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To assess the relationship between use of calcium antagonists and incidence of fatal or non-fatal cancer over 3 years in the Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY) population.A prospective cohort study with follow-up analysis after 3 years.In 1992 STEPHY workers investigated the total population aged > 65 years (n = 1190) of two villages in Bavaria, Germany. With 982 participants (response rate 83%) the prevalence of ‘actual’ hypertension (blood pressure ≥ 160/95 mmHg or treatment) was 53%. Of all hypertensives (n = 491), 54% were being treated, 28% (n = 137) with calcium antagonists. Participants with a history of cancer or manifest cancer were excluded from further analysis. In 1995 in STEPHY II, the 3-year follow-up, we assessed total mortality (including cases of fatal cancer), cardiovascular events and cases of non-fatal cancer between 1992 and 1995. The evaluation included a second interview, use of case records of general practitioners and hospitals and analysis of the official death certificates. The total incidence of fatal and nonfatal cancer (a combined end point) was calculated for participants treated with calcium antagonists and those not taking calcium antagonists.Total mortality over 3 years was 12.1% (n = 119). There were 22 deaths due to cancer and 75 cases of newly diagnosed non-fatal cancer. The combined incidence of fatal and non-fatal cancer (primary end point) was 10.9% (n = 15) for participants treated with calcium antagonists and 9.7% (n = 82) for those not taking calcium antagonists (odds ratio 1.12, 95% confidence interval 0.7–1.8). There was also no significant difference between the incidences of fatal cancer (2.2% in both groups), non-fatal cancer (12.5% for participants treated with calcium antagonists and 10.8% for those not taking calcium antagonists) and total mortality (14.6% for participants taking calcium antagonists and 11.7% for those not treated with calcium antagonists).Use of calcium antagonists does not increase the risk of fatal or non-fatal cancer over 3 years in an elderly mid-European population.