Renin–angiotensin system blockade for the risk of cancer and death. (July 2016)

• Record Type: Journal Article
• Authors: Shen, Jian; Huang, Yan-Mei; Wang, Min; Hong, Xue-Zhi; Song, Xin-Nan; Zou, Xia; Pan, Yan-Hong; Ling, Wei; Zhu, Min-Hui; Zhang, Xiao-Xi; Sui, Yi; Zhao, Hai-Lu
• Is Part Of: Journal of the renin-angiotensin-aldosterone system. Volume 17:Number 3(2016:Sep.)
• Publication Date: 2016-07
• Subjects: Angiotensin-converting enzyme inhibitors -- angiotensin II receptor blockers -- renin–angiotensin system -- cancer -- angiotensin-receptor blocker; Renin-angiotensin system -- Periodicals; 616.132
• DOI: 10.1177/1470320316656679
• Languages: English
• ISSNs: 1470-3203

Abstract

Introduction: The effects of renin–angiotensin system blockade with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) on cancer remain inconsistent. Methods: We searched existing databases from 1960 to August 2015, for randomised controlled trials and observational studies (case–control studies and cohort studies) of ARB/ACEI therapy with a minimal one year of follow-up. Outcomes were incidence and mortality of cancer. Results: We included 14 randomised controlled trials and 17 observational studies of 3, 957, 725 participants (350, 329 ARB/ACEI users). The users had a lower incidence of cancer in the observational studies (RR 0.82, 95% CI 0.73–0.93) but not in the randomised controlled trials (RR 1.00, 95% CI 0.92–1.08). The protection persisted for lung cancer (RR 0.85, 95% CI 0.75–0.97) but not for other sites of cancer. The relative risk of cancer associated with renin–angiotensin system blockade was reduced along with time of follow-up. Mortality reduction with ARB/ACEI was marginally significant in the observational studies (RR 0.71, 95% CI 0.55–0.93) but not in the randomised controlled trials (RR 0.99, 95% CI 0.89–1.09). Conclusions: The significant benefits of renin–angiotensin system blockade observed in case–control studies and cohort studies might diminish in randomised controlled trials. Clinical design, site of cancer and duration of follow-up may affect the clinical outcomes.