Long-term use of angiotensin-converting enzyme inhibitors (ACEIs) may increase the risk of lung cancer, according to a study published in the BMJ.
To investigate the association between this commonly used antihypertensive class and lung cancer, researchers conducted a population based cohort study involving 992,061 patients from the United Kingdom Clinical Practice Research Datalink. Between January 1 1995 and December 31 2015, they identified patients newly treated with an antihypertensive medication and followed them until December 31 2016. “Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) with 95% confidence intervals (CI) of incident lung cancer associated with the time varying use of ACEIs, compared with use of angiotensin receptor blockers (ARBs), overall, by cumulative duration of use, and by time since initiation,” the authors explained.
The study cohort was followed for a mean of 6.4 years; during this time, 335,135 patients were treated with ACEIs, with the 3 most commonly prescribed drugs being ramipril, lisinopril, and perindopril. During 6,350,584 person years of follow-up, 7952 patients were newly diagnosed with lung cancer (crude incidence rate: 1.3 per 1000 person years). Data showed that compared with ARBs, the use of ACEIs was associated with a 14% increased risk of lung cancer (incidence rate: 1.6 vs 1.2 per 1000 person years; HR 1.14, 95% CI, 1.01 to 1.29). While the use of ACEIs for <5 years was not associated with increased risk, hazard ratios increased with longer duration of ACEI use (5-10 years: HR 1.22; >10 years: HR 1.31).
“The magnitudes of the observed estimates are modest, but these small relative effects could translate into large absolute numbers of patients at risk, so these findings should be replicated in other settings,” the authors concluded.
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