전향적 코호트를 이용한 고혈압이 암사망에 미치는 영향

Abstract

[한글]

악성신생물의 전형적 특성인 세포증식이 고혈압과 심혈관 질환에서 나타남에 따라, 고혈압과 악성신생물과의 관련성에 대한 가설이 끊임없이 제시되고 있다. 이에 본 연구에서는 대규모 코호트를 통하여 고혈압과 암사망의 관련성을 규명하고자 하였다.

본 연구는 국민건강보험공단에서 실시한 공무원 교직원 건강검진에 1992년 1994년 모두 참여한 수검자를 대상으로 최종 남자 576,562명을 대상으로 하였고, 1995-2001년 까지의 통계청 사망자료를 이용하여 이들의 암사망 자료를 수집하였다.

고혈압과 암사망과의 관련성 분석은 수축기 및 이완기 혈압, JNC VII(The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure)에 기준한 혈압, 그리고 고혈압 유병에 따라 대상자들의 연령, 흡연상태, 혈당, 총 콜레스테롤, 비만도, 식습관, 운동유무를 통제한 상태에서 실시되었다.

그 결과 수축기 혈압의 증가는 결장, 췌장, 후두, 신장, 뇌암사망과 관련이 있었으며, 이완기 혈압의 증가는 식도, 후두, 신장, 뇌암사망과 관련이 있었다. JNC VII 구분에 의해서는 식도, 결장, 후두, 신장, 뇌암으로 인한 사망위험을 증가시켰으며, 고혈압은 식도, 위, 결장, 췌장, 후두, 신장, 뇌암으로 인한 사망위험을 증가시켰다.

이러한 결과에서 혈압의 상승은 암사망의 위험인자임을 알 수 있었다. 또한 고혈압은 암으로 인한 모든 사망에 대해서는 흡연과의 교호작용으로 인한 암사망 위험인자였으나, 위, 후두, 신장, 뇌암 사망에는 독립적 위험인자임을 알 수 있었다.

[영문]There have been studies to find out, which risk factors may cause cancer. Among the risk factors, whether they were clearly identified or not as cancer causing risk factors, hypertenstion has been under the controversial discussion. One of the resons may partly have been due to small study samples. Other factors such as obesity, diabetes, and smoking have been also under scientific scrutiny as risk risk factors for causing cancer.

Objectives : To examine the effects of hypertension on cancer mortality and to determine the interactive effect of hypertension and smoking on cancer mortality.

Material and methods : A ten-year prospective cohort study was carried out with a sample of 576 562 Korean men with health insurance plan coverage from the National Health Insurance Corporation and who went through biennial medical exams in 1992 to 1994. The deaths from any types of cancer, obtained from the National Statistical Office were used as a main outcome measure(a dependant variable).

To assess the independent effects of blood pressure on cancer mortality, multivariate Cox’s proportional hazards models were used, controlling for age, smoking status, diabetes, body mass index, serum cholesterol concentration, dietary, exercise, and alcohol use.

Results : In present study, hypertension was the factor contributing to the total cancer mortality (RR=1.07, 95% CI:1.02-1.13). For the types of cancer, it was noted that there was a significant association with colon, larynx, kidney, and brain cancer mortality. When the interaction term was included in a multivatiate model, there was a significant interaction effects of hypertension with smoking on the total cancer mortality. But there was no significant interactive effect of hypertension with smoking on larynx, kidney, and brain cancer mortality

Conclusion : Prospective study has provided strong support that hypertension might be in fact one of the independent risk factors for cancer. In specific, from present study, hypertension was an independent risk factor in stomach, larynx, kidney, and brain cancer mortality. Hypertension alone was not an independent risk factor in all types of cancer mortality.

Many uncertainties remain concerning a probable relationship between hypertension and the risk of cancer. Unresolved findings persist concerning the interaction with other factors for cancer. Future studies should focus more on plausible physiological mechanisms for cancer and cancer causing risk factors.