Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, Copenhagen S, Denmark.
Circulation. 2011 Apr 26;123(16):1729-36. doi: 10.1161/CIRCULATIONAHA.110.007336. Epub 2011 Apr 11.
A recent meta-analysis of randomized trials suggested that use of angiotensin receptor blockers (ARBs) may be associated with a modestly increased risk of incident cancer, particularly lung cancer.
We linked individual-level data from Danish registries on filled drug prescriptions, diagnostic information, and covariates. In a nationwide cohort of new users of ARBs and angiotensin-converting enzyme inhibitors ≥35 years of age during 1998 to 2006, we compared incidence rates of all cancer, cancer subgroups by anatomic site, and cancer mortality. Among 107 466 ARB users, 3954 cases of cancer were detected during 312 753 person-years of follow-up compared with 6214 cases during 435 207 person-years of follow-up in 209 692 angiotensin-converting enzyme inhibitor users (adjusted rate ratio, 0.99; 95% confidence interval, 0.95 to 1.03). Cancer risk did not increase with increasing duration of ARB exposure (increase in rate ratio per year, 0.99; 95% confidence interval, 0.99 to 1.00,) and was similar across individual ARBs. In subgroup analyses, there was a significant association between ARB use and cancer of male genital organs (rate ratio, 1.15; 95% confidence interval, 1.02 to 1.28), but no significantly increased risk of any of the other 15 cancer subgroups, including lung cancer (rate ratio, 0.92; 95% confidence interval, 0.82 to 1.02). For cancer mortality, the rate ratio was 0.77 (95% confidence interval, 0.72 to 0.82).
In this large nationwide cohort, use of ARBs was not significantly associated with increased risk of incident cancer overall or of lung cancer.
最近一项随机试验的荟萃分析表明，血管紧张素受体阻滞剂（ARB）的使用可能与癌症的发生风险略有增加相关，特别是肺癌。
我们将丹麦登记处的个人层面数据与药物处方、诊断信息和协变量相关联。在 1998 年至 2006 年期间，年龄≥35 岁的新使用 ARB 和血管紧张素转换酶抑制剂的全国性队列中，我们比较了所有癌症、按解剖部位划分的癌症亚组以及癌症死亡率的发病率。在 107466 名 ARB 使用者中，在 312753 人年的随访期间发现了 3954 例癌症病例，而在 209692 名血管紧张素转换酶抑制剂使用者中，在 435207 人年的随访期间发现了 6214 例癌症病例（调整后的比率比，0.99；95%置信区间，0.95 至 1.03）。ARB 暴露时间的增加并未导致癌症风险增加（每年的比率比增加，0.99；95%置信区间，0.99 至 1.00），并且在个体 ARB 之间相似。在亚组分析中，ARB 使用与男性生殖器官癌症之间存在显著关联（比率比，1.15；95%置信区间，1.02 至 1.28），但与其他 15 个癌症亚组（包括肺癌）的任何癌症风险均无显著增加（比率比，0.92；95%置信区间，0.82 至 1.02）。对于癌症死亡率，比率比为 0.77（95%置信区间，0.72 至 0.82）。
在这项大型全国性队列研究中，ARB 的使用与总体癌症发生率或肺癌发生率的增加均无显著相关性。
