Angiotensin-Converting Enzyme Inhibitors and Risk of Esophageal and Gastric Cancer: A Nested Case-Control Study

Abstract

There are contradictory results regarding the association between angiotensin-converting enzyme (ACE) inhibitors and cancer. We aimed to investigate whether ACE inhibitors protect against esophageal and gastric cancer. We conducted a population-based case-control study nested within the General Practitioners' Research Database in the United Kingdom. All individuals in the General Practitioners' Research Database aged 40-84 years between 1994 and 2001 were followed up until detection of an esophageal or gastric cancer (cases), other cancer, age of 85 years, death, or end of study period. Among 4.34 million person-years, 909 cases of esophageal and 1023 cases of gastric cancer were identified, and 10,000 matched controls were selected at random. Adjustments included smoking, body mass index, concurrent medication, and gastrointestinal disorders. Current use of ACE inhibitors decreased the risk of esophageal adenocarcinoma by 29% (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.43-1.17), but not of squamous-cell carcinoma (OR, 1.27; 95% CI, 0.71-2.28) compared with nonusers. A high daily dose of ACE inhibitors decreased the risk of both adenocarcinoma and squamous-cell cancer of the esophagus and rendered a 45% decrease of total esophageal cancer (OR, 0.55; 95% CI, 0.33-0.93). Our data showed no clear association between the use of ACE inhibitors and risk of gastric cancer (OR, 1.07; 95% CI, 0.84-1.36). The use of ACE inhibitors may decrease the risk of developing esophageal cancer, particularly among users with a high daily dose. No association was found between gastric cancer and ACE inhibitors.