of carvedilol versus bisoprolol on the risk of cancer in patients with HF. Carvedilol was not associated with a lower risk of cancer than bisoprolol. Thirdly, I emulated two target trials to investigate the effect of statin, and different durations of statin treatment on the risk of cancer in patients with HF. Statin, regardless of the duration of the treatment, was not associated with a lower risk of cancer. Lastly, I conducted a longitudinal drug utilisation study to evaluate changes in the use of medical therapies for HF before and after a cancer diagnosis. Patients were more likely to experience treatment interruptions and de-escalations for the medical therapies for HF after cancer.

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