Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study

Hicks, Blánaid; Filion, Kristian B.; Yin, Hui; Sakr, Lama; Udell, Jacob A.; Azoulay, Laurent

doi:10.1136/bmj.k4209

Cited by 169 publications

(186 citation statements)

References 47 publications

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“…Similar to the findings of Hick et al, 6 our study revealed that ACEI users were at a 1.36-fold higher risk of lung cancer compared with ARB users. Further analysis revealed that ACEI users were at a 1.87-fold and 1.8-fold higher risks of lung cancer when the medication was used for > 45 days or the accumulated dosage of ACEI was > 540 mg, respectively.…”

Section: Discussionsupporting

confidence: 91%

“…Safety concerns regarding the use of ACEIs have been raised, especially their cancer risk [3][4][5]. Hicks et al reported that the use of ACEIs is associated with a 1.14-fold higher risk of lung cancer compared with the use of angiotensin receptor blockers (ARBs) [6]. However, the latest meta-analysis conducted by Bahaj et al concluded that no significant association exists between ACEI use and the development of lung cancer [7].…”

Section: Introductionmentioning

confidence: 99%

“…However, the latest meta-analysis conducted by Bahaj et al concluded that no significant association exists between ACEI use and the development of lung cancer [7]. Therefore, the association between ACEIs and lung cancer remains unclear [4,[6][7][8][9][10]. Possible reasons for the discrepancies among these studies might be the baseline bias of other comorbidities, insufficient follow-up, confounding effects of other antihypertensive medications and inadequate selection of the control cohort [4,6,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study

Lin

et al. 2020

Cancers

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Background: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex-and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. Results: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11-1.67). Duration-response and dose-response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48-2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43-2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). Conclusions: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study

Lin

et al. 2020

Cancers

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“…Its association with Alzheimer's disease and the worsening of prostate and breast cancers is still being investigated. Bradykinin and Substance P buildup in patients on ACE‐I/ARB for more than 5 years have recently been reported to be associated with lung cancer . With an equal or greater role for neprilysin in bradykinin metabolism than ACE, a faster substance P buildup in the lungs appears likely with a sacubitril/valsartan combination, since sacubitril also inhibits ACE .…”

Section: Arni (Secubitril/valsartan) Unsettled Safety and Cost‐effectmentioning

confidence: 99%

GDMT for heart failure and the clinician's conundrum

Samarendra

2019

Clinical Cardiology

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Therapeutic advances in management of CHF have decreased mortality and have impacted progression in patients with mild to moderate heart failure. Aggressive campaigns by cardiology societies aimed at increasing implementation of these measures in routine practices have almost generalized the treatment of heart failure irrespective of individual variations of clinical status of patients and stages of heart failure. This explains why morbidity compression and quality of life improvement have not been realized fully particularly in patients with advanced disease. To examine whether GDMT for CHF is backed by unambiguous evidence of clinical efficacy for its global implementation in every patient at all stages of the syndrome. ACC/AHA, ESC Guidelines for CHF, and their updates were reviewed. Clinical trial cited in the guideline documents and other pertaining published literatures were analyzed.FindingsMany of the recommended GDMT for CHF lack unequivocal evidence of clinical efficacy in patients with diverge etiology of heart failure and concomitant comorbid conditions Some of the recommendations which are useful in early stages, lack evidence of efficacy in more advanced stages of heart failure. Application of results of research trials in patients beyond their inclusion and exclusion criteria, appears mere extrapolation, Clinicians are faced with the conundrum of implementing the recommendations without indubitable evidence of their efficacy in every patient of their practice.ConclusionA reappraisal of Guidelines is needed to address outstanding questions pertaining to the efficacy of recommendations and plug the knowledge gaps without assumption and extrapolation of results of RCTs beyond their inclusion and exclusion criteria.

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“…In a linked paper , Hicks and colleagues (doi:10.1136/bmj.k4209) use registry data from the UK Clinical Practice Research Datalink (CPRD) to investigate the association of antihypertensive drugs with the risk of lung cancer 4. Their study population included 992 061 people, newly treated with antihypertensive drugs between 1995 and 2015, with follow-up until end of December 2016.…”

mentioning

confidence: 99%