Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Am J Cardiol. 2011 Jul 15;108(2):294-301. doi: 10.1016/j.amjcard.2011.03.038. Epub 2011 May 19.
The renin-angiotensin system is an important mediator of tumor progression and metastasis. A recent meta-analysis of randomized controlled trials reported an increased risk of cancer with angiotensin receptor blockers. It is unknown whether angiotensin-converting enzyme (ACE) inhibitors may have a similar effect. Our primary objective was to determine the effect of ACE inhibitors on cancer occurrence and cancer death. Our secondary objective was to determine the effect of ACE inhibitors on occurrence of gastrointestinal (GI) cancers given previous concerns of increased risk. Systematic searches of SCOPUS (covering MEDLINE, EMBASE, and other databases) and the Food and Drug Administration official web site were conducted for all randomized controlled trials of ACE inhibitors. Trials with ≥1 year of follow-up and enrolling a minimum of 100 patients were included. Fourteen trials reported cancer data in 61,774 patients. This included 10 trials of 59,004 patients providing information on cancer occurrence, 7 trials of 37,515 patients for cancer death, and 5 trials including 23,291 patients for GI cancer. ACE inhibitor therapy did not have an effect on occurrence of cancer (I(2) 0%, risk ratio [RR] 1.01, 95% confidence interval [CI] 0.95 to 1.07, p = 0.78), cancer death (I(2) 0%, RR 1.00, 95% CI 0.88 to 1.13, p = 0.95), or GI cancer (RR 1.09, 95% CI 0.88 to 1.35, p = 0.43). In conclusion, ACE inhibitors did not significantly increase or decrease occurrence of cancer or cancer death. There was also no significant difference in risk of GI cancer.
肾素-血管紧张素系统是肿瘤进展和转移的重要介质。最近一项随机对照试验的荟萃分析报告称，血管紧张素受体阻滞剂会增加癌症风险。目前尚不清楚血管紧张素转换酶（ACE）抑制剂是否可能有类似的作用。我们的主要目标是确定 ACE 抑制剂对癌症发生和癌症死亡的影响。我们的次要目标是确定 ACE 抑制剂对胃肠道（GI）癌症发生的影响，因为之前有过增加风险的担忧。我们对 SCOPUS（涵盖 MEDLINE、EMBASE 和其他数据库）和食品和药物管理局官方网站进行了系统搜索，以查找所有 ACE 抑制剂的随机对照试验。纳入了随访时间≥1 年且至少纳入 100 名患者的试验。14 项试验报告了 61774 例癌症数据。其中 10 项试验（59004 例患者）提供了癌症发生的信息，7 项试验（37515 例患者）提供了癌症死亡的信息，5 项试验（23291 例患者）包括胃肠道癌症。ACE 抑制剂治疗对癌症发生（I(2)0%，风险比[RR]1.01，95%置信区间[CI]0.95 至 1.07，p=0.78）、癌症死亡（I(2)0%，RR 1.00，95%CI 0.88 至 1.13，p=0.95）或胃肠道癌症（RR 1.09，95%CI 0.88 至 1.35，p=0.43）均无影响。总之，ACE 抑制剂并未显著增加或降低癌症或癌症死亡的发生。胃肠道癌症的风险也没有显著差异。
