Helgeson Scott A, Waddle Mark R, Burnside Rebecca C, Debella Yalew T, Lee Augustine S, Burger Charles D, Li Zhuo, Johnson Patrick W, Patel Neal M
From the Departments of Pulmonary Medicine, Radiation Oncology, and Statistics, Mayo Clinic, Jacksonville, Florida.
South Med J. 2021 Sep;114(9):607-613. doi: 10.14423/SMJ.0000000000001293.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are the most commonly prescribed antihypertensives, with prior studies identifying a possible association between long-term use and increased rates of lung cancer. This study evaluated this potential association in a large population using propensity matching.
This was a population-based cohort study in a large healthcare system in three regions of the United States. Pairwise propensity score matching was performed using demographics and comorbidities. All of the adult patients in the healthcare system from January 1, 2000 to April 30, 2018 with at least 1 year of follow-up were included.
In total, 3,253,811 patients with a median age of 59 (range 18-103) years were included. The ACEI group had a higher freedom from lung cancer versus controls at 15 years (98.47%, 95% confidence interval [CI] 98.41-98.54) versus 98.26%, (95% CI 98.20-98.33), whereas ARBs had similar rates versus controls at all time points. For patients diagnosed as having lung cancer, median all-cause survival was significantly higher in the ACEI (34.7 months, 95% CI 32.8-36.6) and ARB (30.9 months, 95% CI 28.1-33.8) groups than the control group (20.6 months, 95% CI 20.1-21.1).
This study showed lower rates of lung cancer with ACEI use and no difference in risk with ARBs. In addition, use of these medications was found to be associated with increased survival in those diagnosed as having lung cancer. This study supports the continued use of these medications without concern for increasing the risk of lung cancer.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）是最常用的降压药，既往研究发现长期使用与肺癌发病率增加之间可能存在关联。本研究采用倾向匹配法在大量人群中评估了这种潜在关联。
这是一项在美国三个地区的大型医疗系统中进行的基于人群的队列研究。使用人口统计学和合并症进行成对倾向评分匹配。纳入了2000年1月1日至2018年4月30日在该医疗系统中至少随访1年的所有成年患者。
总共纳入了3253811名患者，中位年龄为59岁（范围18 - 103岁）。ACEI组在15年时肺癌无病生存率高于对照组（98.47%，95%置信区间[CI] 98.41 - 98.54），而对照组为98.26%（95% CI 98.20 - 98.33），而ARB在所有时间点与对照组的发病率相似。对于诊断为肺癌的患者，ACEI组（34.7个月，95% CI 32.8 - 36.6）和ARB组（30.9个月，95% CI 28.1 - 33.8）的全因中位生存期显著高于对照组（20.6个月，95% CI 20.1 - 21.1）。
本研究表明使用ACEI肺癌发病率较低，而使用ARB风险无差异。此外，发现使用这些药物与肺癌诊断患者生存率提高有关。本研究支持继续使用这些药物，无需担心增加肺癌风险。
