Abstract
BackgroundAcute pancreatitis is a potentially lethal disease, with a rising incidence in the Western world. Yet, no pharmacological prevention or specific treatment for acute pancreatitis exists. Also, the connection with severity of acute pancreatitis is unknown. Experimental and epidemiological research suggests a protective effect of angiotensin II receptor blockers.MethodsDuring 2006 to 2008, we performed a nationwide case–control study on Swedish residents aged 40–84 years. First-time cases with acute pancreatitis were identified in the National Patient Register and data on dispensed prescriptions was retrieved from the Prescribed Drug Register. Controls were randomly selected from the general population in Sweden frequency-matched on sex, age, and calendar year. To estimate relative risk of acute pancreatitis, by degree of severity, among users of angiotensin II receptor blockers, as compared to non-users, we used multivariable logistic regression analysis to calculate odds ratios (OR) with 95% confidence interval (CI).ResultsAmong 6,161 cases of acute pancreatitis and 61,637 controls, current use of angiotensin II receptor blockers was followed by a decreased risk of acute pancreatitis, compared to non-users, adjusted OR 0 · 77 (95% CI 0 · 69–0 · 86). No protective association, but an increased risk was found for users of angiotensin-converting enzyme inhibitors (adjusted OR 1 · 11, 95% CI: 1 · 01–1 · 21), analysed for comparison reasons. There was a significant decreased risk associated with both severe acute pancreatitis, (OR 0 · 71 (0 · 59–0 · 85), and mild acute pancreatitis; adjusted OR 0 · 81 (0 · 70–0 · 94).ConclusionThis population-based case–control study indicates that use of angiotensin II receptor blockers might be associated with a lesser risk of acute pancreatitis, and that the protective association was significant among cases of both severe and mild acute pancreatitis.
Highlights
Acute pancreatitis is a potentially lethal disease, with a rising incidence in the Western world
Our aim in this study was to elucidate the association between Angiotensin II receptor blockers (ARB) with regard to risk of acute pancreatitis, by degree of severity, in a population-based case–control study, taking into account the inherent risk increase that these drug users have due to the indication of the antihypertensive medication
This study suggests that usage of ARB might be associated with a lower risk of acute pancreatitis
Summary
Acute pancreatitis is a potentially lethal disease, with a rising incidence in the Western world. No pharmacological prevention or specific treatment for acute pancreatitis exists. Experimental and epidemiological research suggests a protective effect of angiotensin II receptor blockers. Pharmacological prevention of acute pancreatitis is warranted. Acute pancreatitis accounts for considerable morbidity and health care costs in Western countries. Angiotensin II receptor blockers (ARB) are often used to treat hypertension and heart failure. The ARB losartan reduces the inflammation in induced acute pancreatitis among rats [18,19,20]. We have performed a small randomized clinical trial, investigating the effect of losartan on pancreatic hyperenzymemia following endoscopic retrograde cholangiopancreatography [21]. In our study we saw no differences between the groups, but the conclusion was hampered by lack of statistical power
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