Thiazide Diuretics and Risk of Colorectal Cancer: A Population-Based Cohort Study

Julie Rouette, Emily G. McDonald, Tibor Schuster, Ilan Matok, James M. Brophy, Laurent Azoulay*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Evidence from clinical trials and observational studies on the association between thiazide diuretics and colorectal cancer risk is conflicting. We aimed to determine whether thiazide diuretics are associated with an increased colorectal cancer risk compared with dihydropyridine calcium channel blockers (dCCBs). A population-based, new-user cohort was assembled using the UK Clinical Practice Research Datalink. Between 1990-2018, we compared thiazide diuretic initiators with dCCB initiators and estimated hazard ratios (HR) with 95% confidence intervals (CIs) of colorectal cancer using Cox proportional hazard models. Models were weighted using standardized morbidity ratio weights generated from calendar time-specific propensity scores. The cohort included 377,760 thiazide diuretic initiators and 364,300 dCCB initiators, generating 3,619,883 person-years of follow-up. Compared with dCCBs, thiazide diuretics were not associated with colorectal cancer (weighted HR = 0.97, 95% CI: 0.90, 1.04). Secondary analyses yielded similar results, although an increased risk was observed among patients with inflammatory bowel disease (weighted HR = 2.45, 95% CI: 1.13, 5.35) and potentially polyps (weighted HR = 1.46, 95% CI: 0.93, 2.30). Compared with dCCBs, thiazide diuretics were not associated with an overall increased colorectal cancer risk. While these findings provide some reassurance, research is needed to corroborate the elevated risks observed among patients with inflammatory bowel disease and history of polyps.

Original languageAmerican English
Pages (from-to)47-57
Number of pages11
JournalAmerican Journal of Epidemiology
Volume193
Issue number1
DOIs
StatePublished - 8 Jan 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.

Keywords

  • antihypertensive drugs
  • calcium channel blockers
  • cohort
  • colorectal cancer
  • dihydropyridine
  • propensity score
  • thiazide diuretics

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