Lever A F, Hole D J, Gillis C R, McCallum I R, McInnes G T, MacKinnon P L, Meredith P A, Murray L S, Reid J L, Robertson J W
Department of Medicine and Therapeutics, University of Glasgow, Western Infirmary, UK.
Lancet. 1998 Jul 18;352(9123):179-84. doi: 10.1016/S0140-6736(98)03228-0.
Previous studies have reported an increased risk of cancer with calcium-channel blockers in man. Other work in animals suggests that inhibitors of angiotensin-I-converting enzyme (ACE) protect against cancer. We aimed to assess the risk of cancer in hypertensive patients receiving ACE inhibitors or other antihypertensive drugs.
Our retrospective cohort study was based on the records of 5207 patients who attended the Glasgow Blood Pressure Clinic between Jan 1, 1980, and Dec 31, 1995. The patients' records are linked with the Registrar General Scotland and the West of Scotland Cancer Registry.
Compared with the West of Scotland controls, the relative risks of incident and fatal cancer among the 1559 patients receiving ACE inhibitors were 0.72 (95% CI 0.55-0.92) and 0.65 (0.44-0.93). Among the 3648 patients receiving antihypertensive drugs other than ACE inhibitors (calcium-channel blockers 1416, diuretics 2099, beta-blockers 2681), the corresponding relative risks were 110 (0.97-1.22) and 1.03 (0.87-1.20). The relative risk of cancer was lowest in women on ACE inhibitors: 0.63 (0.41-0.93) for incident cancer; 0.48 (0.23-0.88) for fatal cancer; and 0.37 (0.12-0.87) for female-specific cancers. The reduced relative risk of cancer in patients on ACE inhibitors was greatest with follow-up of longer than 3 years. Calcium-channel blockers, diuretics, and beta-blockers had no apparent effect on risk of cancer.
Long-term use of ACE inhibitors may protect against cancer. The status of this finding is more that of hypothesis generation than of hypothesis testing; randomised controlled trials are needed.
既往研究报道，钙通道阻滞剂会增加人类患癌风险。动物实验的其他研究表明，血管紧张素转换酶（ACE）抑制剂具有抗癌作用。我们旨在评估接受ACE抑制剂或其他降压药物的高血压患者的患癌风险。
我们的回顾性队列研究基于1980年1月1日至1995年12月31日期间在格拉斯哥血压诊所就诊的5207例患者的记录。患者记录与苏格兰总登记官办公室以及苏格兰西部癌症登记处相关联。
与苏格兰西部的对照组相比，1559例接受ACE抑制剂治疗的患者发生癌症和死于癌症的相对风险分别为0.72（95%CI 0.55 - 0.92）和0.65（0.44 - 0.93）。在3648例接受ACE抑制剂以外降压药物治疗的患者中（钙通道阻滞剂1416例，利尿剂2099例，β受体阻滞剂2681例），相应的相对风险分别为1.10（0.97 - 1.22）和1.03（0.87 - 1.20）。接受ACE抑制剂治疗的女性患癌相对风险最低：发生癌症的相对风险为0.63（0.41 - 0.93）；死于癌症的相对风险为0.48（0.23 - 0.88）；女性特定癌症的相对风险为0.37（0.12 - 0.87）。接受ACE抑制剂治疗的患者患癌相对风险降低在随访超过3年时最为明显。钙通道阻滞剂、利尿剂和β受体阻滞剂对患癌风险无明显影响。
长期使用ACE抑制剂可能具有抗癌作用。这一发现目前更倾向于提出假设，而非进行假设检验；需要开展随机对照试验。
