The Association between Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Lung Cancer in a Population of Over 3 Million Patients

Abstract

Background: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are the most commonly prescribed anti-hypertensives with prior studies identifying a possible association between long-term use and increased rates of lung cancer. This study evaluated the potential association between the use of ACEIs and/or ARBs and the development of lung cancer in a large population using propensity matching. Methods: This was a population-based cohort study in a large healthcare system in three regions of the US. All adult patients who entered the Mayo Clinic health system from January 1, 2000 to April 30, 2018 with at least one year of follow-up were included. Pairwise propensity score matching was performed using demographics and comorbidities. Findings: 3,253,811 patients with median age of 59 (range 18-103) years old were included. The ACEI group had a higher freedom from lung cancer versus controls at 5, 10, and 15 years [15 year: 98.47% (CI95: 98.41%-98.54%) vs. 98.26% (CI95: 98.20%-98.33%)] while ARB had similar rates versus controls at all time points. For patients diagnosed with lung cancer, median all-cause survival was significantly higher in the ACEI [34.7 months (CI 95: 32.8-36.6)] and ARB (30.9 months (CI95: 28.1-33.8)] groups than the control group (20.6 months (CI95: 20.1-21.1). Interpretation: This is the largest analysis of lung cancer risk with ACEI and ARBs using patient data from three regions of the United States. This study demonstrates a decreased risk of lung cancer with ACEI use, no difference in risk with ARBs, and no difference in the lung cancer subtypes with ACEI or ARB usage versus controls using propensity score matching. Additionally, ACEI and ARB use was found to be associated with increased survival in those diagnosed with lung cancer. This study supports the continued use of ACEIs without concern for increasing the risk of lung cancer. Funding Statement: Grant Number UL1 TR000135 from the NIH Clinical and Translational Award for the search engine and not awarded to any authors. Declaration of Interests: All authors (SH, MW, RB, YD, AL, CB, ZL, PJ, and NP) report no conflict of interest. Ethics Approval Statement: The Mayo Clinic Institutional Review Board approved this study