Angiotensin converting enzyme inhibitors and lung cancer
Menée au Royaume-Uni à partir de données portant sur 992 061 patients utilisant des médicaments antihypertenseurs entre 1995 et 2015, cette étude évalue l'association entre une utilisation d'inhibiteurs de l'enzyme de conversion de l'angiotensine et le risque de cancer du poumon (durée moyenne de suivi : 6,4 ans ; 7 952 cas de cancer)
Any extra risk must be balanced against the mortality benefits of ACEI use Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers are indicated for the treatment of hypertension, heart disease, renal insufficiency, and chronic kidney disease. ACEIs decrease the production of angiotensin II, whereas angiotensin receptor blockers selectively block its binding to angiotensin receptors.1 These drugs target the renin angiotensin aldosterone system, which may play a role in cancer development.23 In a linked paper, Hicks and colleagues (doi:10.1136/bmj.k4209) use registry data from the UK Clinical Practice Research Datalink (CPRD) to investigate the association of antihypertensive drugs with the risk of lung cancer.4 Their study population included 992 061 people, newly treated with antihypertensive drugs between 1995 and 2015, with follow-up until end of December 2016. Their findings indicate an increased risk of lung cancer associated with the use of ACEIs compared with angiotensin receptor blockers; with the highest risk associated with more than 10 years of ACEI use. The authors propose that the underlying biological mechanism of this association involves the accumulation of bradykinin or substance P in the lungs, which are implicated in tumorigenesis.5 The study has several noteworthy strengths. The use of prospectively registered, population based CPRD data6 eliminated recall bias and minimised selection bias. The validity of the cancer registration data in the CPRD is high.7 The CPRD also enabled retrieval of data on potential confounders, including smoking. Although drugs registered in the CPRD are those prescribed by general practitioners and might not necessarily reflect drug consumption or adherence, repeat prescriptions over several years likely reflect actual use, and potential adherence bias in long term users seems unlikely to differ by antihypertensive drug class.