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BMJ. 2018 Oct 24;363:k4209. doi: 10.1136/bmj.k4209.

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

Hicks BM1,2,3, Filion KB1,2,4, Yin H1, Sakr L5, Udell JA6,7, Azoulay L8,2,9.

Author information

1
Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada, H3T 1E2.
2
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
3
Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
4
Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada.
5
Division of Pulmonary Diseases, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada.
6
Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
7
Cardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
8
Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada, H3T 1E2 laurent.azoulay@mcgill.ca.
9
Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.

Abstract

OBJECTIVE:

To determine whether the use of angiotensin converting enzyme inhibitors (ACEIs), compared with use of angiotensin receptor blockers, is associated with an increased risk of lung cancer.

DESIGN:

Population based cohort study.

SETTING:

United Kingdom Clinical Practice Research Datalink.

PARTICIPANTS:

A cohort of 992‚ÄČ061 patients newly treated with antihypertensive drugs between 1 January 1995 and 31 December 2015 was identified and followed until 31 December 2016.

MAIN OUTCOME MEASURES:

Cox proportional hazards models were used to estimate adjusted hazard ratios with 95% confidence intervals of incident lung cancer associated with the time varying use of ACEIs, compared with use of angiotensin receptor blockers, overall, by cumulative duration of use, and by time since initiation.

RESULTS:

The cohort was followed for a mean of 6.4 (SD 4.7) years, generating 7952 incident lung cancer events (crude incidence 1.3 (95% confidence interval 1.2 to 1.3) per 1000 person years). Overall, use of ACEIs was associated with an increased risk of lung cancer (incidence rate 1.6 v 1.2 per 1000 person years; hazard ratio 1.14, 95% confidence interval 1.01 to 1.29), compared with use of angiotensin receptor blockers. Hazard ratios gradually increased with longer durations of use, with an association evident after five years of use (hazard ratio 1.22, 1.06 to 1.40) and peaking after more than 10 years of use (1.31, 1.08 to 1.59). Similar findings were observed with time since initiation.

CONCLUSIONS:

In this population based cohort study, the use of ACEIs was associated with an increased risk of lung cancer. The association was particularly elevated among people using ACEIs for more than five years. Additional studies, with long term follow-up, are needed to investigate the effects of these drugs on incidence of lung cancer.

PMID:
30355745
PMCID:
PMC6199558

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this study was funded by the Canadian Institutes of Health Research; JAU has participated in research projects funded by AstraZeneca, Janssen, Novartis, and Sanofi and received personal consultancy fees and honorariums for symposia from Amgen, AstraZeneca, Boehringer-Ingelheim, Janssen, Merck, Novartis, and Sanofi; these have no relation to the work presented in this manuscript; no other relationships or activities that could appear to have influenced the submitted work.

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