ACE inhibitors and lung cancer: a link?

A British observational study found that people taking ACE inhibitors have an increased risk of lung cancer by 6%. However, this study is an observational study that can only show badociations, but does not prove that there is a real cause-and-effect relationship. For this, a prospective randomized study would be needed, in which any "disruptive influences" would be excluded in advance. Because lung cancer is a multifactorial disease, its development can be promoted by several factors. In addition to the genetic disposition, risk factors are primarily smoking, but also pollutants in the air or stress, for example, at work, with carcinogenic substances (asbestos, arsenic, chromium, nickel). Obesity and alcohol consumption can also increase the risk of developing certain cancers. In the end, age is also a risk factor for cancer and even (yet) lung cancer by bad: according to the Robert Koch Institute [2] In 2012, 34,490 men contracted lung cancer, but only 18,030 women.

Looking at the patient data from this study, it is recognized that the distribution of risk in the groups was not uniform. For example, in the group treated with ACE inhibitors, there were more obese people (32.3% vs. 19.9%), more people with alcohol problems (8, 7% vs. 6.8%) and fewer people who have never smoked (47.9% and 49.1%). In addition, the group of study participants who received ACE inhibitors was older and the average age was 57.8 years (vs. 54.9 years). Also in this group, 63.9% were men, in the group of untreated study participants, only 41.2%. These differences may have influenced the study results and the higher risk of lung cancer in patients treated with ACE inhibitors. In addition, the typical adverse effect of ACE inhibitors may have been badociated with coughing for earlier detection of lung cancer.

"The probative value of this study is therefore rather weak and the authors of the study themselves have called for more in-depth investigations," explains Prof. Dr. med. Bernhard Krämer, President of the German high pressure league e.V. DHL® | German Society for Hypertension and Prevention. "We hope the result will not cause cancer patients to stop their treatment for high blood pressure without consulting their family doctor." The reduction in mortality of ACE inhibitors is significant Reason for cardiovascular disease and overall mortality.

Simply omitting medications for high blood pressure can have serious consequences; untreated, high blood pressure can lead to strokes, heart attacks, kidney failure or dementia – and often well before the development of any cancer. "Patients who are unsafe must therefore talk to their family doctor and discuss the individual risk.If necessary, for example, if the patient has an increased family risk of lung cancer or is smoking a lot, the doctor may consider prescribing another antihypertensive treatment.In all cases, the treatment of hypertension must be continued, "says the expert.

[1] Hicks BM, KB Filion, Yin H. et al. Angiotensin converting enzyme inhibitors and lung cancer risk: population-based cohort study. BMJ. October 24, 2018; 363: k4209. The full publication is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199558.

[2] https://www.rki.de/DE/Content/Service/Presse/Pressemitteilungen/2015/11_2015.html

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