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Based on results of an observational study published earlier this week in The BMJAngiotensin-converting-enzyme (ACE) inhibitors were badociated with an increased risk of lung cancer, compared with a similar, but distinct type of blood pressure medication known as angiotensin-receptor blockers (ARBs).
Lisinopril, molecular model. Drug of the angiotensin-converting enzyme (ACE) inhibitor clbad used to treat hypertension, congestive heart failure and heart attacks. Atoms are represented as spheres and are color-coded: carbon (gray), hydrogen (white), nitrogen (blue) and oxygen (red). (Courtesy of Getty Images)
Researchers evaluated patients from a U.K. primary care database and identified over 900,000 adults who had been treated with cancer since 1995.
Over 335,000 patients were treated with ACE inhibitors, 29,000 with ARBs, and 101,000 with both an ACE and ARB inhibitor. Ramipril (26%) was the most common ACE noted in the study, along with lisinopril (12%) and perindopril (7%).
Over a period of 6 years, this cancer was diagnosed in 0.8% (7,952) of this 900,000-person cohort. After ACE inhibitor use, ACE inhibitor was badociated with a 14% greater risk for lung cancer relative to ARB use (1.6 vs. 1.2 per 1000 person-years). In a secondary badysis, an ACE inhibitor for less than 5 years was not badociated with an elevated risk for lung cancer.
However, the study noted that ACE inhibitor for 5 years , but increased with greater than 10 years of use (31% increased risk).
In their study, researchers explained that use of ACE inhibitors results in the accumulation of bradykinin in the lungs , which has been reported to increase growth of lung cancer. ACE inhibitor can also result in elevated levels of a substance known as P substance, produced in lung cancer cells and related to growth of the tumor and its badociated blood vessels.
In light of such data, it is important to understand that this is an observational study – a double blind placebo controlled study – making the absolute risk to low patients. Objective data indicates that ACE inhibitors account for nearly a third of all blood pressure medications prescribed in the UK, making the results a potential concern for a large number of patients.
While ACE inhibitors have been highly effective in the treatment of long-term hypertension, they have been investigated for the purpose of long-term lung cancer.
In addition, the risk of cancer is high, with no clear consensus to date, and meta-badyzes of high risk cancer. small size and length of follow-up (median of 3.5 years)
Important limitations of the study should be included in the discussion of socioeconomic status, diet, exposure to asbestos or radon, as well as in patients with cancer. The authors also did not have detailed information on the number of pack-years of smoking, an important risk factor for the incidence of lung cancer.
That said, There is biochemical evidence demonstrating a possible badociation between ACE inhibitor and risk of lung cancer with elevated levels of bradykinin and substance that could facilitate growth of lung cancer.
Certainly in any patient at risk for lung cancer, the benefits badociated with taking ACE inhibitor to reduce blood pressure and cardiac risk.
This view is made by the expert who is concerned about the risks badociated with ACE inhibitors.
"This high quality study shows that ACE inhibitors are at risk for lung cancer," said Klaus Lessnau, MD, a pulmonary and critical care specialist at Lenox Hill Hospital in New York City.
"The most important factor remains smoking, but implies that ACE inhibitors should be contraindicated in smokers and ex-smokers," "One wonders if they should be continued." nonsmokers, "he added.
As a result, this study is important to highlight patients with long-term risk of ACE inhibitors and the risk of cancer. of this study.
Again, it is important to emphasize that this is an observational study and the overall risk to patients is relatively low. Patients should have a discussion with their health care provider about the risks and benefits of an ACE inhibitor. One option might be to switch to an ARB if there is ongoing concern, since there has been no increased risk of lung cancer with this clbad of antihypertensives. ARBs may, in fact, reduce risk of lung cancer with a protective effect, based on recent studies.
In an accompanying editorial in BMJDr. Deirdre Cronin-Fenton, Associate Professor, Department of Clinical Epidemiology, Aarhus University in Denmark, but recommends the need for ongoing and further studies to validate the findings of this prospective observational cohort study.
Cronin-Fenton writes that the study "highlights the value of registry data and a 'big data' approach to evaluating long-term outcomes, which may be challenging to investigate in clinical trials. to a large absolute risk, ACEIs worldwide. "
Continuous Cronin-Fenton: "Nonetheless, in an individual patient, concerns about the long term risk of lung cancer should be balanced against gains in life expectancy badociated with use of ACEIs. [the authors] point out, further studies with long term follow-up are now needed to enhance the scientific evidence on the long term safety of these drugs. "
ACE inhibitors have been beneficial in controlling blood pressure in the clinical setting. While this study focuses on a biochemical mechanism, the data is still in the process of being determined in a more detailed manner. blood pressure.
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Based on results of an observational study published earlier this week in The BMJAngiotensin-converting-enzyme (ACE) inhibitors were badociated with an increased risk of lung cancer, compared with a similar, but distinct type of blood pressure medication known as angiotensin-receptor blockers (ARBs).
Lisinopril, molecular model. Drug of the angiotensin-converting enzyme (ACE) inhibitor clbad used to treat hypertension, congestive heart failure and heart attacks. Atoms are represented as spheres and are color-coded: carbon (gray), hydrogen (white), nitrogen (blue) and oxygen (red). (Courtesy of Getty Images)
Researchers evaluated patients from a U.K. primary care database and identified over 900,000 adults who had been treated with cancer since 1995.
Over 335,000 patients were treated with ACE inhibitors, 29,000 with ARBs, and 101,000 with both an ACE and ARB inhibitor. Ramipril (26%) was the most common ACE noted in the study, along with lisinopril (12%) and perindopril (7%).
Over a period of 6 years, this cancer was diagnosed in 0.8% (7,952) of this 900,000-person cohort. After ACE inhibitor use, ACE inhibitor was badociated with a 14% greater risk for lung cancer relative to ARB use (1.6 vs. 1.2 per 1000 person-years). In a secondary badysis, an ACE inhibitor for less than 5 years was not badociated with an elevated risk for lung cancer.
However, the study noted that ACE inhibitor for 5 years , but increased with greater than 10 years of use (31% increased risk).
In their study, researchers explained that use of ACE inhibitors results in the accumulation of bradykinin in the lungs , which has been reported to increase growth of lung cancer. ACE inhibitor can also result in elevated levels of a substance known as P substance, produced in lung cancer cells and related to growth of the tumor and its badociated blood vessels.
In light of such data, it is important to understand that this is an observational study – a double blind placebo controlled study – making the absolute risk to low patients. Objective data indicates that ACE inhibitors account for nearly a third of all blood pressure medications prescribed in the UK, making the results a potential concern for a large number of patients.
While ACE inhibitors have been highly effective in the treatment of long-term hypertension, they have been investigated for the purpose of long-term lung cancer.
In addition, the risk of cancer is high, with no clear consensus to date, and meta-badyzes of high risk cancer. small size and length of follow-up (median of 3.5 years)
Important limitations of the study should be included in the discussion of socioeconomic status, diet, exposure to asbestos or radon, as well as in patients with cancer. The authors also did not have detailed information on the number of pack-years of smoking, an important risk factor for the incidence of lung cancer.
That said, There is biochemical evidence demonstrating a possible badociation between ACE inhibitor and risk of lung cancer with elevated levels of bradykinin and substance that could facilitate growth of lung cancer.
Certainly in any patient at risk for lung cancer, the benefits badociated with taking ACE inhibitor to reduce blood pressure and cardiac risk.
This view is made by the expert who is concerned about the risks badociated with ACE inhibitors.
"This high quality study shows that ACE inhibitors are at risk for lung cancer," said Klaus Lessnau, MD, a pulmonary and critical care specialist at Lenox Hill Hospital in New York City.
"The most important factor remains smoking, but implies that ACE inhibitors should be contraindicated in smokers and ex-smokers," "One wonders if they should be continued." nonsmokers, "he added.
As a result, this study is important to highlight patients with long-term risk of ACE inhibitors and the risk of cancer. of this study.
Again, it is important to emphasize that this is an observational study and the overall risk to patients is relatively low. Patients should have a discussion with their health care provider about the risks and benefits of an ACE inhibitor. One option might be to switch to an ARB if there is ongoing concern, since there has been no increased risk of lung cancer with this clbad of antihypertensives. ARBs may, in fact, reduce risk of lung cancer with a protective effect, based on recent studies.
In an accompanying editorial in BMJDr. Deirdre Cronin-Fenton, Associate Professor, Department of Clinical Epidemiology, Aarhus University in Denmark, but recommends the need for ongoing and further studies to validate the findings of this prospective observational cohort study.
Cronin-Fenton writes that the study "highlights the value of registry data and a 'big data' approach to evaluating long-term outcomes, which may be challenging to investigate in clinical trials. to a large absolute risk, ACEIs worldwide. "
Continuous Cronin-Fenton: "Nonetheless, in an individual patient, concerns about the long term risk of lung cancer should be balanced against gains in life expectancy badociated with use of ACEIs. [the authors] point out, further studies with long term follow-up are now needed to enhance the scientific evidence on the long term safety of these drugs. "
ACE inhibitors have been beneficial in controlling blood pressure in the clinical setting. While this study focuses on a biochemical mechanism, the data is still in the process of being determined in a more detailed manner. blood pressure.
