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Angiotensin receptor blockers: are they related to lung cancer?

Rao, Gowtham Adamanea; Mann, Joshua R.b; Shoaibi, Azzac; Pai, Sachin G.d; Bottai, Matteoe; Sutton, Shawn Scottf; Haddock, Kathlyn Suea; Bennett, Charles Leef; Hebert, James R.g

doi: 10.1097/HJH.0b013e3283621ea3
ORIGINAL PAPERS: Therapeutic aspects

Introduction: Angiotensin receptor blockers (ARBs) are commonly used antihypertensive medication with several other additional proven benefits. Recent controversy on association of lung cancer and other solid malignancy with the use of ARBs is concerning, although the follow-up studies have shown no such association.

Methods: We used data from the Department of Veterans Affairs electronic medical record system and registries to conduct a retrospective cohort study that compared first-time ARB users with nonusers in 1:15 ratio, after balancing for many baseline differences using inverse probability of treatment weights. We conducted time-to-event survival analyses on the weighted cohort.

Results: Of the 1 229 902 patients in the analytic cohort, 346 (0.44%) of the 78 075 treated individuals had a newly incident lung cancer and 6577 (0.57%) of 1 151 826 nontreated individuals were diagnosed with lung cancer. On double robust regression, the weighted hazard ratio was 0.74 (0.67–0.83, P < 0.0001), suggesting a lung cancer reduction effect with ARB use. There was no difference in rates by ARB subtype.

Conclusion: In this large nationwide cohort of United States Veterans, we found no evidence to support any concern of increased risk of lung cancer among new users of ARBs compared with nonusers. Our findings were consistent with a protective effect of ARBs.

aResearch Department, Veterans Affairs Medical Center

bDepartment of Family and Preventive Medicine, School of Medicine

cDepartment of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia, South Carolina

dDepartment of Internal Medicine, Louisiana State University Health Science Center, Shreveport, Louisiana, USA

eKarolinska Institutet, The Institute of Environmental Medicine, Stockholm, Sweden

fSouth Carolina College of Pharmacy

gCancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA

Correspondence to Gowtham Adamane Rao, MD, PhD, MPH, University of South Carolina, School of Medicine, Columbia, South Carolina, USA. Tel: +18034347399; fax: +1 803 434 8374; e-mail:

Abbreviations: ACEi, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; FDA, Food and Drug Administration; VA, Department of Veterans Affairs; VINCI, Veterans Affairs Informatics and Computing Infrastructure

Received 19 November, 2012

Revised 6 March, 2013

Accepted 11 April, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins