Introduction:

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.

Methods:

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.

Results:

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, P = .014; adjusted HR = 1.18, CI: 1.06, 1.31, P = .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.

Conclusions:

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.

中文翻译：

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血管紧张素转换酶抑制剂治疗与肺癌风险的评估：ERACER——一项观察性队列研究

介绍：

血管紧张素转换酶抑制剂 (ACEI) 是广泛使用的处方药。英国最近的一项研究报告称，与血管紧张素受体阻滞剂 (ARB) 处方相比，ACEI 的肺癌风险增加了 14%，并且风险随着使用时间的延长而增加。我们试图验证这一观察结果。

方法：

我们从 1996 年到 2018 年在 Intermountain Enterprise Data Warehouse 中搜索了新接受 ACEI 或 ARB 治疗且随访时间≥1 年或发生肺癌或死亡的患者。与 ARB 相比，计算了 ACEI 的肺癌和肺癌或全因死亡率的未调整和调整风险比 (HR)。

结果：

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 和 ACEI 组的绝对肺癌发病率分别为每 1000 患者年 2.16 和 2.31。肺癌的 HR 随 ACEI 适度增加（未调整 HR = 1.11, CI: 1.02, 1.22, P = .014；调整后 HR = 1.18, CI: 1.06, 1.31, P = .002；需要伤害的人数 [NNH] 6,667)。随着时间的推移，肺癌或死亡率的复合发生率也有利于 ARB。肺癌事件曲线在 10-12 年开始的纵向随访中逐渐分离。

结论：

我们注意到与 ARB 相比，ACEI 的肺癌风险长期小幅增加。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很小，但由于 ACEI 的广泛使用，其影响可能很重要。因此，需要额外的工作来验证这些发现。