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Nonselective beta‐blockers are associated with a lower risk of hepatocellular carcinoma among cirrhotic patients in the United States
Summary Background Previous studies have demonstrated an association between nonselective beta‐blockers (NSBBs) and lower risk of hepatocellular carcinoma (HCC) in cirrhosis. However, there has been no population‐based study investigating the risk of HCC among cirrhotic patients treated using carved...
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| Published in: | Alimentary pharmacology & therapeutics 2021-08, Vol.54 (4), p.481-492 |
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| creator | Wijarnpreecha, Karn Li, Fang Xiang, Yang Xu, Xun Zhu, Cong Maroufy, Vahed Wang, Qing Tao, Wei Dang, Yifang Pham, Huy Anh Zhou, Yujia Li, Jianfu Zhang, Xinyuan Xu, Hua Taner, C. Burcin Yang, Liu Tao, Cui |
| description | Summary
Background
Previous studies have demonstrated an association between nonselective beta‐blockers (NSBBs) and lower risk of hepatocellular carcinoma (HCC) in cirrhosis. However, there has been no population‐based study investigating the risk of HCC among cirrhotic patients treated using carvedilol.
Aims
To determine the risk of HCC among cirrhotic patients with NSBBs including carvedilol.
Methods
This retrospective cohort study utilised the Cerner Health Facts database in the United States from 2000 to 2017. Kaplan‐Meier estimate, Cox proportional hazards regression, and propensity score matching (PSM) were used to test the HCC risk among the carvedilol, nadolol, and propranolol groups compared with no beta‐blocker group.
Results
The final cohort comprised 107 428 eligible patients. The 100‐month cumulative HCC incidence of NSBBs was significantly lower than the no beta‐blocker group (carvedilol (11.24%) vs no beta‐blocker (15.69%), nadolol (27.55%) vs no beta‐blocker (32.11%), and propranolol (26.17%) vs no beta‐blocker (28.84%) (P values |
| doi_str_mv | 10.1111/apt.16490 |
| format | article |
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Background
Previous studies have demonstrated an association between nonselective beta‐blockers (NSBBs) and lower risk of hepatocellular carcinoma (HCC) in cirrhosis. However, there has been no population‐based study investigating the risk of HCC among cirrhotic patients treated using carvedilol.
Aims
To determine the risk of HCC among cirrhotic patients with NSBBs including carvedilol.
Methods
This retrospective cohort study utilised the Cerner Health Facts database in the United States from 2000 to 2017. Kaplan‐Meier estimate, Cox proportional hazards regression, and propensity score matching (PSM) were used to test the HCC risk among the carvedilol, nadolol, and propranolol groups compared with no beta‐blocker group.
Results
The final cohort comprised 107 428 eligible patients. The 100‐month cumulative HCC incidence of NSBBs was significantly lower than the no beta‐blocker group (carvedilol (11.24%) vs no beta‐blocker (15.69%), nadolol (27.55%) vs no beta‐blocker (32.11%), and propranolol (26.17%) vs no beta‐blocker (28.84%) (P values < 0.0001). NSBBs were associated with a significantly lower risk of HCC (Hazard ratio: carvedilol 0.61 (95% CI 0.51‐0.73), nadolol 0.74 (95% CI 0.63‐0.87), propranolol 0.75 (95% CI 0.66‐0.84) after PSM in the multivariate cox analysis. In subgroup analysis, NSBBs reduced the risk of HCC in cirrhosis with complications and non‐alcoholic cirrhosis.
Conclusions
NSBBs, including carvedilol, were associated with a significantly decreased risk of HCC in patients with cirrhosis when compared with no beta‐blocker regardless of complications status. Future randomised‐controlled studies comparing the incidence of HCC among NSBBs should elucidate which NSBB would be the best option to prevent HCC in cirrhosis.
From the population‐based retrospective cohort study, our novel findings include: (a) The 100‐month cumulative HCC incidence of NSBBs groups were significantly lower than the no beta‐blocker group. (b) NSBBs use was associated with a significant lower HCC risk in the multivariate cox analysis as well as subgroup analyses.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.16490</identifier><language>eng</language><publisher>Chichester: Wiley Subscription Services, Inc</publisher><subject>Beta blockers ; Cirrhosis ; Hepatocellular carcinoma ; Liver cancer ; Liver cirrhosis ; Population studies ; Propranolol</subject><ispartof>Alimentary pharmacology & therapeutics, 2021-08, Vol.54 (4), p.481-492</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3300-d029e1f0dd705f47ca6bdabec1b13e96b4fcf7dbfc627bc62d0b272eece521c43</citedby><cites>FETCH-LOGICAL-c3300-d029e1f0dd705f47ca6bdabec1b13e96b4fcf7dbfc627bc62d0b272eece521c43</cites><orcidid>0000-0003-1395-6805 ; 0000-0001-8865-7717 ; 0000-0002-4267-1924 ; 0000-0002-5274-4672 ; 0000-0002-6232-6343</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Wijarnpreecha, Karn</creatorcontrib><creatorcontrib>Li, Fang</creatorcontrib><creatorcontrib>Xiang, Yang</creatorcontrib><creatorcontrib>Xu, Xun</creatorcontrib><creatorcontrib>Zhu, Cong</creatorcontrib><creatorcontrib>Maroufy, Vahed</creatorcontrib><creatorcontrib>Wang, Qing</creatorcontrib><creatorcontrib>Tao, Wei</creatorcontrib><creatorcontrib>Dang, Yifang</creatorcontrib><creatorcontrib>Pham, Huy Anh</creatorcontrib><creatorcontrib>Zhou, Yujia</creatorcontrib><creatorcontrib>Li, Jianfu</creatorcontrib><creatorcontrib>Zhang, Xinyuan</creatorcontrib><creatorcontrib>Xu, Hua</creatorcontrib><creatorcontrib>Taner, C. Burcin</creatorcontrib><creatorcontrib>Yang, Liu</creatorcontrib><creatorcontrib>Tao, Cui</creatorcontrib><title>Nonselective beta‐blockers are associated with a lower risk of hepatocellular carcinoma among cirrhotic patients in the United States</title><title>Alimentary pharmacology & therapeutics</title><description>Summary
Background
Previous studies have demonstrated an association between nonselective beta‐blockers (NSBBs) and lower risk of hepatocellular carcinoma (HCC) in cirrhosis. However, there has been no population‐based study investigating the risk of HCC among cirrhotic patients treated using carvedilol.
Aims
To determine the risk of HCC among cirrhotic patients with NSBBs including carvedilol.
Methods
This retrospective cohort study utilised the Cerner Health Facts database in the United States from 2000 to 2017. Kaplan‐Meier estimate, Cox proportional hazards regression, and propensity score matching (PSM) were used to test the HCC risk among the carvedilol, nadolol, and propranolol groups compared with no beta‐blocker group.
Results
The final cohort comprised 107 428 eligible patients. The 100‐month cumulative HCC incidence of NSBBs was significantly lower than the no beta‐blocker group (carvedilol (11.24%) vs no beta‐blocker (15.69%), nadolol (27.55%) vs no beta‐blocker (32.11%), and propranolol (26.17%) vs no beta‐blocker (28.84%) (P values < 0.0001). NSBBs were associated with a significantly lower risk of HCC (Hazard ratio: carvedilol 0.61 (95% CI 0.51‐0.73), nadolol 0.74 (95% CI 0.63‐0.87), propranolol 0.75 (95% CI 0.66‐0.84) after PSM in the multivariate cox analysis. In subgroup analysis, NSBBs reduced the risk of HCC in cirrhosis with complications and non‐alcoholic cirrhosis.
Conclusions
NSBBs, including carvedilol, were associated with a significantly decreased risk of HCC in patients with cirrhosis when compared with no beta‐blocker regardless of complications status. Future randomised‐controlled studies comparing the incidence of HCC among NSBBs should elucidate which NSBB would be the best option to prevent HCC in cirrhosis.
From the population‐based retrospective cohort study, our novel findings include: (a) The 100‐month cumulative HCC incidence of NSBBs groups were significantly lower than the no beta‐blocker group. (b) NSBBs use was associated with a significant lower HCC risk in the multivariate cox analysis as well as subgroup analyses.</description><subject>Beta blockers</subject><subject>Cirrhosis</subject><subject>Hepatocellular carcinoma</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Population studies</subject><subject>Propranolol</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kL1OwzAURi0EEqUw8AaWmBjS2k5iN2NV8SdVgEQ7R7ZzQ9ymcbBdqm5srDwjT0JKWLnDvcv5visdhC4pGdFuxrINI8qTjByhAY15GjES82M0IIxnEZvQ-BSdeb8ihHBB2AB9PtrGQw06mHfACoL8_vhStdVrcB5LB1h6b7WRAQq8M6HCEtd2Bw4749fYlriCVgaroa63tXRYS6dNYzcSy41tXrE2zlU2GI07zEATPDYNDhXgZWMOpS-h6_bn6KSUtYeLvztEy9ubxew-mj_dPcym80jHMSFRQVgGtCRFIUhaJkJLrgqpQFNFY8i4SkpdikKVmjOhulUQxQQD0JAyqpN4iK763tbZty34kK_s1jXdy5ylKZ8IIkTWUdc9pZ313kGZt85spNvnlOQHz3nnOf_13LHjnt2ZGvb_g_n0edEnfgBXoYQR</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Wijarnpreecha, Karn</creator><creator>Li, Fang</creator><creator>Xiang, Yang</creator><creator>Xu, Xun</creator><creator>Zhu, Cong</creator><creator>Maroufy, Vahed</creator><creator>Wang, Qing</creator><creator>Tao, Wei</creator><creator>Dang, Yifang</creator><creator>Pham, Huy Anh</creator><creator>Zhou, Yujia</creator><creator>Li, Jianfu</creator><creator>Zhang, Xinyuan</creator><creator>Xu, Hua</creator><creator>Taner, C. Burcin</creator><creator>Yang, Liu</creator><creator>Tao, Cui</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><orcidid>https://orcid.org/0000-0003-1395-6805</orcidid><orcidid>https://orcid.org/0000-0001-8865-7717</orcidid><orcidid>https://orcid.org/0000-0002-4267-1924</orcidid><orcidid>https://orcid.org/0000-0002-5274-4672</orcidid><orcidid>https://orcid.org/0000-0002-6232-6343</orcidid></search><sort><creationdate>202108</creationdate><title>Nonselective beta‐blockers are associated with a lower risk of hepatocellular carcinoma among cirrhotic patients in the United States</title><author>Wijarnpreecha, Karn ; Li, Fang ; Xiang, Yang ; Xu, Xun ; Zhu, Cong ; Maroufy, Vahed ; Wang, Qing ; Tao, Wei ; Dang, Yifang ; Pham, Huy Anh ; Zhou, Yujia ; Li, Jianfu ; Zhang, Xinyuan ; Xu, Hua ; Taner, C. Burcin ; Yang, Liu ; Tao, Cui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3300-d029e1f0dd705f47ca6bdabec1b13e96b4fcf7dbfc627bc62d0b272eece521c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Beta blockers</topic><topic>Cirrhosis</topic><topic>Hepatocellular carcinoma</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Population studies</topic><topic>Propranolol</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wijarnpreecha, Karn</creatorcontrib><creatorcontrib>Li, Fang</creatorcontrib><creatorcontrib>Xiang, Yang</creatorcontrib><creatorcontrib>Xu, Xun</creatorcontrib><creatorcontrib>Zhu, Cong</creatorcontrib><creatorcontrib>Maroufy, Vahed</creatorcontrib><creatorcontrib>Wang, Qing</creatorcontrib><creatorcontrib>Tao, Wei</creatorcontrib><creatorcontrib>Dang, Yifang</creatorcontrib><creatorcontrib>Pham, Huy Anh</creatorcontrib><creatorcontrib>Zhou, Yujia</creatorcontrib><creatorcontrib>Li, Jianfu</creatorcontrib><creatorcontrib>Zhang, Xinyuan</creatorcontrib><creatorcontrib>Xu, Hua</creatorcontrib><creatorcontrib>Taner, C. Burcin</creatorcontrib><creatorcontrib>Yang, Liu</creatorcontrib><creatorcontrib>Tao, Cui</creatorcontrib><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wijarnpreecha, Karn</au><au>Li, Fang</au><au>Xiang, Yang</au><au>Xu, Xun</au><au>Zhu, Cong</au><au>Maroufy, Vahed</au><au>Wang, Qing</au><au>Tao, Wei</au><au>Dang, Yifang</au><au>Pham, Huy Anh</au><au>Zhou, Yujia</au><au>Li, Jianfu</au><au>Zhang, Xinyuan</au><au>Xu, Hua</au><au>Taner, C. Burcin</au><au>Yang, Liu</au><au>Tao, Cui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nonselective beta‐blockers are associated with a lower risk of hepatocellular carcinoma among cirrhotic patients in the United States</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><date>2021-08</date><risdate>2021</risdate><volume>54</volume><issue>4</issue><spage>481</spage><epage>492</epage><pages>481-492</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Previous studies have demonstrated an association between nonselective beta‐blockers (NSBBs) and lower risk of hepatocellular carcinoma (HCC) in cirrhosis. However, there has been no population‐based study investigating the risk of HCC among cirrhotic patients treated using carvedilol.
Aims
To determine the risk of HCC among cirrhotic patients with NSBBs including carvedilol.
Methods
This retrospective cohort study utilised the Cerner Health Facts database in the United States from 2000 to 2017. Kaplan‐Meier estimate, Cox proportional hazards regression, and propensity score matching (PSM) were used to test the HCC risk among the carvedilol, nadolol, and propranolol groups compared with no beta‐blocker group.
Results
The final cohort comprised 107 428 eligible patients. The 100‐month cumulative HCC incidence of NSBBs was significantly lower than the no beta‐blocker group (carvedilol (11.24%) vs no beta‐blocker (15.69%), nadolol (27.55%) vs no beta‐blocker (32.11%), and propranolol (26.17%) vs no beta‐blocker (28.84%) (P values < 0.0001). NSBBs were associated with a significantly lower risk of HCC (Hazard ratio: carvedilol 0.61 (95% CI 0.51‐0.73), nadolol 0.74 (95% CI 0.63‐0.87), propranolol 0.75 (95% CI 0.66‐0.84) after PSM in the multivariate cox analysis. In subgroup analysis, NSBBs reduced the risk of HCC in cirrhosis with complications and non‐alcoholic cirrhosis.
Conclusions
NSBBs, including carvedilol, were associated with a significantly decreased risk of HCC in patients with cirrhosis when compared with no beta‐blocker regardless of complications status. Future randomised‐controlled studies comparing the incidence of HCC among NSBBs should elucidate which NSBB would be the best option to prevent HCC in cirrhosis.
From the population‐based retrospective cohort study, our novel findings include: (a) The 100‐month cumulative HCC incidence of NSBBs groups were significantly lower than the no beta‐blocker group. (b) NSBBs use was associated with a significant lower HCC risk in the multivariate cox analysis as well as subgroup analyses.</abstract><cop>Chichester</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1111/apt.16490</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-1395-6805</orcidid><orcidid>https://orcid.org/0000-0001-8865-7717</orcidid><orcidid>https://orcid.org/0000-0002-4267-1924</orcidid><orcidid>https://orcid.org/0000-0002-5274-4672</orcidid><orcidid>https://orcid.org/0000-0002-6232-6343</orcidid></addata></record> |
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| ispartof | Alimentary pharmacology & therapeutics, 2021-08, Vol.54 (4), p.481-492 |
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| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Beta blockers Cirrhosis Hepatocellular carcinoma Liver cancer Liver cirrhosis Population studies Propranolol |
| title | Nonselective beta‐blockers are associated with a lower risk of hepatocellular carcinoma among cirrhotic patients in the United States |
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