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Meta-Analysis
. 2020 Jul-Sep;21(3):1470320319895646.
doi: 10.1177/1470320319895646.

Renin-angiotensin system inhibitor use and colorectal cancer risk and mortality: A dose-response meta analysis

Xia Chen  1 , Chang-Hong Yi  2 , Kuang-Guan Ya  3
Affiliations
Meta-Analysis

Renin-angiotensin system inhibitor use and colorectal cancer risk and mortality: A dose-response meta analysis

Xia Chen et al. J Renin Angiotensin Aldosterone Syst. 2020 Jul-Sep.

Abstract

Objective: This study was undertaken to determine whether use of the renin-angiotensin system (RAS) inhibitors would increase colorectal cancer morbidity and mortality.

Methods: Databases were electronically searched to collect data of RAS use and colorectal cancer morbidity and mortality from inception to October 2018. Stata 12.0 software was used to perform a meta-analysis.

Results: A total of 16 publications involving 2,847,597 participants were included. RAS inhibitor use was related to colorectal cancer risk (relative risk (RR): 0.86; 95% confidence interval (CI): 0.78-0.93) and mortality (RR: 0.80; 95% CI: 0.66-0.98) decrement. Subgroup analysis showed angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) (RR: 0.82; 95% CI: 0.69-0.96) or ARB (RR: 0.86; 95% CI: 0.73-0.98) or ACEI (RR: 0.81; 95% CI: 0.70-0.92) were related to colorectal cancer risk decrement. Furthermore, RAS inhibitor use was related to colorectal cancer risk decrement in Caucasians (RR: 0.88; 95% CI: 0.80-0.96) and Asians (RR: 0.72; 95% CI: 0.61-0.85). Additionally, dose-response showed that per one year duration of RAS inhibitor use incremental increase was related to 6% colorectal cancer risk decrement (RR: 0.94; 95% CI: 0.90-0.97).

Conclusion: According to the evidence, RAS inhibitor use was associated with colorectal cancer risk and mortality decrement.

Keywords: Colorectal cancer; dose–response relationship; meta analysis; renin–angiotensin system inhibitors.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the study selection process.
Figure 2.
Figure 2.
Forest plot showing the pooled effects of renin–angiotensin system use on the risk of colorectal cancer. Solid diamonds and horizontal lines represent RRs (95% CIs) for the outcome of interest. Solid circles and horizontal lines represent RRs (95% CIs); the gray boxes reflect the statistical weight of the study. The dotted vertical line denotes the point estimate for the pooled RRs and the solid vertical line indicates the line of no effect. The open diamond represents the pooled RR with its 95% CI. RR: relative risk; CI: confidence interval; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker.
Figure 3.
Figure 3.
Forest plot showing the pooled effects of renin–angiotensin system use on colorectal cancer mortality. Solid diamonds and horizontal lines represent RRs (95% CIs) for the outcome of interest. Solid circles and horizontal lines represent RRs (95% CIs); the gray boxes reflect the statistical weight of the study. The dotted vertical line denotes the point estimate for the pooled RRs and the solid vertical line indicates the line of no effect. The open diamond represents the pooled RR with its 95% CI. RR: relative risk; CI: confidence interval; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker.
Figure 4.
Figure 4.
Dose–response analysis between renin–angiotensin system use and colorectal cancer risk. The solid line represents point estimates of the association of antidepressant use and colorectal cancer risk with the use of a restricted cubic splines model, and the dashed lines indicate 95% confidence intervals; lbwithref: predicted lowest rr values; ubwithref: predicted highest rr values; rrwithref: predicted rr values; rr_lin: best fitting values of rr.
Figure 5.
Figure 5.
A funnel plot for the meta-analysis between renin–angiotensin system use and colorectal cancer risk. SE: standard error; a: log(rr).
Figure 6.
Figure 6.
The association between renin–angiotensin system inhibitor use and colorectal cancer risk based on the type of study (a), the year of publication (b), different drugs (c) and the number of participants (d), using meta regression. SMD: standardized mean difference.
See this image and copyright information in PMC

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