Lin Shih-Yi, Lin Cheng-Li, Lin Cheng-Chieh, Hsu Wu-Huei, Lin Chia-Der, Wang I-Kuan, Hsu Chung-Y, Kao Chia-Hung
Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40447, Taiwan.
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan.
Cancers (Basel). 2020 Mar 21;12(3):747. doi: 10.3390/cancers12030747.
Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking.
The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model.
The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11-1.67). Duration-response and dose-response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48-2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43--2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, = 0.002).
ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
缺乏亚洲血管紧张素转换酶抑制剂（ACEI）使用者患肺癌风险的直接证据。
ACEI队列包括22384名年龄≥18岁且首次开具ACEI处方的患者。对照的血管紧张素受体阻滞剂（ARB）队列由年龄、性别和合并症匹配的患者组成，比例为1:1。主要结局是肺癌发病率，使用比例风险模型进行评估。
ACEI队列和ARB队列中肺癌的总体发病率分别为每10000人年16.6例和12.2例。ACEI队列患肺癌的风险显著高于ARB队列（调整后风险比[aHR]=1.36；95%置信区间[CI]=1.11-1.67）。持续时间-反应和剂量-反应分析显示，与未接受ACEI的患者相比，每年接受ACEI治疗超过45天的患者（aHR=1.87；95%CI=1.48-2.36）和每年接受超过540限定日剂量ACEI的患者（aHR=1.80；95%CI=1.43-2.27）患肺癌的风险显著更高。ACEI队列中肺癌的累积发病率也显著高于ARB队列（对数秩检验，P=0.002）。
与使用ARB相比，使用ACEI与肺癌风险增加相关。使用ARB的患者患肺癌的风险显著低于未使用ARB的患者。
