Long-Term Use of Angiotensin Receptor Blockers and the Risk of Cancer

Abstract

The association between angiotensin receptor blockers (ARBs) and cancer is controversial with meta-analyses of randomized controlled trials and observational studies reporting conflicting results. Thus, the objective of this study was to determine whether ARBs are associated with an overall increased risk of the four most common cancers, namely, lung, colorectal, breast and prostate cancers, and to explore these effects separately for each cancer type. We conducted a retrospective cohort study using a nested case-control analysis within the United Kingdom (UK) General Practice Research Database. We assembled a cohort of patients prescribed antihypertensive agents between 1995, the year the first ARB (losartan) entered the UK market, and 2008, with follow-up until December 31, 2010. Cases were patients newly-diagnosed with lung, colorectal, breast and prostate cancer during follow-up. We used conditional logistic regression to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of cancer incidence, comparing ever use of ARBs with ever use of diuretics and/or beta-blockers. The cohort included 1,165,781 patients, during which 41,059 patients were diagnosed with one of the cancers under study (rate 554/100,000 person-years). When compared to diuretics and/or beta-blockers, ever use of ARBs was not associated with an increased rate of cancer overall (RR: 1.00; 95% CI: 0.96–1.03) or with each cancer site separately. The use of angiotensin-converting enzyme inhibitors and calcium channel blockers was associated with an increased rate of lung cancer (RR: 1.13; 95% CI: 1.06–1.20 and RR: 1.19; 95% CI: 1.12–1.27, respectively). This study provides additional evidence that the use of ARBs does not increase the risk of cancer overall or any of the four major cancer sites. Additional research is needed to further investigate a potentially increased risk of lung cancer with angiotensin-converting enzyme inhibitors and calcium channel blockers.

Relationship between drugs affecting the renin-angiotensin system and colorectal cancer: The MCC-Spain study

“…ARBs is associated with a decrease in the risk of CRC development [6,7,9], as well as in advanced adenomatous colon polyps [8] or advanced neoplasia. In addition, a recently published meta-analysis of observational studies [10] also found a protective effect of the combination of ACEis or ARBs against CRC.…”

“…Nowadays, the role of aspirin therapy in the reduction of colorectal cancer risk and precancerous adenomas [3,4] is well known and there is increasing evidence of the chemopreventive effect of many others drugs used for cardiovascular diseases such as statins [5] and renin-angiotensin system (RAS) inhibitors [6]. In addition, recent observational studies and one meta-analysis have shown a protective effect of RAS therapy against CRC [7][8][9][10]. Despite these encouraging findings, other studies have yielded conflicting results [11][12][13], calling for additional studies before recommending the clinical use of RAS inhibitors for CRC chemoprevention.…”

Angiotensin receptor blockers use and the risk of lung cancer: A meta-analysis

“…However, other studies could not confirm this result. [5][6][7][8][9][10][11][12] Thus, the result is still controversial. We performed this meta-analysis to assess the relationship between ARB and LC risk.…”

Oncology-related issues of angiotensin-receptor blockers

“…A vizsgálat szerint a rendszeres ACE-gátló/ARB használat nem hogy nem fokozza a daganatképződés kockázatát, hanem egyenesen protektív ÖSSZEFOGLALÓ KÖZLEMÉNY hatású ebben a vonatkozásban. Angliai háziorvosok adatbázisának feldolgozásával vizsgálták a négy leggyakoribb daganat (tüdő, vastagbél/végbél, prosztata, emlő) kialakulása és az ARB-kezelés közötti összefüggést [45]. Az ARB-terápia hatását a diuretikumokhoz és béta-blokkolókhoz viszonyították.…”

“…Egyrészt számos vizsgálat együtt analizálja az ACE-gátló/ARB terápiákat, jóllehet, a kettő hatásmechanizmusa eltér egymástól. Az angol háziorvo-sok már idézett adatai szerint például az ARB-k nem befolyásolták a tumorképződés kockázatát, az ACE-gátlók és kalciumantagonisták viszont fokozták azt [45]. A vizsgálatok kimenetelének eltérő jelentése hibaforrás lehet az összevont analízisek során, ráadásul nem minden adat nyilvánosan elérhető, ami az ismételt analízishez szük-séges lenne, így ez is felelős lehet az ellentmondásokért.…”