Long-Term Use of Angiotensin Receptor Blockers and the Risk of Cancer

<div><p>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.</p> </div

Prevalence of Co-existing Autoimmune Disease in Rheumatoid Arthritis: A Cross-Sectional Study

<p><strong>Article full text</strong></p> <p><br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s12325-017-0627-3"><b>here</b>.</a><br> <br> <strong>Provide enhanced digital features for this article</strong><br> If you are an author of this publication and would like to provide additional enhanced digital features for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:<br> • Slide decks<br> • Videos and animations<br> • Audio abstracts<br> • Audio slides<u></u></p

Crude and adjusted rate ratios of lung, colorectal, prostate and breast cancer associated with antihypertensive agents relative to diuretic and/or beta-blocker use.

<p>Abbreviations: RR, rate ratio; CI, confidence interval; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; CCB, calcium channel blocker.</p>*<p>Cases and controls were matched on year of birth, year of cohort entry, sex, prevalent user status, and duration of follow-up.</p>†<p>All models were adjusted for excessive alcohol use, body mass index, smoking, diabetes, previous cancer, and ever of aspirin, statins, and NSAIDs. In addition, cholecystectomy, inflammatory bowel disease and history of polyps for colorectal cancer; benign prostatic hyperplasia, 5-alpha reductase inhibitors, and number of PSA tests for prostate cancer; oophorectomy, use of hormone replacement therapy, and prior use of oral contraceptives for breast cancer.</p>‡<p>Defined prescriptions of both agents overlapping each other for at least one day.</p

Crude and adjusted rate ratios of cancer associated with antihypertensive agents relative to diuretic and/or beta-blocker use.

<p>Abbreviations: RR, rate ratio; CI, confidence interval; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; CCB, calcium channel blocker; DDD, defined daily doses.</p>*<p>Cases and controls were matched on year of birth, year of cohort entry, sex, prevalent user status, and duration of follow-up.</p>†<p>Adjusted for excessive alcohol use, body mass index, smoking, diabetes, previous cancer, and ever of aspirin, statins, and NSAIDs.</p>‡<p>Defined as receiving prescriptions for both agents on the same day on at least one occasion.</p>§<p>Dose-response analyses conducted among the 5583 cases and 56,817 controls exposed to ARBs. Categories based on tertiles.</p

Adjusted rate ratios of specific cancers associated with use of angiotensin receptor blockers relative to the use of diuretics or beta-blockers.

<p>Adjusted rate ratios of specific cancers associated with use of angiotensin receptor blockers relative to the use of diuretics or beta-blockers.</p

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.

<p>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.</p