Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer-A Nationwide, Population-Based, Propensity Score-Matched Cohort Study.

I.-Kuan Wang,Chung-Y Hsu,Shih-Yi Lin,Cheng-Li Lin,Chia-Hung Kao,Chia-Der Lin,Cheng-Chieh Lin,Wu-Huei Hsu

doi:10.3390/cancers12030747

I.-Kuan Wang, Chung-Y Hsu + Show 6 more

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https://doi.org/10.3390/cancers12030747

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Journal: Cancers	Publication Date: Mar 21, 2020
Citations: 80	License type: CC BY 4.0

Affiliation: China Medical University, Asian University

Abstract

Background: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. Results: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11–1.67). Duration–response and dose–response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48–2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43–-2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). Conclusions: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.

Highlights

Angiotensin-converting enzyme inhibitors (ACEIs) cause vasodilation by inhibiting the formation of angiotensin II and angiotensin-converting enzyme inhibitors (ACEIs) comprise a critical class of antihypertensive medication indicated for heart failure, asymptomatic left ventricular dysfunction, proteinuria, diabetic nephropathy and postmyocardial infarction [1,2]
Hicks et al reported that the use of ACEIs is associated with a 1.14-fold higher risk of lung cancer compared with the use of angiotensin receptor blockers (ARBs) [6]
Regarding the distribution of air pollutants, the daily average concentrations of PM2.5, PM10 and SO2 were significantly higher in the ACEI cohort than in the ARB cohort (p < 0.05)

Summary

Introduction

Angiotensin-converting enzyme inhibitors (ACEIs) cause vasodilation by inhibiting the formation of angiotensin II and ACEIs comprise a critical class of antihypertensive medication indicated for heart failure, asymptomatic left ventricular dysfunction, proteinuria, diabetic nephropathy and postmyocardial infarction [1,2]. Safety concerns regarding the use of ACEIs have been raised, especially their cancer risk [3,4,5]. Hicks et al reported that the use of ACEIs is associated with a 1.14-fold higher risk of lung cancer compared with the use of angiotensin receptor blockers (ARBs) [6]. The latest meta-analysis conducted by Bahaj et al concluded that no significant association exists between ACEI use and the development of lung cancer [7]. Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged. Cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model

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