Shih-Yi Lin1,2, Cheng-Li Lin3,4, Cheng-Chieh Lin1,5, Wu-Huei Hsu1,6, Chia-Der Lin1,7, I-Kuan Wang1,2, Chung-Y Hsu1, Chia-Hung Kao1,8,9,10. 1. Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40447, Taiwan. 2. Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan. 3. Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan. 4. College of Medicine, China Medical University, Taichung 40447, Taiwan. 5. Department of Family Medicine, China Medical University Hospital, Taichung 40447, Taiwan. 6. Department of Chest Medicine, China Medical University Hospital, Taichung 40447, Taiwan. 7. Department of Otolaryngology, China Medical University Hospital, Taichung 40447, Taiwan. 8. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 40447, Taiwan. 9. Department of Bioinformatics and Medical Engineering, Asia University, Taichung 40447, Taiwan. 10. Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 40447, Taiwan.
Abstract
BACKGROUND: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. METHODS: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. RESULTS: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11-1.67). Duration-response and dose-response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48-2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43--2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). CONCLUSIONS: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
BACKGROUND: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. METHODS: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. RESULTS: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11-1.67). Duration-response and dose-response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48-2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43--2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). CONCLUSIONS:ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
Entities:
Keywords:
air pollutant; angiotensin-converting enzyme inhibitors (ACEIs); lung cancer
Authors: James Yarmolinsky; Virginia Díez-Obrero; Tom G Richardson; Marie Pigeyre; Jennifer Sjaarda; Guillaume Paré; Venexia M Walker; Emma E Vincent; Vanessa Y Tan; Mireia Obón-Santacana; Demetrius Albanes; Jochen Hampe; Andrea Gsur; Heather Hampel; Rish K Pai; Mark Jenkins; Steven Gallinger; Graham Casey; Wei Zheng; Christopher I Amos; George Davey Smith; Richard M Martin; Victor Moreno Journal: PLoS Med Date: 2022-02-03 Impact factor: 11.069