Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study.
Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study.
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DOI：
10.1136/bmj.k4209
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发表时间：
2018-10-24
期刊：
影响因子：
--
通讯作者：
Azoulay L
中科院分区：
文献类型：
--
作者：
Hicks BM;Filion KB;Yin H;Sakr L;Udell JA;Azoulay L
确定与血管紧张素受体阻滞剂相比，血管紧张素转换酶抑制剂（ACEIs）的使用是否与肺癌风险增加相关。基于人群的队列研究。英国临床实践研究数据链。确定了1995年1月1日至2015年12月31日期间新接受抗高血压药物治疗的992061例患者队列，并随访至2016年12月31日。采用考克斯比例风险模型，以95%置信区间估计与使用血管紧张素受体阻滞剂相比，使用ACEI随时间变化相关的肺癌事件的校正风险比，总体而言，按累积使用时间和自开始使用以来的时间。该队列平均随访6.4（SD 4.7）年，产生7952例肺癌事件（粗发病率1.3（95%置信区间1.2 - 1.3）/1000人年）。总体而言，与使用血管紧张素受体阻滞剂相比，使用ACEI与肺癌风险增加相关（发病率1.6 vs 1.2/1000人年;风险比1.14，95%置信区间1.01 - 1.29）。随着使用时间的延长，风险比逐渐增加，使用5年后相关性明显（风险比1.22，1.06至1.40），使用10年后达到峰值（1.31，1.08至1.59）。自开始治疗以来，随着时间的推移观察到类似的结果。在这项基于人群的队列研究中，使用ACEI与肺癌风险增加相关。这种关联在使用ACEI超过五年的人群中尤其明显。这些药物对肺癌发病率的影响还需要进一步的长期随访研究。
To determine whether the use of angiotensin converting enzyme inhibitors (ACEIs), compared with use of angiotensin receptor blockers, is associated with an increased risk of lung cancer. Population based cohort study. United Kingdom Clinical Practice Research Datalink. A cohort of 992 061 patients newly treated with antihypertensive drugs between 1 January 1995 and 31 December 2015 was identified and followed until 31 December 2016. Cox proportional hazards models were used to estimate adjusted hazard ratios with 95% confidence intervals of incident lung cancer associated with the time varying use of ACEIs, compared with use of angiotensin receptor blockers, overall, by cumulative duration of use, and by time since initiation. The cohort was followed for a mean of 6.4 (SD 4.7) years, generating 7952 incident lung cancer events (crude incidence 1.3 (95% confidence interval 1.2 to 1.3) per 1000 person years). Overall, use of ACEIs was associated with an increased risk of lung cancer (incidence rate 1.6 v 1.2 per 1000 person years; hazard ratio 1.14, 95% confidence interval 1.01 to 1.29), compared with use of angiotensin receptor blockers. Hazard ratios gradually increased with longer durations of use, with an association evident after five years of use (hazard ratio 1.22, 1.06 to 1.40) and peaking after more than 10 years of use (1.31, 1.08 to 1.59). Similar findings were observed with time since initiation. In this population based cohort study, the use of ACEIs was associated with an increased risk of lung cancer. The association was particularly elevated among people using ACEIs for more than five years. Additional studies, with long term follow-up, are needed to investigate the effects of these drugs on incidence of lung cancer.
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