Comparison Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Incidence of Lung Cancer: A Retrospective Study

Abstract

Introduction: Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blockers (ARBs) are taken as the first treatment option for hypertensive patients. The various global trials have suggested that ACEIs and ARBs may increase risk of lung cancer; however, the results are contradictory and there is no local study available. This study is conducted to compare the incidence of lung cancers in patients on ACEIs and ARBs.Methods: This retrospective study, conducted in a major cardiology unit of a tertiary care hospital in Pakistan, included patients diagnosed with hypertension, between 2005 and 2010, who were prescribed either ACEIs or ARBs. During the period of 2005 to 2010, 47,823 naïve hypertensive patients were reported in the outpatient department of the cardiology unit. Of which, 22,241 were prescribed ACEI and 25,582 were prescribed ARBs. After sorting patient data based on our inclusion criteria, n = 14,891 participants were included in the ACEI group and n = 19,112 participants were included in the ARB group.Results: The incidence of lung cancer in the ACEI and ARB group was n = 165 and n = 160, respectively. In this study, the overall incidence rates of lung cancer in the ACEI and ARB cohorts were 12.2 and 16.6 per 10,000 person-years, respectively. The hazard ratio was 1.32 (95% confidence interval: 1.06-1.64; p-value: 0.01). Conclusion:In this study, the incidence of lung cancer was relatively more among people using ACEIs than ARBs. Hence, patients undergoing long-term treatment with ACEIs need regular follow-up and proper scanning to avoid grave complications.

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 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).…”

Chemopreventive Effects of Concomitant or Individual Use of Statins, Aspirin, Metformin, and Angiotensin Drugs: A Study Using Claims Data of 23 Million Individuals

“…Additionally, ACEIs/ARBs have shown their association with a decreased risk of lung cancer in previous studies [ 53 , 54 ]. Research articles have further indicated a lower incidence of lung cancer in ARB users than in their ACEI counterparts [ 55 , 56 ]. It has, however, been revealed that high cumulative doses of ACEIs/ARBs are associated with an elevated risk of lung cancer [ 57 ].…”

Cardio-Oncology: A Myriad of Relationships Between Cardiovascular Disease and Cancer

“…Moreover, they found that the higher the dose and longer the duration of ACEI use, the higher the incidence of lung cancer. Kumar et al ( 94 ) and Hsu et al ( 95 ) subsequent studies support this view. There are different conclusions, a 2021 study by Lee et al ( 96 ) concluded that there was no significant difference in the effect of ACEI and ARB on lung cancer.…”