Browse > Article
http://dx.doi.org/10.3961/jpmph.20.405

Association Between Angiotensin II Receptor Blockers and the Risk of Lung Cancer Among Patients With Hypertension From the Korean National Health Insurance Service-National Health Screening Cohort  

Moon, Sungji (Department of Preventive Medicine, Seoul National University College of Medicine)
Lee, Hae-Young (Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine)
Jang, Jieun (Department of Preventive Medicine, Korea University College of Medicine)
Park, Sue K. (Department of Preventive Medicine, Seoul National University College of Medicine)
Publication Information
Journal of Preventive Medicine and Public Health / v.53, no.6, 2020 , pp. 476-486 More about this Journal
Abstract
Objectives: The objective of this study was to estimate the risk of lung cancer in relation to angiotensin II receptor blocker (ARB) use among patients with hypertension from the Korean National Health Insurance Service-National Health Screening Cohort. Methods: We conducted a retrospective cohort study of patients with hypertension who started to take antihypertensive medications and had a treatment period of at least 6 months. We calculated the weighted hazard ratios (HRs) and their 95% confidence intervals (CIs) of lung cancer associated with ARB use compared with calcium channel blocker (CCB) use using inverse probability treatment weighting. Results: Among a total of 60 469 subjects with a median follow-up time of 7.8 years, 476 cases of lung cancer were identified. ARB use had a protective effect on lung cancer compared with CCB use (HR, 0.75; 95% CI, 0.59 to 0.96). Consistent findings were found in analyses considering patients who changed or discontinued their medication (HR, 0.50; 95% CI, 0.32 to 0.77), as well as for women (HR, 0.56; 95% CI, 0.34 to 0.93), patients without chronic obstructive pulmonary disease (HR, 0.75; 95% CI, 0.56 to 1.00), never-smokers (HR, 0.64; 95% CI, 0.42 to 0.99), and non-drinkers (HR, 0.69; 95% CI, 0.49 to 0.97). In analyses with different comparison antihypertensive medications, the overall protective effects of ARBs on lung cancer risk remained consistent. Conclusions: The results of the present study suggest that ARBs could decrease the risk of lung cancer. More evidence is needed to establish the causal effect of ARBs on the incidence of lung cancer.
Keywords
Angiotensin II type 1 receptor blockers; Renin-angiotensin system; Lung neoplasms; Korea;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D. Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health 2010;13(2):273-277.   DOI
2 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011;46(3):399-424.   DOI
3 Austin PC. Variance estimation when using inverse probability of treatment weighting (IPTW) with survival analysis. Stat Med 2016;35(30):5642-5655.   DOI
4 Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J 2016;48(3):889-902.   DOI
5 Rotshild V, Azoulay L, Zarifeh M, Masarwa R, Hirsh-Raccah B, Perlman A, et al. The risk for lung cancer incidence with calcium channel blockers: a systematic review and meta-analysis of observational studies. Drug Saf 2018;41(6):555-564.   DOI
6 Seretis A, Cividini S, Markozannes G, Tseretopoulou X, Lopez DS, Ntzani EE, et al. Association between blood pressure and risk of cancer development: a systematic review and metaanalysis of observational studies. Sci Rep 2019;9(1):8565.   DOI
7 Catarata MJ, Ribeiro R, Oliveira MJ, Robalo Cordeiro C, Medeiros R. Renin-angiotensin system in lung tumor and microenvironment interactions. Cancers (Basel) 2020;12(6):1457.   DOI
8 Nehme A, Zouein FA, Zayeri ZD, Zibara K. An update on the tissue renin angiotensin system and its role in physiology and pathology. J Cardiovasc Dev Dis 2019;6(2):14.   DOI
9 Pazzagli L, Linder M, Zhang M, Vago E, Stang P, Myers D, et al. Methods for time-varying exposure related problems in pharmacoepidemiology: An overview. Pharmacoepidemiol Drug Saf 2018;27(2):148-160.   DOI
10 Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005;111(20):2605-2610.   DOI
11 Hernan MA, Robins JM. Using big data to emulate a target trial when a randomized trial is not available. Am J Epidemiol 2016;183(8):758-764.   DOI
12 Levesque LE, Hanley JA, Kezouh A, Suissa S. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ 2010;340:b5087.   DOI
13 Wegman-Ostrosky T, Soto-Reyes E, Vidal-Millan S, SanchezCorona J. The renin-angiotensin system meets the hallmarks of cancer. J Renin Angiotensin Aldosterone Syst 2015;16(2):227-233.   DOI
14 Korean Society Hypertension (KSH); Hypertension Epidemiology Research Working Group, Kim HC, Cho MC. Korea hypertension fact sheet 2018. Clin Hypertens 2018;24:13.   DOI
15 Peach MJ. Renin-angiotensin system: biochemistry and mechanisms of action. Physiol Rev 1977;57(2):313-370.   DOI
16 George AJ, Thomas WG, Hannan RD. The renin-angiotensin system and cancer: old dog, new tricks. Nat Rev Cancer 2010;10(11):745-759.   DOI
17 Xu J, Fan J, Wu F, Huang Q, Guo M, Lv Z, et al. The ACE2/angiotensin-(1-7)/Mas receptor axis: pleiotropic roles in cancer. Front Physiol 2017;8:276.   DOI
18 Jung KW, Won YJ, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat 2019;51(2):417-430.   DOI
19 Ager EI, Neo J, Christophi C. The renin-angiotensin system and malignancy. Carcinogenesis 2008;29(9):1675-1684.   DOI
20 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394-424.   DOI
21 Gallagher PE, Arter AL, Deng G, Tallant EA. Angiotensin-(1-7): a peptide hormone with anti-cancer activity. Curr Med Chem 2014;21(21):2417-2423.   DOI
22 Bhaskaran K, Douglas I, Evans S, van Staa T, Smeeth L. Angiotensin receptor blockers and risk of cancer: cohort study among people receiving antihypertensive drugs in UK General Practice Research Database. BMJ 2012;344:e2697.   DOI
23 Wang KL, Liu CJ, Chao TF, Huang CM, Wu CH, Chen TJ, et al. Long-term use of angiotensin II receptor blockers and risk of cancer: a population-based cohort analysis. Int J Cardiol 2013;167(5):2162-2166.   DOI
24 Lin SY, Lin CL, Lin CC, Hsu WH, Lin CD, Wang IK, et al. Association between angiotensin-converting enzyme inhibitors and lung cancer-a nationwide, population-based, propensity scorematched cohort study. Cancers (Basel) 2020;12(3):747.   DOI
25 Shrank WH, Patrick AR, Brookhart MA. Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. J Gen Intern Med 2011;26(5):546-550.   DOI
26 D'Arcy M, Sturmer T, Lund JL. The importance and implications of comparator selection in pharmacoepidemiologic research. Curr Epidemiol Rep 2018;5(3):272-283.   DOI
27 Zhang J, Liu J, Chen J, Li X, Wu Y, Chen H, et al. Angiotensin receptor blockers (ARBs) reduce the risk of lung cancer: a systematic review and meta-analysis. Int J Clin Exp Med 2015;8(8):12656-12660.
28 Datzmann T, Fuchs S, Andree D, Hohenstein B, Schmitt J, Schindler C. Systematic review and meta-analysis of randomised controlled clinical trial evidence refutes relationship between pharmacotherapy with angiotensin-receptor blockers and an increased risk of cancer. Eur J Intern Med 2019;64:1-9.   DOI
29 Seong SC, Kim YY, Park SK, Khang YH, Kim HC, Park JH, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open 2017;7(9): e016640.   DOI
30 Lund JL, Richardson DB, Stürmer T. The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application. Curr Epidemiol Rep 2015;2(4):221-228.   DOI
31 Roberts AW, Dusetzina SB, Farley JF. Revisiting the washout period in the incident user study design: why 6-12 months may not be sufficient. J Comp Eff Res 2015;4(1):27-35.   DOI
32 Lee HY, Park JB. The Korean Society of Hypertension guidelines for the management of hypertension in 2013: its essentials and key points. Pulse (Basel) 2015;3(1):21-28.   DOI
33 Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70(1):41-55.   DOI
34 Grimaldi-Bensouda L, Klungel O, Kurz X, de Groot MC, Maciel Afonso AS, de Bruin ML, et al. Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD). BMJ Open 2016;6(1):e009147.   DOI
35 Rosenberg L, Rao RS, Palmer JR, Strom BL, Stolley PD, Zauber AG, et al. Calcium channel blockers and the risk of cancer. JAMA 1998;279(13):1000-1004.   DOI
36 Pottegard A, Friis S, Sturmer T, Hallas J, Bahmanyar S. Considerations for pharmacoepidemiological studies of drug-cancer associations. Basic Clin Pharmacol Toxicol 2018;122(5):451-459.   DOI
37 Htoo PT, Sturmer T, Jonsson-Funk M, Pate V, Simpson RJ Jr, Lund JL. Renin-angiotensin-aldosterone system-based antihypertensive agents and the risk of colorectal cancer among medicare beneficiaries. Epidemiology 2019;30(6):867-875.   DOI
38 Seo HJ, Oh IH, Yoon SJ. A comparison of the cancer incidence rates between the national cancer registry and insurance claims data in Korea. Asian Pac J Cancer Prev 2012;13(12):6163-6168.   DOI
39 Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015;34(28):3661-3679.   DOI
40 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.   DOI