Antihypertension and Colorectal Cancer Prevention: Getting Two Birds With One Stone?
Menée à partir des données 1987-2002 de l'étude EPIC portant sur 2 847 patients souffrant d'hypertension et atteints d'un cancer colorectal, et sur 28 239 témoins, cette étude évalue l'association entre l'utilisation d'un inhibiteur de l'enzyme de conversion de l'angiotensine et le risque de développer la maladie
As a classical antihypertensive drug, angiotensin I–converting enzyme inhibitor (ACEI) has been suggested to protect against cancer ever since Lever et al.’s landmark report in 1998 of a 28% reduced cancer incidence among ACEI users compared with general control subjects (1). Despite the ongoing enthusiasm, most prospective studies failed to find any secondary benefit of ACEI use on colorectal cancer (CRC) or overall cancer risk (2–4). Similarly, null associations have been observed for another antihypertensive drug, angiotension receptor blocker (ARB), with CRC risk in all but one prospective study (5). In a recent meta-analysis of 70 randomized controlled trials, no evidence of benefit was observed on any cancer (including CRC) incidence or mortality after ACEI or ARB therapy, although an increased overall cancer risk was suggested for the combinations of ACEI plus ARB in a fixed-effects model (6). Several limitations of this secondary analysis of trials have been noted, including short duration of included trials, cancer as a nonpredefined outcome, domination of results by one trial, and incomplete inclusion of studies (7,8). In the current issue of the Journal, Makar et al. (9) report findings from a nested case–control study within a large primary care database in the United Kingdom that examined the association between ACEI/ARB therapy and risk of CRC. The study found a 16% reduction in CRC incidence after 3 or more years of ACEI/ARB therapy among patients with a diagnosis of hypertension or hypertension-related complication. The magnitude of this …