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. 2012;7(12):e50893.
doi: 10.1371/journal.pone.0050893. Epub 2012 Dec 12.

Long-term use of angiotensin receptor blockers and the risk of cancer

Laurent Azoulay  1 , Themistocles L Assimes, Hui Yin, Dorothee B Bartels, Ernesto L Schiffrin, Samy Suissa
Affiliations

Long-term use of angiotensin receptor blockers and the risk of cancer

Laurent Azoulay et al. PLoS One. 2012.

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.

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Conflict of interest statement

Competing Interests: We have the following interests. This study was partly funded by Boehringer-Ingelheim. Dorothee Bartels is an employee of Boehringer-Ingelheim. Ernesto Schiffrin served as a consultant for Takeda and Daiichi-Sankyo, and served on advisory boards for Takeda. Samy Suissa spoke at symposia organized by Boehringer-Ingelheim (in the field of COPD, not hypertension). There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study flow chart.
Figure 2
Figure 2. Adjusted rate ratios of specific cancers associated with use of angiotensin receptor blockers relative to the use of diuretics or beta-blockers.
Figure 3
Figure 3. Adjusted rate ratios of specific cancers associated with use of angiotensin receptor blockers in combination with angiotensin-converting enzyme inhibitors relative to the use of diuretics or beta-blockers.
See this image and copyright information in PMC

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