ACE INHIBITORS LINKED TO HIGHER LUNG CANCER

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ACE Inhibitors Linked to Higher Lung Cancer Risk

The use of angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure was associated with an overall increased risk for lung cancer of 14% compared to hypertension therapy with angiotensin receptor blockers (ARBs), a large, population-based cohort study shows.


The widespread use of ACE inhibitors for the treatment of hypertension, this relatively modest association could result in large absolute numbers of patients at risk for lung cancer, the researchers warn.

An analysis of primary care records of almost one million patients in the United Kingdom showed that as treatment with ACE inhibitors continued, the risk for lung cancer increased. For patients who took ACE inhibitors for 5 years, the risk for lung cancer increased by 22% compared to those who took ARBs. The increased risk for lung cancer peaked at 31% for patients who took ACE inhibitors for 10 years or longer.
Secondary analyses showed that the use of ACE inhibitors for less than 5 years was not associated with an increased risk for lung cancer (hazard ratio [HR], 1.1). "This represents a novel finding that suggests a latent effect of the exposure on this cancer," said lead author Laurent Azoulay, PhD, of the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, Quebec, Canada.
"Given the potential impact of our findings, they need to be replicated in other settings, particularly among patients exposed for longer durations," the team comments.
"We believe that while physicians should be aware of this association, it would be premature at this stage to withhold this treatment in patients for whom there are known benefits," Azoulay told Medscape Medical News.
"Certainly, additional studies are needed to corroborate our findings. These need to have sufficient follow-up, given the long-term effect observed in our study," he added.
In an accompanying editorial, Deirdre Cronin Fenton, PhD, associate professor in the Department of Clinical Epidemiology at Aarhus University, Denmark, agreed that long-term studies are needed to verify the safety of ACE inhibitors.
These drugs target the renin-angiotensin-aldosterone system, which may play a role in cancer development, she pointed out.
Like Azoulay, Fenton cautions against withholding ACE inhibitors from patients, noting that both ACE inhibitors and ARBs are indicated for the treatment of hypertension, heart disease, renal insufficiency, and chronic kidney disease.
"[I]n an individual patient, concerns about the long term risk of lung cancer should be balanced against gains in life expectancy associated with use of ACEIs," she writes.
Fenton also cautions that, despite the study's rigorous analytic approach, the findings may be limited by residual confounding. She notes that generic ACE inhibitors were available in 1995 but that generic ARBs did not enter the market until 2010. Socioeconomic changes during this period could have influenced prescribing patterns, and environmental exposures to radon or asbestos may have had an impact on lung cancer risk, she notes.

this article has been taken from Medscape.com

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