在纳入 138769 人的 15 项试验中，替米沙坦、厄贝沙坦、缬沙坦、坎地沙坦和氯沙坦对癌症的影响。
Effects of telmisartan, irbesartan, valsartan, candesartan, and losartan on cancers in 15 trials enrolling 138,769 individuals.
出版信息
J Hypertens. 2011 Apr;29(4):623-35. doi: 10.1097/HJH.0b013e328344a7de.
BACKGROUND
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) reduce cardiovascular disease (CVD) events, but a recent meta-analysis of selected studies suggested that ARBs may increase cancer risks.
OBJECTIVE
Candesartan, irbesartan, telmisartan, valsartan, and losartan were assessed for incident cancers in 15 large parallel long-term multicenter double-blind clinical trials of these agents involving 138,769 participants.
PATIENTS AND METHODS
Individuals at high CVD risk were randomized to telmisartan (three trials, n=51,878), irbesartan (three trials, n=14,859), valsartan (four trials, n=44,264), candesartan (four trials, n=18,566), and losartan (one trial, n=9193) and followed for 23-60 months. Incident cancer cases were compared in patients randomized to ARBs versus controls. In five trials (n=42,403), the ARBs were compared to ACEi and in 11 trials (n=63,313) to controls without ACEi. In addition, in seven trials (n=47,020), the effect of ARBs with ACEi was compared to ACEi alone and in two trials ARBs with ACEi versus ARB alone (n=25,712).
RESULTS
Overall, there was no excess of cancer incidence with ARB therapy compared to controls in the 15 trials [4549 (6.16%) cases of 73,808 allocated to ARB versus 3856 (6.31%) of 61 106 assigned to non-ARB controls; odds ratio (OR) 1.00, 95% confidence interval (CI) 0.95-1.04] overall or when individual ARBs were examined. ORs comparing combination therapy with ARB along with ACEi versus ACEi was 1.01 (95% CI 0.94-1.10), combination versus ARB alone 1.02 (95% CI 0.91-1.13), ARB alone versus ACEi alone 1.06 (95% CI 0.97-1.16) and ARB versus placebo/control without ACEi 0.97 (95% CI 0.91-1.04). There was no excess of lung, prostate or breast cancer, or overall cancer deaths associated with ARB treatment.
CONCLUSION
There was no significant increase in the overall or site-specific cancer risk from ARBs compared to controls.
背景
血管紧张素转换酶抑制剂（ACEi）和血管紧张素 II 受体阻滞剂（ARB）可降低心血管疾病（CVD）事件的发生，但最近对部分研究的荟萃分析表明，ARB 可能会增加癌症风险。
目的
在这 15 项涉及 138769 名参与者的大型平行长期多中心双盲临床试验中，评估坎地沙坦、厄贝沙坦、替米沙坦、缬沙坦和氯沙坦治疗癌症的发生率。
患者和方法
将高 CVD 风险的个体随机分配至替米沙坦（三项试验，n=51878）、厄贝沙坦（三项试验，n=14859）、缬沙坦（四项试验，n=44264）、坎地沙坦（四项试验，n=18566）和氯沙坦（一项试验，n=9193），并随访 23-60 个月。将随机分配至 ARB 的患者与对照组的癌症病例进行比较。在五项试验（n=42403）中，将 ARB 与 ACEi 进行比较，在 11 项试验（n=63313）中与无 ACEi 的对照组进行比较。此外，在七项试验（n=47020）中，将 ARB 联合 ACEi 的效果与 ACEi 单独治疗进行了比较，在两项试验（n=25712）中，将 ARB 联合 ACEi 与 ARB 单独治疗进行了比较。
结果
总体而言，与对照组相比，ARB 治疗并未导致癌症发病率增加[4549（6.16%）例分配至 ARB 的患者中发生癌症，3856（6.31%）例分配至非 ARB 对照组；比值比（OR）1.00，95%置信区间（CI）0.95-1.04]，在 15 项试验中或当单独检查 ARB 时均如此。与 ACEi 相比，联合治疗与 ARB 联合 ACEi 与 ACEi 的 OR 为 1.01（95%CI 0.94-1.10），联合治疗与 ARB 单独治疗的 OR 为 1.02（95%CI 0.91-1.13），ARB 单独治疗与 ACEi 单独治疗的 OR 为 1.06（95%CI 0.97-1.16），ARB 与无 ACEi 的安慰剂/对照组的 OR 为 0.97（95%CI 0.91-1.04）。与 ARB 治疗相关的肺癌、前列腺癌或乳腺癌或总体癌症死亡率并未增加。
结论
与对照组相比，ARB 治疗并未显著增加总体或特定部位的癌症风险。
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