Anderson Jeffrey L, Knowlton Kirk U, Muhlestein J Brent, Bair Tami L, Le Viet T, Horne Benjamin D
Intermountain Heart Institute, 98078Intermountain Medical Center, Salt Lake City, UT, USA.
School of Medicine, University of Utah, Salt Lake City, UT, USA.
J Cardiovasc Pharmacol Ther. 2021 Jul;26(4):321-327. doi: 10.1177/1074248420987054. Epub 2021 Jan 29.
Angiotensin converting enzyme inhibitors (ACEIs) are widely prescribed medications. A recent British study reported a 14% increased risk of lung cancer with ACEI versus angiotensin receptor blocker (ARB) prescriptions, and risk increased with longer use. We sought to validate this observation.
We searched the Intermountain Enterprise Data Warehouse from 1996 to 2018 for patients newly treated with an ACEI or an ARB and with ≥1 year's follow-up or to incident lung cancer or death. Unadjusted and adjusted hazard ratios (HRs) for lung cancer and for lung cancer or all-cause mortality were calculated for ACEIs compared to ARBs.
A total of 187,060 patients met entry criteria (age 60.2 ± 15.1 y; 51% women). During a mean of 7.1 years follow-up (max: 20.0 years), 3,039 lung cancers and 43,505 deaths occurred. Absolute lung cancer rates were 2.16 and 2.31 per 1000 patient-years in the ARB and ACEI groups, respectively. The HR of lung cancer was modestly increased with ACEIs (unadjusted HR = 1.11, CI: 1.02, 1.22, = .014; adjusted HR = 1.18, CI: 1.06, 1.31, = .002; number needed to harm [NNH] 6,667). Rates of the composite of lung cancer or death over time also favored ARBs. Lung cancer event curves separated gradually over longitudinal follow-up beginning at 10-12 years.
We noted a small long-term increase in lung cancer risk with ACEIs compared with ARBs. Separation of survival curves was delayed until 10-12 years after treatment initiation. Although the observed increases in lung cancer risk are small, implications are potentially important because of the broad use of ACEIs. Thus, additional work to validate these findings is needed.
血管紧张素转换酶抑制剂（ACEI）是广泛使用的处方药。最近一项英国研究报告称，与使用血管紧张素受体阻滞剂（ARB）相比，使用ACEI患肺癌的风险增加了14%，且使用时间越长风险越高。我们试图验证这一观察结果。
我们在山间企业数据仓库中搜索了1996年至2018年期间新接受ACEI或ARB治疗且随访时间≥1年或发生肺癌或死亡的患者。计算了ACEI与ARB相比患肺癌以及肺癌或全因死亡率的未调整和调整风险比（HR）。
共有187,060名患者符合入选标准（年龄60.2±15.1岁；51%为女性）。在平均7.1年的随访期间（最长20.0年），发生了3,039例肺癌和43,505例死亡。ARB组和ACEI组的绝对肺癌发病率分别为每千患者年2.16例和2.31例。ACEI使肺癌的HR略有增加（未调整HR = 1.11，CI：1.02, 1.22，P = 0.014；调整HR = 1.18，CI：1.06, 1.31，P = 0.002；伤害所需人数[NNH]为6,667）。随着时间推移，肺癌或死亡的复合发生率也更有利于ARB组。肺癌事件曲线在10 - 12年开始的纵向随访中逐渐分开。
我们注意到与ARB相比，ACEI会使肺癌风险有小幅长期增加。生存曲线的分离延迟到治疗开始后10 - 12年。尽管观察到的肺癌风险增加幅度较小，但由于ACEI的广泛使用，其影响可能很重要。因此，需要开展更多工作来验证这些发现。
