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Renin-angiotensin system blockade for the risk of cancer and death

Jian Shen1, Yan-Mei Huang2, Min Wang2

  • 1Center for Diabetic Systems Medicine, Guilin Medical University, China Department of Pathology, Affiliated Hospital of Guilin Medical University, China.

Journal of the Renin-Angiotensin-Aldosterone System : JRAAS
|July 13, 2016
PubMed
Abstract

Insights

Renin-angiotensin system blockade may reduce cancer incidence, particularly lung cancer, according to observational studies. However, randomized controlled trials show no significant effect, suggesting study design influences outcomes.

Area of Science:

  • Cardiovascular Pharmacology
  • Oncology
  • Clinical Trials

Background:

  • The impact of renin-angiotensin system (RAS) blockade, including ACE inhibitors (ACEIs) and ARBs, on cancer risk and outcomes is debated.
  • Existing evidence presents inconsistencies regarding the association between RAS blockade and cancer incidence and mortality.

Purpose of the Study:

  • To systematically evaluate the effects of RAS blockade (ACEIs/ARBs) on cancer incidence and mortality.
  • To synthesize findings from both randomized controlled trials (RCTs) and observational studies to clarify the relationship.

Main Methods:

  • A comprehensive literature search was conducted for studies published from 1960 to August 2015.
  • Included were RCTs and observational studies (case-control, cohort) with a minimum one-year follow-up, assessing cancer incidence and mortality in ARB/ACEI users.

Main Results:

  • The analysis included 14 RCTs and 17 observational studies, totaling 3,957,725 participants.
  • Observational studies indicated a reduced cancer incidence (RR 0.82) and mortality (RR 0.71) with ARB/ACEI use, but RCTs showed no significant effect (incidence RR 1.00, mortality RR 0.99).
  • A protective effect was observed for lung cancer (RR 0.85), and risk reduction correlated with longer follow-up duration.

Conclusions:

  • Observed benefits of RAS blockade on cancer in observational studies may not translate to RCTs.
  • Factors such as clinical trial design, cancer site, and follow-up duration appear to influence the clinical outcomes of RAS blockade in cancer.
  • Further research is needed to reconcile discrepancies between study types and elucidate the role of RAS blockade in cancer prevention or treatment.
Keywords:
Angiotensin-converting enzyme inhibitorsangiotensin II receptor blockersangiotensin-receptor blockercancerrenin–angiotensin system

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