Association between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Lung Cancer

Abstract

Objectives: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are the most commonly prescribed antihypertensives, with prior studies identifying a possible association between long-term use and increased rates of lung cancer. This study evaluated this potential association 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 United States. Pairwise propensity score matching was performed using demographics and comorbidities. All of the adult patients in the healthcare system from January 1, 2000 to April 30, 2018 with at least 1 year of follow-up were included.Results: In total, 3,253,811 patients with a median age of 59 (range 18-103) years were included. The ACEI group had a higher freedom from lung cancer versus controls at 15 years (98.47%, 95% confidence interval [CI] 98.41-98.54) versus 98.26%, (95% CI 98.20-98.33), whereas ARBs had similar rates versus controls at all time points. For patients diagnosed as having lung cancer, median all-cause survival was significantly higher in the ACEI (34.7 months, 95% CI 32.8-36.6) and ARB (30.9 months, 95% CI 28.1-33.8) groups than the control group (20.6 months,.Conclusions: This study showed lower rates of lung cancer with ACEI use and no difference in risk with ARBs. In addition, use of these medications was found to be associated with increased survival in those diagnosed as having lung cancer. This study supports the continued use of these medications without concern for increasing the risk of lung cancer.

Association between angiotensin-converting enzyme inhibitors and the risk of lung cancer: a systematic review and meta-analysis

“…Based on the search strategy, 2400 records from the databases were screened, of which 392 duplicated records and 1976 records did not meet the inclusion criteria and were excluded. Finally, 11 clinical studies [12][13][14][23][24][25][26][27][28][29][30], including seven cohort studies [12,14,23,[26][27][28]30] and four case-control studies [13,24,25,29], conducted between 1988 and 2020 were included in the meta-analysis (Fig. 1).…”

“…The 11 studies comprised 11 study groups and 13 control groups. Four groups were extracted from two cohort studies [26,27] according to the different controls. The meta-analysis comprised a total of 13,061,226 patients, including 1,493,225 patients in the ACEI group and 11,568,001 patients in the non-ACEI group.…”

“…The meta-analysis comprised a total of 13,061,226 patients, including 1,493,225 patients in the ACEI group and 11,568,001 patients in the non-ACEI group. These patients mainly resided in Asia [14,27,28], North America [23,26], and Europe [12,13,24,25,30]. Patient and study characteristics of the cohort and case-control studies are described in Table 1.…”

“…The ACEI group was still considered the study group in all subgroup analyses. Compared with the two control subgroups-one [12][13][14][23][24][25][26][27][28][29][30] comprising ARBs users (21,493 of 1,239,877 [1.73%] vs 51,226 of 8,657,649 [0.59%]; OR 1.18; 95% CI 1.03-1.35; P = 0.02; I 2 = 97%) and the other [26] comprising patients neither with ACEIs nor ARBs (2509 of 253,348 [0.99%] vs 21,536 of 2,910,352 [0.74%]; OR 1.34; 95% CI 1.29-1.40), the ACEI group had a higher risk of lung cancer (Fig. 3).…”

Association of Estimated Glomerular Filtration Rate with Risk of Head and Neck Cancer: A Nationwide Population-Based Study

“…In addition, treatment using angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) are typical in CKD patients [ 3 ]. These agents remain controversial for use against lung cancer, but several studies have indicated that they reduce the incidence of some types of cancer [ 21 , 22 ]. The effect of these agents on the incidence of HNC should be further studied.…”